ACUTE INTRAOPERATIVE SUPRACHOROIDAL HEMORRHAGE IN OCULAR SURGERY

Purpose/Background Acute intraoperative suprachoroidal haemorrhage (AI SH) is the most sight-threatening complication of ocular surgery. We i nvestigated the visual outcomes following this intraoperative event, p atient characteristics that may predispose to it and the clinical feat ures that may be of prognostic significance. Methods The records of 45 cases of AISH collected from ophthalmic centres in the United Kingdom , Republic of Ireland and Switzerland were reviewed. Two satisfactory controls in terms of operative procedure, surgeon, age (+/- 5 years) a nd gender were found for each of 33 of our cases. Systemic and ocular characteristics were compared for cases and controls, and the visual r esults of all cases of AISH are analysed. Results Cases and controls d iffered only in terms of axial length and pre-operative intraocular pr essure, both of which were significantly greater for eyes that experie nced an AISH (p < 0.05). Ten eyes (22.2%) achieved a final Snellen acu ity of 6/12 or better. Statistically significant associations with a f inal acuity of counting fingers or worse included spontaneous nuclear expression (p = 0.02), retinal detachment (p < 0.0001), four-quadrant suprachoroidal haemorrhage (p = 0.007) and vision of perception of lig ht or worse at the first dressing (p = 0.0001). Four of the 6 eyes tha t experienced an AISH during phacoemulsification surgery had a visual outcome of 6/12 or better, and this was significantly greater than for cases involving extracapsular cataract surgery (p = 0.004). Conclusio n The results indicate that longer axial length and higher pre-operati ve intraocular pressure are associated with increased risk of AISH. Po or visual results are more likely following spontaneous nuclear expres sion, retinal detachment, four-quadrant suprachoroidal haemorrhage or vision of perception of light or worse at the first dressing. The resu lts also suggest that AISH complicating a phacoemulsification procedur e has a more favourable visual prognosis than AISH that occurs during extracapsular cataract surgery.