Influence of Surgical Procedures and Instruments on the Incidence of Suprachoroidal Hemorrhage during 25-gauge Pars Plana Vitrectomy

Suprachoroidal Hemorrhage

Suprachoroidal hemorrhage (SCH) refers to the accumulation of blood in the suprachoroidal space, a relatively uncommon but significant complication that can occur spontaneously, during ophthalmic surgery, or as a consequence of ocular trauma. If left undiagnosed and untreated, SCH can lead to severe vision loss or even blindness. Therefore, it is crucial for ophthalmologists to have a thorough understanding of this complication, taking proactive measures to prevent it during surgery and being knowledgeable about effective management strategies for patients with SCH. This review article aimed to provide a comprehensive overview of SCH, covering its risk factors, diagnostic approaches, and the best practices for its management. By enhancing awareness and knowledge in this area, we can improve patient outcomes and minimize the impact of SCH in ophthalmic practice.

Suprachoroidal hemorrhage associated with pars plana vitrectomy

Purpose

To analyze the characteristics, related risk factors, and prognosis of suprachoroidal hemorrhage (SCH) associated with pars plana vitrectomy (PPV).

Methods

Cases of SCH associated with PPV excluding trauma were retrospectively analyzed in Beijing Tongren Hospital between January 2010 and June 2020. The data collected included general data, myopia status, axial length, state of the crystalline lens, SCH onset time, range, treatment method, visual prognosis, and methods of operation and anesthesia. Patients were divided into those with SCH related to the first PPV (Group 1), and SCH related to second intraocular surgery in the vitrectomized eye (Group 2). Patients were also classified by the SCH onset time into either the expulsive suprachoroidal hemorrhage group (ESCH) and the delayed suprachoroidal hemorrhage group (DSCH). The general data, related risk factors, and the visual prognosis of SCH in the different groups were analyzed.

Results

SCH associated with PPV was studied in 28 cases with an incidence of 0.06 %; 16 males and 12 females. The mean age of the patients was (53.51 ± 10.21) years old, the mean follow-up time was (24.94 ± 14.60) days, and the mean axial length was (28.21 ± 3.14) mm. Of these cases, 21 were classified as high myopia, 25 as aphakia/ pseudophakic, and 7 as focal hemorrhage. Silicone oil removal occurred in 12 cases (43 %). Patients in Group 2 were younger than Group 1 (P = 0.005). In terms of treatment and prognosis, 5 eyes were simply closely observed, 4 were given single suprachoroidal drainage, 15 were given suprachoroidal drainage combined with silicone tamponade, 2 underwent anterior chamber puncture, and 2 gave up treatment. A follow-up vision: NLP ~ 20/30; among them, 2 eyes with NLP (7.14 %), 6 of ≥ 20/200 (21.43 %). The final outcomes presented a significantly positive correlation with baseline vision but no significant correlation with age or axial length.

Conclusions

SCH has a higher incidence rate after a second intraocular surgery in a vitrectomized eye which is associated with the lack of vitreous support and easier fluctuation of intraocular pressure. SCH associated with PPV is more localized and has a relatively good prognosis; high myopia and aphakic/ pseudophakic eyes are risk factors. Active treatment can effectively improve visual prognosis.

Trial registration

Retrospective case series study, not applicable.

An Alternative Approach for External Drainage of Suprachoroidal Hemorrhage: Active Aspiration with Butterfly Needle

Purpose: To describe a novel surgical technique for external drainage of choroidal detachment/suprachoroidal hemorrhage with a butterfly needle.Materials and Methods: This is a retrospective case series on six eyes with serous and/or hemorrhagic choroidal detachments due to previous intraocular surgery or perforating ocular trauma that underwent active external suprachoroidal fluid drainage procedure with butterfly needle. The primary outcome measures were perioperative controlled fluid discharge and presence of choroidal detachment at 1 week, 1 month, and 6 months postoperatively. Secondary outcome measures were postoperative visual acuity and intraocular pressure.Results: During drainage, controlled hemorrhage discharge was observed. Drainage resolved hemorrhagic choroidal detachments at 1 week postoperatively. Intraocular pressure significantly increased, and visual acuity improved in all eyes. No complications were noted.Conclusion: Management of hemorrhagic choroidal detachment is challenging, and external drainage can be complicated. Active aspiration of hemorrhagic material with a butterfly needle may help early resolution.

Extending the limbus-to-cannula distance to 6.0 mm during pars plana vitrectomy in highly myopic eyes

PURPOSE

To evaluate the utility of extending the limbus-to-cannula distance to 6.0 mm during pars plana vitrectomy (PPV) for highly myopic eyes.

METHODS

Four eyes with axial lengths exceeding 31.0 mm, that underwent 25-gauge PPV were retrospectively evaluated. Assuming that cannulas were inserted 3.5 and 6.0 mm from the corneal limbus, the distance from the cannula to the fovea (CF distance) was preoperatively evaluated using anterior segmental optical coherence tomography. Surgical complications were also investigated.

RESULTS

The CF distance was shortened by 1.22±0.05 mm and 1.22±0.09 mm on the temporal and nasal sides, respectively, by inserting the cannula at 3.5 to 6.0 mm from the corneal limbus. As per the preoperatively measured CF distance, one of the cannulas was inserted 6.0 mm from the corneal limbus in 3 eyes. Their cannulas were confirmed to be inserted at the pars plana, and no surgical complications associated with this technique were observed.

CONCLUSION

Extending the limbus-to-cannula distance to 6.0 mm during PPV could be one of the options to reach the posterior pole in highly myopic eyes. A preoperatively measured CF distance can be a clinical criterion in determining the cannula position.