Abstract
Purpose/Background Acute intraoperative suprachoroidal haemorrhage (AISH) is the most sight-threatening complication of ocular surgery. We investigated the visual outcomes following this intraoperative event, patient characteristics that may predispose to it and the clinical features 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) and gender were found for each of 33 of our cases. Systemic and ocular characteristics were compared for cases and controls, and the visual results of all cases of AISH are analysed.
Results Cases and controls differed only in terms of axial length and pre-operative intraocular pressure, both of which were significantly greater for eyes that experienced an AISH (p < 0.05). Ten eyes (22.2%) achieved a final Snellen acuity of 6/12 or better. Statistically significant associations with a final 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 light or worse at the first dressing (p = 0.0001). Four of the 6 eyes that 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).
Conclusion The results indicate that longer axial length and higher pre-operative intraocular pressure are associated with increased risk of AISH. Poor visual results are more likely following spontaneous nuclear expression, retinal detachment, four-quadrant suprachoroidal haemorrhage or vision of perception of light or worse at the first dressing. The results also suggest that AISH complicating a phacoemulsification procedure has a more favourable visual prognosis than AISH that occurs during extracapsular cataract surgery.
Similar content being viewed by others
Article PDF
References
Manshot WA . The pathology of expulsive haemorrhage. Am J Ophthalmol 1955;40:15–23.
Perry HD, Hsieh RC, Evans RM . Malignant melanoma of the choroid associated with spontaneous expulsive choroidal haemorrhage. Am J Ophthalmol 1977;84:205–8.
van Meurs JC, van den Bosch WA . Suprachoroidal haemorrhage following a Valsalva maneuver. Arch Ophthalmol 1993;111:1025–6.
Davison JA . Acute intraoperative suprachoroidal hemorrhage in extracapsular cataract surgery. J Cataract Refract Surg 1986;12:606–22.
Arnold PN . Study of acute intraoperative suprachoroidal hemorrhage. J Cataract Refract Surg 1992;18:489–94.
Ruderman JM, Harbin TS, Campbell DG . Postoperative suprachoroidal hemorrhage following filtration procedures. Arch Ophthalmol 1986;104:201–5.
Frenkel REP, Shin DH . Prevention and management of delayed suprachoroidal hemorrhage after filtration surgery. Arch Ophthalmol 1986;104:1459–63.
Davison JA . Acute intraoperative suprachoroidal hemorrhage in capsular bag phacoemulsification. J Cataract Refract Surg 1993;19:534–7.
Reynolds MG, Haimovici R, Flynn HW, DiBernardo C, Frazier-Byrne S, Feuer W . Suprachoroidal hemorrhage: clinical features and results of secondary surgical management. Ophthalmology 1993;100:460–5.
Speaker MG, Guerrierio PN, Met JA, Coad CT, Berger A, Marmor M . A case-control study of risk-factors for intraoperative suprachoroidal expulsive hemorrhage. Ophthalmology 1991;98:202–10.
Lakhanpal V, Schocket SS, Elman MJ, Dogra AR . Intraoperative massive suprachoroidal hemorrhage during pars plana vitrectomy. Ophthalmology 1990;97:1114–9.
Piper JG, Han DP, Abrams GW, Mieler WF . Perioperative choroidal hemorrhage at pars plana vitrectomy: a case-control study. Ophthalmology 1993;100:699–704.
Ingraham HJ, Donnenfeld ED, Perry HD . Massive suprachoroidal hemorrhage in penetrating keratoplasty. Am J Ophthalmol 1989;108:670–5.
Price FW, Whitson WE, Ahad KA, Tavakkoli H . Suprachoroidal hemorrhage in penetrating keratoplasty. Ophthalmic Surg 1994;25:521–5.
Fastenberg DM, Perry HD, Donnenfeld ED, Schwartz PL, Shakin JL . Expulsive suprachoroidal hemorrhage with scleral buckling surgery. Arch Ophthalmol 1991;109:323.
Taylor DM . Expulsive hemorrhage. Am J Ophthalmol 1974;78:961–6.
