Abstract
Purpose :
To review published peer-reviewed reports of massive suprachoroidal hemorrhage (MSCH) between 1990 and 2021.
Methods :
We performed a systematic review and meta-analysis of published reports of MSCH, defined as ≥ 2 quadrant involvement, macular involvement, kissing, expulsive, or otherwise defined as “massive” by authors, published between January 1990 and May 2021. The search terms “suprachoroidal hemorrhage”, “choroidal hemorrhage”, “hemorrhagic choroidal detachment”, and “expulsive choroidal hemorrhage” were used to query PubMed, EMBASE, Web of Science, and Google Scholar, and studies with ≥ 3 patients with MSCH and ≥ 3 months follow up were included. Study- and patient-level data including demographics, risk factors, precipitating event, timing of hemorrhage, treatment, pre- and post-treatment best corrected visual acuity (BCVA), anatomic success, and complications were extracted and analyzed using OpenMeta[Analyst] software.
Results :
Sixty-four studies including 1423 eyes of 1409 patients with mean (SD) age 62.4 (17.2) years were included. Precipitating event types included 1279/1412 (90.6%) perioperative, 90/1412 (6.3%), traumatic, and 41/1412 (2.9%) spontaneous. The mean (SD) number of quadrants involved was 3.8 (0.4), with 230/330 (71%, 95% CI 60-81%) macular involving, 312/622 (64%, 95% CI 52-76%) kissing, and 160/383 (40%, 95% CI 24-57%) expulsive. 655/1166 (64%, 95% CI 54-74%) eyes were treated surgically, with mean (SD) time until surgery of 9.5 (9.3) days. Patients were followed for mean (SD) 15.0 (9.4) months. Mean (SD) logMAR BCVA was 2.4 (0.3) pre-treatment and 1.6 (0.6) post-treatment. 176/268 (71%, 95% CI 61-80%) eyes achieved improvement in logMAR BCVA (Figure 1) and 136/223 (67%, 95% CI 55-78%) eyes achieved anatomic success (Figure 2) defined as attached macula at last follow up.
Conclusions :
In this meta-analysis of published reports of MSCH, the majority of cases were perioperative, with many cases involving the macula, kissing choroidal detachments, or expulsive hemorrhage. Approximately two-thirds of eyes were treated surgically. A majority of eyes experienced some improvement in logMAR BCVA or anatomic success at last follow up, but vision remained limited. Predictors for BCVA improvement and anatomic success are the subject of ongoing analyses.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.