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Suprachoroidal hemorrhage
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Uday R Desai, Alexander Rubowitz
The term ‘massive suprachoroidal hemorrhage’ is also subjective and is not constrained by any rigid definition – typically, retinal apposition (‘kissing choroidals’) is present. The term may also be applied in cases without retinal apposition but with other conditions that mandate surgical intervention, such as ocular pain or secondary glaucoma. Although massive suprachoroidal hemorrhage may resolve spontaneously in some patients,5 surgical intervention is often required.6–;13
Aqueous Shunts
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Brian J. Song, JoAnn A. Giaconi, Anne L. Coleman
Complications associated with aqueous shunts can be categorized as those associated with the reduction of intraocular pressure, with the functioning and placement of the tube, with the episcleral plate and the response of surrounding tissues to it, and with intraocular surgery per se. A complete list of complications is provided in Table 18.4. Information about the steps of the surgery and potential associated complications are illustrated by Figures 18.1 through 18.38. Suprachoroidal hemorrhage is a complication that can occur in any eye predisposed to develop it regardless of the presence of a device to restrict flow. Ocular hypotony with or without consequent serous choroidal effusion may occur with both valved and nonvalved devices with which flow is restricted. Ocular hypotony can have many etiologies, including inadequate restriction of aqueous flow, leakage of aqueous around the tube, or the decreased production of aqueous humor by the ciliary body. Phthisis bulbi has been reported in 2%–18% of eyes following shunt placement with neovascular glaucoma having a greater risk.5,28 Complications associated with intraocular surgery per se also occur with glaucoma drainage devices. The incidence of retinal detachment has been reported as 0%–14% and that of vitreous hemorrhage is 0%–11% (although vitreous hemorrhages may be secondary to underlying disease, such as proliferative diabetic retinopathy).29–32 The incidence of epiretinal membranes and/or cystoid macular edema have been reported in 0%–14% of eyes, and that of endophthalmitis after aqueous shunt implantation is 0%–3%.20,32–36
Controversies in Pediatric Angle Surgery and Secondary Surgical Treatment
Published in Seminars in Ophthalmology, 2023
Alexander K. Young, Deborah K. Vanderveen
A particularly feared complication is suprachoroidal hemorrhage. A recent large study by Al-Abeeri et al. reported a 0.15% incidence of suprachoroidal hemorrhage after trabeculectomy and a 0.23% incidence after placement of a GDD.50 In comparison, the incidence of suprachoroidal hemorrhage in adults is higher, with an adult trabeculectomy carrying a 2% incidence.51 It is postulated that the reduced risk of hemorrhage in children is due to the robust strength of the choroidal vessels that can withstand trauma, unlike more friable vessels seen in adults.52 Drainage of suprachoroidal hemorrhages can be delayed by up to 14 days in adults, but in children, intervention within a few days by drainage is recommended.53 Other rare complications include retinal detachment and phthisis.54
Treatment of Massive Suprachoroidal Hemorrhage by Drainage Surgery with Vitrectomy: Experience of a Single Center
Published in Seminars in Ophthalmology, 2022
Xiang Chen, Baoke Hou, Lan Yin, Fengxiang Wang
SCH is the most serious complication of intraocular surgery, and it can cause a complete loss of vision. A sudden decrease in intraoperative or postoperative intraocular pressure and a persistent low intraocular pressure are considered to be among the causes of suprachoroidal hemorrhage. Limited SCH, with no vitreous or retinal incarceration or macular involvement, can be monitored. Visual function can be preserved in most patients by rapid closure of the incision, using a posterior scleral incision to drain the bleeding, reconstruction of the anterior chamber, and vitreoretinal surgery. Indications for surgical treatment are involvement of the macula, choroidal detachment involving the posterior pole, kissing choroidal detachment, retinal detachment, and vitreous incarceration.14
Posterior Capsule Rupture during Cataract Surgery in Eyes Receiving Intravitreal anti-VEGF Injections
Published in Current Eye Research, 2021
D. Claire Miller, Karen L. Christopher, Jennifer L. Patnaik, Anne M. Lynch, Leonard K. Seibold, Naresh Mandava, Michael J. Taravella
In a sub-analysis of the 53 eyes that experienced PCR, operative characteristics were fairly similar between eyes that had a history of injections compared to eyes without injections (Table 5). Mean nuclear, cortical, and posterior subcapsular cataract grades were very similar between groups. About half of all eyes in each group experienced PCR during quadrant removal, followed by about one-third experiencing PCR during the cortex removal stage in both groups. Rates of vitreous loss were not significantly different between groups (7/8 (88%) vs 34/45 (76%) p = .6652). Injected eyes had significantly worse pre-operative BCVA (logMAR 1.6 ± 1.3 vs logMAR 0.8 ± 1.0, p < .0001) and post-operative BCVA (logMAR 1.7 ± 1.4 vs logMAR 0.4 ± 0.7, p = .0021), and non-injected eyes had significantly better improvement in BCVA from pre-operation to post-operation (logMAR −0.1 ± 1.2 vs logMAR 0.3 ± 0.7, p = .0146). One eye in the injection group developed a suprachoroidal hemorrhage which left the eye with no light perception vision. In the no-injection group, there was one patient with a suprachoroidal hemorrhage, two with a retinal tear, three with a retinal detachment, one that required additional surgery to re-position the intraocular lens, and three that developed persistent elevated intraocular pressures that required treatment including with a glaucoma drainage device.