Payne JW, Kameen AJ, Jensen AD, Christy NE . Expulsive hemorrhage: its incidence in cataract surgery and a report of four bilateral cases. Trans Am Ophthalmol Soc 1985;83:181–204.
Wolter JR, Garfinkel RA . Ciliochoroidal effusion as precursor of suprachoroidal hemorrhage: a pathologic study. Ophthalmic Surg 1988;19:344–9.
Beyer CF, Peyman GA, Hill JM . Expulsive choroidal hemorrhage in rabbits: a histopathologic study. Arch Ophthalmol 1989;107:1648–53.
Maumenee AE, Schwartz MF . Acute intraoperative choroidal effusion. Am J Ophthalmol 1985;100:147–54.
Hoffmann P, Pollack A, Oliver M . Limited choroidal hemorrhage associated with extracapsular cataract extraction. Arch Ophthalmol 1984;102:1761–5.
Bukelman A, Hoffman P, Oliver M . Limited choroidal hemorrhage associated with extracapsular cataract extraction. Arch Ophthalmol 1987;105:338–41.
Welch JC, Spaeth GL, Benson WE . Massive suprachoroidal hemorrhage: follow-up and outcome of 30 cases. Ophthalmology 1988;95:1202–6.
Blumenthal M, Grinbaum A, Assia EI . Preventing expulsive hemorrhage using an anterior chamber maintainer to eliminate hypotony. J Cataract Refract Surg 1997;23:476–9.
Elliot AJ . Expulsive haemorrhage during phacoemulsification. Eye 1993;7:598–9.
Spaeth GL . Suprachoroidal hemorrhage: no longer a disaster. Ophthalmic Surg 1987;18:329–30.
Whitehouse GM, Filipic M, Francis IC . Expulsive choroidal haemorrhage: a clinical and pathological review. Aust NZ J Ophthalmol 1989;17:225–32.
Dellaporta A . Scleral trephination for subchoroidal effusion. Arch Ophthalmol 1983;101:1917–9.
Lambrou FH Jr, Meredith TA, Kaplan HJ . Secondary surgical management of expulsive choroidal hemorrhage. Arch Ophthalmol 1987;105:1195–8.
Chu TG, Cano MR, Green RL, Liggett PE, Lean JS . Massive suprachoroidal hemorrhage with central retinal apposition: a clinical and echographic study. Arch Ophthalmol 1995;109:1575–81.
Le Mer Y, Renard Y, Allagui M . Secondary management of suprachoroidal hemorrhages. Graefes Arch Clin Exp Ophthalmol 1993;231:351–3.
Lakhanpal V, Schodket SS, Elman MJ, Nirankari VS . A new modified vitreoretinal surgical approach in the management of massive suprachoroidal hemorrhage. Ophthalmology 1989;96:793–800.
Abrams GW, Thomas MA, Williams GA, Burton TC . Management of postoperative suprachoroidal hemorrhage with continuous-infusion air pump. Arch Ophthalmol 1986;104:1455–8.
Bryant WR . Secondary intraocular lens implantation in eyes that experienced suprachoroidal hemorrhage during primary cataract surgery. J Cataract Refract Surg 1989;15:629–34.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Beatty, S., Lotery, A., Kent, D. et al. Acute intraoperative suprachoroidal haemorrhage in ocular surgery. Eye 12, 815–820 (1998). https://doi.org/10.1038/eye.1998.210
Issue Date:
DOI: https://doi.org/10.1038/eye.1998.210
Keywords
This article is cited by
-
The Royal College of Ophthalmologists’ National Ophthalmology Database Study of Cataract Surgery: Report 12, Risk factors for suprachoroidal haemorrhage during cataract surgery
Eye (2023)
-
Hemorrhagic complications associated with suprachoroidal buckling
International Journal of Retina and Vitreous (2020)
-
Anterior chamber paracentesis in patients with acute elevation of intraocular pressure
Graefe's Archive for Clinical and Experimental Ophthalmology (2007)
-
Spontaneous suprachoroidal haemorrhage associated with high myopia and aspirin
Eye (2003)
-
Suprachoroidal haemorrhage
Eye (1998)