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[Vis-à-tergo. Uveal effusion and expulsive hemorrhage in cataract surgery]
Insights
Vis-à-tergo complications like choroidal effusion (CE) and expulsive hemorrhage (EH) are rare in modern cataract surgery. Prompt diagnosis and treatment, including surgical intervention for EH, can lead to good visual outcomes.
Area of Science:
- Ophthalmology
- Surgical Complications
- Intraocular Pressure Management
Background:
- Self-sealing incisions in cataract surgery minimize acute intraocular pressure rise.
- Choroidal effusion (CE) and expulsive hemorrhage (EH) require distinct diagnostic and treatment approaches.
Observation:
- Vis-à-tergo incidence was 1.7%, with CE at 0.1% and EH at 0.03% in 3,000 cataract operations.
- Ultrasonic examination aided differential diagnosis between CE and EH.
- One EH case involved massive intraocular pressure rise post-lens implantation with capsular rupture.
Findings:
- CE cases were completed without further complications, though one required interruption and rescheduling.
- The EH case presented with postoperative chorioidal hemorrhage affecting the macula.
- Surgical management (posterior sclerotomy, anterior chamber infusion) in the EH case led to near-complete choroidal reattachment and improved visual acuity to 0.5.
Implications:
- Modern cataract surgery rarely leads to severe vis-à-tergo complications like EH.
- Even incomplete forms of EH can be managed effectively.
- Appropriate therapeutic procedures can restore good visual function after vis-à-tergo events.
Background:
Since introduction of the self-sealing incision for cataract surgery it has been possible to avoid serious complications due to an acute rise in intraocular pressure. Chorioidal effusion (CE) and expulsive hemorrhage (EH) should be determined and treated differently.
Patients And Methods:
The incidence of vis-à-tergo in our patients was 1.7%. CE was ascertained in 0.1%; in one case, the operation had to be interrupted. EH occurred in one patient (0.03%) in the last 3,000 cataract operations. Differential diagnoses were made by ultrasonic examination.
Results:
Operations in CE cases were completed without further complications. However, in one case the operation was interrupted and the procedure was completed on the following day. A 63-year-old woman with EH had a massive rise in intraocular pressure directly after lens implantation with a peripheral capsular rupture. Postoperatively, a chorioidal hemorrhage in two quadrants, including the macula, was found. One week after surgery a posterior sclerotomy was performed with simultaneous infusion into the anterior chamber with BSS. The nearly complete chorioidal reattachment was achieved after drainage of the liquified blood. Visual acuity has improved to 0.5.
Conclusion:
Vis-à-tergo in modern cataract surgery only rarely results in an ES or EH. Also, in an EH there is an incomplete form. After an adequate therapeutic procedure good visual function can be expected.