A new modified vitreoretinal surgical approach in the management of massive suprachoroidal hemorrhage

The authors describe a new surgical approach used in six consecutive patients referred to us between August 1986 and August 1988 with massive suprachoroidal hemorrhage (MSCH) during or after cataract extraction (4 patients), glaucoma filtering surgery (1 patient), or scleral buckling (1 patient). All patients had large hemorrhagic choroidal detachments with five eyes showing "kissing" detachments. Secondary surgery was delayed 7 to 25 days (mean, 14 days) to allow liquefaction of the blood clot and reduce intraocular inflammation. All eyes underwent posterior drainage sclerotomies under constantly maintained limbal fluid infusion line pressure, followed by pars plana anterior and posterior vitrectomy in five of six eyes. Additionally, two eyes underwent secondary lens implantation during surgery and 6 months later, respectively. Mean follow-up was 10 months. Visual acuity improved in all eyes from a preoperative range of light perception-hand motions to hand motions-20/40. Advantages and disadvantages of this aggressive surgical approach in the management of MSCH are discussed.     

Massive postoperative suprachoroidal hemorrhage: a case study

Suprachoroidal hemorrhage is a dramatic complication of intraocular surgery. We report a case of massive suprachoroidal hemorrhage with central retinal apposition and a good visual outcome. We discuss the physiopathogenic mechanisms, clinical aspects, prognostic factors, and surgical treatments through this case and other cases found in the literature.     

Massive suprachoroidal hemorrhage in penetrating keratoplasty

We studied the frequency of massive suprachoroidal hemorrhage during and after penetrating keratoplasty. Nine cases of intraoperative or immediately postoperative massive suprachoroidal hemorrhage were identified in 830 consecutive patients (1.08%) undergoing penetrating keratoplasties at the Manhattan Eye, Ear, and Throat Hospital over a 2 1/2-year period. Six of the nine patients had atherosclerotic disease or hypertension, six of nine patients had glaucoma, and eight of nine patients had undergone previous intraocular surgery. Surgery was performed under general anesthesia in 714 patients, and four of these patients (0.56%) suffered hemorrhages. Five of 116 (4.3%) local anesthesia patients experienced expulsive choroidal hemorrhage. The increased resistance to venous outflow associated with retrobulbar anesthetic injection may significantly contribute to the risk of massive suprachoroidal hemorrhage.     

Massive suprachoroidal hemorrhage: secondary treatment and outcome

PURPOSE: Massive suprachoroidal expulsive hemorrhage (SCH) is a dramatic and devastating intraocular complication of intraocular surgery and trauma that can result in total loss of vision. The aim of our study was to present the results of secondary surgical treatment of eyes following massive SCH. PATIENTS AND METHODS: We treated 10 patients suffering from massive SCH by combined radial sclerotomies for suprachoroidal drainage and vitrectomy with use of perfluorocarbon and instillation of silicone oil. We analyzed the clinical characteristics, visual acuity and anatomical status before and after secondary treatment. RESULTS: Visual acuity of all eyes suffering from SCH was light perception. Postoperatively five patients with SCH showed either no improvement of function or visual acuity of counting fingers. An increase in visual acuity to maximal 0.1 was seen in four eyes; one patient achieved 0.6. With a minimum of 6 months' follow-up, four eyes developed hypotony, two eyes became phthisical, and in two eyes recurrent traction retinal detachment occurred. CONCLUSIONS: Secondary treatment by combined suprachoroidal drainage by sclerotomies and vitrectomy should be performed to minimize the damaging effect of choroidal hemorrhage.     

Massive suprachoroidal hemorrhage during pars plana vitrectomy associated with Valsalva maneuver

PURPOSE: To report the intraoperative occurrence of massive intraocular suprachoroidal hemorrhage associated with Valsalva maneuver. METHODS: Retrospective, multicenter study of patients who developed massive choroidal hemorrhage associated with Valsalva maneuver during vitrectomy. RESULTS: Massive intraoperative suprachoroidal hemorrhage in seven patients (seven eyes) involved three men and four women with a median age of 52 years (range, 26 to 82 years). General anesthesia was used in six of seven cases. Coughing or "bucking" on the endotracheal tube during general anesthesia or severe coughing during the one vitrectomy performed under local anesthesia was associated with massive suprachoroidal hemorrhage. In five of seven eyes, this occurred near the end of surgery, after air-fluid exchange but before sclerotomy closure. Scleral plugs were immediately placed, and sclerotomy closure was performed exigently. Immediate posterior sclerotomy was performed on five of seven eyes; an additional patient underwent posterior sclerotomy postoperatively. After median follow-up of 18 months (range, 3 to 36 months), final visual acuity was no light perception in four eyes, light perception in one eye, 20/250 in one eye, and 20/20 in one eye. Four eyes became phthisical. CONCLUSIONS: Valsalva maneuver during pars plana vitrectomy may result in massive suprachoroidal hemorrhage with disastrous visual consequences. Precautionary measures to prevent coughing or "bucking" on the endotracheal tube during general anesthesia, or a prolonged episode of coughing during local anesthesia, may prevent this potentially devastating complication.     

