Massive suprachoroidal hemorrhage during pars plana vitrectomy associated with Valsalva maneuver

PURPOSE: To report the intraoperative occurrence of massive intraocular sup rachoroidal hemorrhage associated with Valsalva maneuver. METHODS: Retrospective, multicenter study of patients who developed massive choroidal hemorrhage associated with Valsalva maneuver during vitrectomy. RESULTS: Massive intraoperative suprachoroidal hemorrhage in seven patients (seven eyes) involved three men and four women with a median age of 52 yea rs (range, 26 to 82 years). General anesthesia was used in six of seven cas es. Coughing or "bucking" on the endotracheal tube during general anesthesi a or severe coughing during the one vitrectomy performed under local anesth esia was associated with massive suprachoroidal hemorrhage. In five of seve n eyes, this occurred near the end of surgery, after air-fluid exchange but before sclerotomy closure. Scleral plugs were immediately placed, and scle rotomy closure was performed exigently. Immediate posterior sclerotomy was performed on five of seven eyes; an additional patient underwent posterior sclerotomy postoperatively. After median follow,up of 18 months (range, 3 t o 36 months), final visual acuity was no light perception in four eyes, lig ht perception in one eye, 20/250 in one eye, and 20/20 in one eye. Four eye s became phthisical. CONCLUSIONS: Valsalva maneuver during pars plana vitrectomy may result in m assive suprachoroidal hemorrhage with disastrous visual consequences. Preca utionary measures to prevent coughing or "bucking" on the endotracheal tube during general anesthesia, or a prolonged episode of coughing during local anesthesia, may prevent this potentially devastating complication. (Am J O phthalmol 2001;132:383-387. (C) 2001 by Elsevier Science Inc. All rights re served.).