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Intraoperative massive suprachoroidal hemorrhage during pars plana vitrectomy
V Lakhanpal1, S S Schocket, M J Elman
1Department of Ophthalmology, University of Maryland School of Medicine, Baltimore 21201.
Abstract:
Seven eyes (7 patients) developed massive suprachoroidal hemorrhage (MSCH) during pars plana vitrectomy (PPV) for complicated retinal detachments. The MSCH developed late in the procedure following PPV, air fluid exchange, endolaser, cryopexy, and scleral buckling in five of seven eyes. In two eyes, mild hemorrhagic choroidal detachments noted intraoperatively progressed to MSCH within 72 hours postoperatively. Diagnosis of MSCH was confirmed by echography and CT scan. Multiple scleral buckling surgeries, high myopia, aphakia, and intraocular inflammation were the main risk factors. Placement of a broad posterior scleral buckle with intraoperative hypotony and cryopexy were important precipitating factors. Visual results were poor, with six of seven eyes showing no light perception. The mean follow-up time was 12.8 months. Once acute MSCH is recognized intraoperatively, surgical decompression at that time should be avoided as MSCH itself may tamponade the choroidal bleed. Details of prevention and management are discussed.
Insights
Massive suprachoroidal hemorrhage (MSCH) can occur during complex retinal detachment repair using pars plana vitrectomy (PPV). Prompt recognition and avoiding intraoperative decompression are key for managing this severe complication.
Area of Science:
- Ophthalmology
- Surgical Complications
Background:
- Pars plana vitrectomy (PPV) is a common procedure for retinal detachments.
- Complicated cases present unique surgical challenges and risks.
Observation:
- Seven eyes developed massive suprachoroidal hemorrhage (MSCH) during or after PPV for retinal detachment.
- MSCH occurred late in PPV, air fluid exchange, endolaser, cryopexy, and scleral buckling, or progressed from intraoperative detachments.
Findings:
- Risk factors included multiple scleral buckling surgeries, high myopia, aphakia, and intraocular inflammation.
- Broad posterior scleral buckles, intraoperative hypotony, and cryopexy were precipitating factors.
- Six of seven eyes had poor visual outcomes, with no light perception.
Implications:
- Surgical decompression for intraoperative MSCH should be avoided as it may tamponade bleeding.
- Understanding risk factors and precipitating factors is crucial for prevention.
- Management strategies for MSCH during PPV require careful consideration.
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