Massive suprachoroidal hemorrhage. Follow-up and outcome of 30 cases

The authors studied the records of 30 patients who suffered a massive suprachoroidal hemorrhage during cataract surgery. Immediate development of a retinal detachment (RD) is a very bad prognostic sign. In none of 12 such cases could the retina be reattached. Retinal complications developed in five of six patients who had vitreous incarceration and who did not have vitrectomy as opposed to only one of seven who underwent vitrectomy along with drainage of the hemorrhage. If vitreous is incarcerated in the cataract incision, drainage of the hemorrhage without vitrectomy is a dangerous procedure.     

Massive suprachoroidal hemorrhage during cataract surgery: case report

A massive suprachoroidal hemorrhage is defined as a hemorrhage in the suprachoroidal space of sufficient volume either to cause extrusion of intraocular contents outside of the eye or to force the inner retinal surfaces into apposition ('kissing'). This is a very rare but one of the most serious complications of the intraocular surgeries. The authors describe a case of 84-year-old woman, who developed a massive suprachoroidal hemorrhage during cataract surgery. In our case, the main reason of expulsive hemorrhage development was a Valsalva effect, caused by unexpected cough during surgery. In a Valsalva maneuver, a sudden increase in venous pressure may lead to vessel-wall rupture, by an apparently excessive pressure gradient across the vessel wall. We present clinical and echographical study of this patient.     

驱逐性脉络膜上腔出血的手术处理

目的 评价驱逐性脉络膜上腔出血的手术处理方法及效果。方法 对１１例术中或术后发生的驱逐性脉络膜上腔出血,于出血后１１￣２８天（平均１５．４天）采用手术处理,先从角膜缘持续灌注,赤道部１或２个巩膜切口引流脉络膜上腔积血,睫状体脱离回复后改从平坦部灌注,行闭合式玻璃体切除视网膜复位术,６例术中应用地氟化碳液体。结果 １１例均成功引流脉络膜了腔积血,积血为七克力色,无血凝块。其中２例发生牵拉性视网膜脱离     

Recurrences of retinal detachment after vitreoretinal surgery, and surgical approach.

PURPOSE: To investigate the causes and management of recurrences of complicated retinal detachment after vitreoretinal surgery. METHODS: Vitreoretinal surgery was performed in 61 patients with complicated retinal detachment who were followed up for 4-24 (mean 7) months. Liquid perfluorocarbon (PFC) was used in all 61, silicone oil in 40 and perfluoropropane (C3F8) in 18 patients. RESULTS: Retinal attachment was achieved in 58 patients (95%) during the first operation. Due to the recurrence of detachment 17 patients (29%) had to be operated for a second, 7 (12%) a third and 4 (7%) a fourth time. Anterior and posterior proliferative vitreoretinopathy, missed tear, retinal incarceration, subretinal membrane and perisilicone proliferation were the factors causing redetachment. CONCLUSIONS: The best anatomical and functional results are obtained by dissection of the anterior membranes. In order to properly remove the retinal periphery the crystalline or intraocular lens should be removed. Comparison of our results with others indicates that anatomical success depends, to a certain extent, on doing only one, radical operation on the pathology that leads to recurrence.     

Development of a surgical approach for a wide-view suprachoroidal retinal prosthesis: evaluation of implantation trauma

Background  

Our research goal is to develop a safe, reproducible surgical approach for implantation of a wide-field retinal stimulating array. The aim of this study was to evaluate the pathological response to acute implantation of a functional prototype electrode array in the suprachoroidal space.     

视网膜脱离伴玻璃体积血的手术治疗

目的:探讨视网膜脱离伴玻璃体积血的手术方式及早期手术的意义。方法：11例行玻璃体切除伴常规的环扎加压手术。结果：术后视力提高10眼,未提高1眼,视网膜完全复位,介质清晰,裂孔封闭。术后随访1眼3月后视网膜再次脱离。结论：对于玻璃体积血,应常规行B超检查并定期随访,一旦发现视网膜脱离,应尽早手术,以期取得较好的视力预后。     

Massive bilateral vitreoretinal hemorrhage in patient with chronic refractory idiopathic thrombocytopenic purpura

Background We describe a patient with chronic, refractory idiopathic thrombocytopenic purpura (ITP) who developed massive vitreoretinal hemorrhages in both eyes. Methods A 49-year-old woman complained of an acute decrease of vision, and ophthalmoscopy revealed bilateral preretinal and subretinal hemorrhages around the optic disc. Her platelet counts were less than 5000/μl in spite of repetitive administration of corticosteroids and immunoglobulins with splenectomy for the chronic refractory ITP. One month later, she developed massive vitreoretinal hemorrhages bilaterally, and vision decreased to hand-motion. Results Vitrectomy was performed on both eyes after medical treatment to increase platelet counts. The intraretinal hemorrhages were absorbed from the area around the disc and vision recovered to 20/100 in the right eye and 20/2000 in the left after one month. Conclusion Massive vitreoretinal hemorrhages can develop in patients with chronic refractory ITP, and vitrectomy can be beneficial for this condition.     

