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Liu T, Elnahry AG, Tauqeer Z, Yu Y, Ying GS, Kim BJ. Incidence and risk factors of perioperative suprachoroidal hemorrhage: A systematic review and meta-analysis. Surv Ophthalmol 2025; 70:54-62. [PMID: 39368555 PMCID: PMC11608138 DOI: 10.1016/j.survophthal.2024.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 09/23/2024] [Accepted: 09/24/2024] [Indexed: 10/07/2024]
Abstract
Suprachoroidal hemorrhage (SCH) is a potentially visually devastating complication of intraocular surgery, but estimates of perioperative SCH incidence vary. We performed a systematic review and meta-analysis of perioperative SCH incidence among population-based studies published between 1990 and 2023. Thirty-five studies collectively reported 1657 cases of perioperative SCH from a population of 3,028,911 surgeries. The estimated incidence of SCH was 0.12 % (95 % CI, 0.10-0.14 %), or about 1 in every 800 surgeries. The estimated incidence of perioperative massive SCH was 0.06 % (95 % CI, 0.04-0.08 %). In multivariable meta-regression, greater SCH incidence was significantly associated with smaller study population size, comparative study design, multicenter study setting, and intraoperative or delayed SCH timing (vs intraoperative alone), while lower SCH incidence was significantly associated with vitreoretinal or mixed surgery type (vs. cataract) (all P < 0.05). Study year was not a significant predictor of SCH incidence, suggesting that the incidence of SCH has not decreased over the past 3 decades despite improvements in surgical technologies and techniques. Given the rarity of SCH, and the strong effect of study population size on reported SCH incidence rates, future studies of SCH incidence should include a minimum population size of at least 1000 surgeries to obtain an accurate estimate of SCH incidence.
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Affiliation(s)
- Tianyu Liu
- Associated Retinal Consultants, Royal Oak, MI, United States; Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Ayman G Elnahry
- Department of Ophthalmology, Cairo University, Cairo, Egypt; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Zujaja Tauqeer
- Associated Retinal Consultants, Royal Oak, MI, United States; Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Yinxi Yu
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Gui-Shuang Ying
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Benjamin J Kim
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Mohan S, Sadeghi E, Mohan M, Iannetta D, Chhablani J. Suprachoroidal Hemorrhage. Ophthalmologica 2023; 246:255-277. [PMID: 37660688 DOI: 10.1159/000533937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
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.
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Affiliation(s)
- Sashwanthi Mohan
- Department of Ophthalmology, Medcare Eye Centre, Al Safa, Dubai, United Arab Emirates
- Department of Education and Research, Rajan Eye Care, Chennai, India
| | - Elham Sadeghi
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Danilo Iannetta
- Ophthalmology Unit, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Välimäki J. Intraoperative Customized Reduction in Baerveldt Implant Plate Size in Elderly Patients with Glaucoma and Short Eyes. Clin Ophthalmol 2023; 17:2287-2293. [PMID: 37581095 PMCID: PMC10423564 DOI: 10.2147/opth.s415406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/24/2023] [Indexed: 08/16/2023] Open
Abstract
Purpose Larger surface area glaucoma drainage implant plates are associated with greater IOP reduction. