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Karine D. Bojikian, Mark A. Slabaugh, Philip P. Chen; Optic Disc Hemorrhage After Phacoemulsification In Patients With Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5024.
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To determine if supra-physiologic short term intraocular pressure (IOP) fluctuation experienced during phacoemulsification and in the early postoperative period are associated with development of optic disc hemorrhage (ODH).
We performed a retrospective review of all glaucoma patients undergoing phacoemulsification as a sole procedure, performed by one surgeon (PPC) between August 1996 and July 2009 at the University of Washington. The diagnosis of glaucoma was based on characteristic optic nerve findings and/or visual field loss, irrespective of IOP. Clinical information prior to phacoemulsification was recorded, as was ODH seen with careful slit lamp biomicroscopy on post-operative day (POD1) one and post-operative month one (POM1). Statistical analysis was performed with Chi square and independent samples 2-tail t test
We included 209 eyes of 209 patients (Table). A total of 7 eyes with ODH were identified (3.3%). In 4 eyes with ODH, an ODH was observed in the operative eye at the clinic visit preceding phacoemulsification (all were seen within 4 weeks of surgery) and on POD1. At POM1, the ODH persisted in 3 of these eyes, and in 1 eye the ODH had resolved. Two other eyes had ODH initially identified on POD1, of which 1 remained at POM1. These 2 patients had their clinic visit preceding phacoemulsification within more than 4 weeks. One additional eye had ODH seen only at POM1. We examined risk factors for ODH including age, sex, race, diabetes, hypertension, type of glaucoma, axial length, pre and post-operative IOP, and visual field severity indices. All 7 patients with ODH were women (P = .026); no other significant differences were noted.
Our cross-sectional study observed a peri-operative ODH rate of 3.3%, similar to that reported in a glaucoma clinic population. This result implies that the supra-physiologic short term IOP fluctuation experienced during phacoemulsification does not commonly lead to ODH.
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