Delayed suprachoroidal hemorrhage after glaucoma filtration procedures

Objectives. To determine the incidence of, risk factors for, and outcomes o f delayed suprachoroidal hemorrhage (DSCH) after glaucoma filtration surger y. Design: Retrospective case-control study. Participants: All patients undergoing glaucoma filtration procedures betwee n 1986 and 2000 at Indiana University who were diagnosed postoperatively wi th suprachoroidal hemorrhage. A total of 66 patients with DSCH were identif ied. These were compared with a randomly selected group of patients who und erwent similar procedures but did not have suprachoroidal hemorrhage. Methods: Total cases of DSCH were initially compared with the total number of glaucoma surgeries to determine the overall incidence and the incidence in the different procedures. Subsequently, a case-control study was perform ed comparing the group with hemorrhage to the control group to identify ris k factors. Finally, outcomes and prognostic factors were determined by comp aring vision preoperatively and postoperatively and parameters of patients with good and poor outcomes. Main Outcome Measures: Incidence of DSCH, risk factors associated with its occurrence, visual outcomes, and factors important for prognosis. Results: Of a total of 2285 glaucoma filtration procedures, 66 (2.9%) cases of DSCH were identified. It developed in 9 of 615 (1.5%) trabeculectomies without antimetabolite, 30 of 1248 (2.4%) trabeculectomies with antimetabol ite, 2 of 72 (2.8%) valved tube shunt implantations, and 25 of 350 (7.1%) n onvalved tube shunt implantations. The increased incidence of DSCH after tu be shunts compared with trabeculectomy-associated DSCH was significant (P < 0.0001) with an odds ratio of 3.2. The risk factors for DSCH after glaucom a surgery include white race (P = 0.012), anticoagulation (P = 0.034), seve re postoperative hypotony (P = 0.033), and aphakia/anterior chamber intraoc ular lens (P = 0.002). The visual outcomes of patients with hemorrhage were poor, with a decrease in logarithm of the minimum angle of resolution visu al acuity from 0.72 to 1.36, which was statistically significant compared w ith the controls (P < 0.009). Conclusions: Delayed suprachoroidal hemorrhage occurs more frequently after tube shunt implantation than after trabeculectomy. Caution should be exerc ised when operating on patients with known risk factors, because the visual outcomes after DSCH are poor. Ophthalmology 2001;108:1808-1811 (C) 2001 by the American Academy of Ophthalmology.