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Hae Jung Sun, Sung Jin Lee; Management and outcome of suprachoroidal hemorrhage encountered during retinal reattachment surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4166.
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© ARVO (1962-2015); The Authors (2016-present)
Suprachoroidal hemorrhage (SCH) is one of the most disastrous complications of retinal reattachment surgery which retinal surgeons would like to avoid due to its poor prognosis. We performed a retrospective, observational clinical study to learn about the factors associated with the prognosis of intraoperative SCH of retinal reattachment surgery.
Medical records of patients who had rhegmatogenous retinal detachment (RD) from January 2011 to December 2015 were reviewed. Depending on the eye status (phakic or pseudophakic, duration of RD, presence of proliferative vitreoretinopathy (PVR), extent of RD) either scleral buckling (SB) or pars plana vitrectomy (PPV) with SB was performed by a single surgeon. All eyes that developed intraoperative SCH were identified to find out if there were any factors affecting the recovery of vision. The timing of the onset of SCH, intraoperative and postoperative managements, any coexisting complications and retinal reattachment status was evaluated.
A total of 369 eyes had retinal reattachment surgery and 268 eyes (72.4%) had combined surgery of PPV + SB. Four eyes were complicated with intraoperative SCH, all of which occurred during combined surgery of PPV + SB (0% of SB vs 1.5% of PPV+SB). In all cases, SCH occurred following SB after completion of vitrectomy; none of the cases had direct needle injury during SB. Intraoperative SCH management was immediate fluid-air exchange and endolaser photocoagulation followed by gas or silicone oil tamponade. Postoperative intraocular pressure (IOP) was well controlled with topical antiglaucoma agents except in one patient who needed surgical drainage of SCH. Retinal reattachment was achieved in all 4 patients. At 1 year follow-up, visual acuity improved to pre-RD state except in one patient who was complicated with ischemic atrophy of the iris.
SCH during vitrectomy is uncommon but one of the most devastating complications a retinal surgeon can encounter. In our experience, the incidence of SCH was higher when PPV was combined with SB procedure which is probably due to the unstable fluctuation of IOP during SB. Visual prognosis was poor when ischemic sequelae was present so IOP control during the absorption of SCH is important in visual recovery.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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