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The Royal College of Ophthalmologists’ National Ophthalmology Database Study of Cataract Surgery: Report 12, Risk factors for suprachoroidal haemorrhage during cataract surgery

Eye volume 37, pages 1778–1787 (2023)Cite this article

Subjects

Learning Objectives

Upon completion of this activity, participants will be able to:

  1. 1.

    Distinguish the prevalence of intraoperative suprachoroidal hemorrhage (AISH) after cataract surgery.

  2. 2.

    Identify the most significant risk factor for AISH after cataract surgery.

  3. 3.

    Compare different techniques of anesthesia for cataract surgery in the context of their associated risk for AISH.

  4. 4.

    Evaluate other patient factors that can affect the risk for AISH after cataract surgery.

Accreditation Statements

In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Springer Nature. Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Credit hours

1.0

Release date: May 12, 2023

Expiration date: May 12, 2024

Post-test link: https://www.medscape.org/eye/posttest989929

EDITOR

Sobha Sivaprasad, MD, Editor, Eye

Journal CME author disclosure information

Charles P. Vega has disclosed the following relevant financial relationships: Consultant or advisor for Boehringer Ingelheim Pharmaceuticals, Inc.; GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Abstract

Objective

To establish the incidence of acute intraoperative suprachoroidal haemorrhage (AISH) during cataract surgery and identify the risk factors for this complication.

Methods

Data from the Royal College of Ophthalmologists’ National Ophthalmology Database was analysed. During the 11-year study period, from 01/04/2010 to 31/03/2021, 709 083 operations performed on 498 170 patients from 65 centres were eligible for inclusion.

Results

AISH occurred in 0.03% (204/709 083, approximately 1 in 3 500) of eligible cataract operations performed during the study period. Posterior capsule rupture was the risk factor most strongly associated with AISH (OR: 17.6, 95% CI: 12.4–24.9, p < 0.001). Other ocular risk factors identified were raised intraocular pressure (IOP) preoperatively (OR: 3.7, 95% CI: 2.5–5.5, p < 0.001), glaucoma (OR: 1.7, 95% CI: 1.2–2.4, p = 0.004). Risk increased with age and patients aged over 90 years were at greatest risk (OR: 6.7, 95% CI: 3.5–12.8, p < 0.001). The addition of intracameral anaesthetic when performing surgery under topical anaesthetic appears to be protective (OR: 0.5, 95% CI: 0.3–0.8, p = 0.003), compared to topical anaesthetic alone. There was a 16-fold increase in the incidence of vision loss when AISH occurred.

Conclusions

The risk of AISH during modern cataract surgery is approximately 1 in 3 500 and is associated with a significant increase in the risk of vision loss should it occur. Posterior capsule rupture is the risk factor most strongly associated with AISH. Preoperative IOP control is a modifiable risk factor. The use of intracameral anaesthesia may reduce the risk of AISH.

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Fig. 1: Suprachoroidal haemorrhage risk factor model odds ratios.
Fig. 2: Suprachoroidal haemorrhage rates for each NHS year between 2010 and 2020, where the NHS year runs from 1st April to 31st March by NHS year.

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Acknowledgements

It is with gratitude that we remember our friend and colleague Robert Johnston, who sadly died in September 2016. Without his inspirational vision, determination and career-long commitment to quality improvement in ophthalmology this work would not have been possible. We acknowledge the support of the hospitals that participated in this National Ophthalmology Database Audit study and thank our medical and non-medical colleagues for the considerable time and effort devoted to data collection.

Funding

The National Cataract Audit is currently funded through participation fees from centres as well as unrestricted financial contributions from Alcon and Bausch + Lomb.

Author information

Authors and Affiliations

  1. Belfast Health and Social Care Trust, Belfast, UK

    Stephen Stewart

  2. Centre for Public Health, Queen’s University Belfast, Belfast, UK

    Stephen Stewart

  3. The Royal College of Ophthalmologists’ National Ophthalmology Audit, London, UK

    Marta H. Gruszka-Goh, Paul H. J. Donachie & John C. Buchan

  4. Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK

    Marta H. Gruszka-Goh & Paul H. J. Donachie

  5. Imperial College Healthcare NHS Trust, London, UK

    Yan Ning Neo

  6. Worcestershire Acute Hospitals NHS, Worcester, UK

    Alice J. Braga

  7. Manchester University NHS Foundation Trust, Manchester, UK

    Timothy A. de Klerk

  8. Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK

    Dan Lindfield

  9. Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK

    Achim Nestel

  10. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK

    John C. Buchan

  11. Leeds Teaching Hospitals NHS Trust, Leeds, UK

    John C. Buchan

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Contributions

All authors participated in initial discussions regarding study design and definitions. All authors reviewed initial drafts and approved final manuscript. SS and MHG-G prepared first draft (MHGG methods and results; SS intro and discussion). PD collaborated with MHGG for the statistical analysis and PD also is responsible for source database. JB oversaw manuscript preparation commenting on interim drafts.

Corresponding author

Correspondence to John C. Buchan.

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Stewart, S., Gruszka-Goh, M.H., Neo, Y.N. et al. The Royal College of Ophthalmologists’ National Ophthalmology Database Study of Cataract Surgery: Report 12, Risk factors for suprachoroidal haemorrhage during cataract surgery. Eye 37, 1778–1787 (2023). https://doi.org/10.1038/s41433-023-02514-y

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