Abstract
Purpose :
Suprachoroidal hemorrhage (SCH) remains one of the most devastating complications associated with intraocular surgery. Although advances in surgical technique have been made, the outcomes of SCH management have generally remained poor. The current study reports management outcomes of SCH after anterior segment surgery at a single institution, and identifies clinical features associated with visual prognosis.
Methods :
Retrospective chart review of patients with suprachoroidal hemorrhage occurring after anterior segment surgery.
Results :
The study includes 112 eyes of 112 patients treated between 2014 and 2020. Factors associated with better visual acuity outcomes included SCH occurring after glaucoma surgery, hypotony at time of presentation, and management by observation. Factors associated with worse visual acuity outcomes included presence of APD (p=0.02), concurrent retinal detachment (p=0.02), appositional SCH (p=0.002), management by delayed drainage (p=0.013), and duration of apposition greater than 7 days (p=0.002). Visual acuity outcomes after management generally remained poor at last follow-up: 58% of patients had a visual acuity (VA) of ≤ 20/200, 17% had light perception (LP), and 10% had no light perception (NLP). Appositional SCH was not found to be associated with worse visual outcome in patients managed with delayed drainage or PPV (n = 66). Both appositional SCH (p=0.01) and duration of apposition (p=0.04) were correlated with worse outcome only in patients that were observed. Regarding management, 53% of patients were observed, 31% underwent delayed drainage, and 31% underwent pars plana vitrectomy (PPV) with or without scleral buckling. Of those with appositional SCH, 12 patients were observed (mean final VA 1.78, SD 1.16), 15 underwent delayed drainage (mean final VA 1.951, SD 0.73), and 13 underwent PPV (mean final VA 1.891, SD 0.73).
Conclusions :
Overall visual outcomes in patients with SCH after anterior segment surgery remain poor. The majority of patients with SCH were of advanced age and pseudophakic. Roughly half of all cases occurred after glaucoma surgery (n=59). Appositional SCH is associated with worse VA outcomes when observed (mean difference = 0.859, p= 0.01), but not when delayed drainage or PPV were undertaken. Observation remains a reasonable management strategy for non-appositional SCH.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.