视网膜裂孔伴玻璃体积血的临床分析

目的探讨急性玻璃体后脱离致视网膜裂孔伴玻璃体积血的治疗方式及疗效。方法回顾性分析31眼视网膜裂孔合并玻璃体积血,早期予双眼包扎、半卧位、止血,出血3d后予活血化瘀、促进玻璃体积血吸收治疗。根据病情变化采用激光封闭裂孔及行20G三通道闭合式玻璃体切除术治疗。所有病例至少随访12个月。结果23眼玻璃体积血在1周～3个月,平均（32．95±12．61）d吸收,采用视网膜激光治疗,裂孔完全封闭,视力无明显变化。4周内,3眼发生孔源性视网膜脱离,行玻璃体切除术治疗,术后1眼矫正视力提高,2眼矫正视力无明显提高。5眼玻璃体积血无明显吸收,2～4周内采用玻璃体切除术,术后视力明显提高,矫正视力0．3—0．6。结论急性玻璃体后脱离引起的视网膜裂孔伴玻璃体积血应引起高度重视。早期诊断并发现裂孔、及时光凝封闭裂孔是获得良好结果的关键。尽早手术是争取较好疗效的重要保障。     

引起玻璃体出血的视网膜裂孔激光治疗

目的探讨激光治疗伴玻璃体出血的视网膜裂孔的疗效。方法对26例伴玻璃体出血的视网膜裂孔的病例在表麻下行氩离子激光治疗,评估疗效。结果除1例因玻璃体出血量较多且裂孔周围浅脱离范围较大,激光治疗失败外,其余病人均获得满意的疗效,视力提高、玻璃体出血吸收、视网膜裂孔封闭良好。结论氩离子激光是治疗伴玻璃体出血的视网膜裂孔的有效方法。     

Anterior retinal cryotherapy in diabetic vitreous hemorrhage

Recurrent vitreous hemorrhage associated with proliferative retinopathy can occur in eyes that do not satisfactorily respond to argon laser pantretinal photocoagulation. To evaluate the effect of relatively low-risk surgical intervention, we performed peripheral retinal cryopexy on 24 eyes of 23 diabetic patients with proliferative diabetic retinopathy and vitreous hemorrhage. In most cases, cryopexy followed complete or nearly complete panretinal photocoagulation which did not prevent subsequent vitreous hemorrhage. Existing vitreous hemorrhage cleared postoperatively in 23 of 24 eyes. The best corrected visual acuity improved in 15 eyes, remained unchanged in five, and worsened in four. Four postoperative anterior segment complications resolved completely within a short time. One patient, a 68-year-old woman who had had diabetes for 18 years, postoperatively had a macular hole in one eye and macular edema with tractional retinal detachment in the other.     

Peripheral retinal cryopexy for subtotal vitreous hemorrhage

We used peripheral retinal cryopexy to treat 20 eyes in 15 patients with subtotal vitreous hemorrhage secondary to proliferative diabetic retinopathy. In 18 eyes, complete panretinal photocoagulation had been performed before the subtotal vitreous hemorrhage and the subsequent cryopexy. The length of follow-up averaged 16 months. The vitreous hemorrhage completely cleared in 11 eyes (55%) and partially cleared in six eyes (30%). Visual acuity after treatment improved in 13 eyes (65%), remained unchanged in six eyes (30%), and decreased in one eye (5%).     

以严谨求实的科学态度开展玻璃体视网膜手术

20世纪 80年代后期 ,我国玻璃体视网膜手术发展迅速 ,这对于推动我国眼科事业的蓬勃发展 ,缩小我国与发达国家眼科医疗水平的差距起到了促进作用。美国于 2 0世纪 70年代始开展了玻璃体手术 ,80年代初开展了视网膜黄斑前膜、黄斑下脉络膜新生血管膜手术 ,90年代起利用玻璃体手术技术进行人眼视网膜移植。虽然我国玻璃体视网膜手术起步较晚 ,但在全国眼科医师的共同努力下 ,我国的玻璃体视网膜手术蓬勃发展。由 80年代后期开展的玻璃体手术 ,发展至 90年代的视网膜黄斑前膜、黄斑下脉络膜新生血管膜及人眼视网膜移植手术。但总体医疗水平与发…