Abstract
Purpose :
To characterize cases of suprachoroidal hemorrhage (SCH) published since 1990, and to determine associations of presenting and management factors with visual and anatomic outcomes.
Methods :
We reviewed peer-reviewed studies of SCH published in PubMed, EMBASE, Web of Science, or Google Scholar from 1/1/1990 to 9/1/2022. The protocol was prospectively registered (https://osf.io/69v3q/). Patient-level data was independently extracted by two authors with differences adjudicated. Regression analysis was performed to determine factors associated with visual acuity (VA) and anatomic success, defined as retina attached at last follow-up.
Results :
Patient-level data was available for 413 eyes of 412 patients from 49 studies, with mean (SD) age 60.8 (22.4) years and 50.6% female. SCH was classified as perioperative (363; 87.9%), traumatic (30; 7.3%), or spontaneous (20; 4.8%). Among eyes with reported data, 147/181 (81.2%) involved four quadrants, 176/216 (81.5%) were macular involving, 158/232 (68.1%) were kissing, and 55/201 (27.4%) were expulsive. 270/365 (74.0%) were treated surgically, with drainage only (107/263; 40.7%), drainage with vitrectomy (147/263; 55.9%), or drainage with vitrectomy and scleral buckle (9/263; 3.4%). The mean (SD) time between SCH diagnosis and surgery was 11.1 (15.7) days, with 41/239 (17.2%) treated immediately. 85/156 (54.5%) were treated with topical steroids and 61/126 (48.4%) with systemic steroids. Among eyes with follow-up ≥ 3 months, the mean (SD) change in VA was -0.9 (0.9) logMAR, with 122/162 (75.3%) with VA improvement ≥ 0.3 logMAR, 90/241 (37.3%) with final VA 20/200 or better, and 149/180 (82.8%) with anatomic success. In multivariable regression, VA improvement ≥ 0.3 logMAR was associated with delayed SCH onset, treatment with drainage and vitrectomy (versus drainage only), and topical steroid use (all P<0.05, Table 1). Anatomic success was associated with lack of hypertension and systemic steroid use (all P<0.05, Table 2). Timing of surgery was not significant for any outcome.
Conclusions :
Most eyes with SCH achieve some VA improvement but final VA outcomes are poor, with most cases leading to severe visual impairment. Although limited by nonrandomized observational data, treatment with drainage and vitrectomy may be associated with greater chance of VA improvement, while timing of surgery may not influence outcomes.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.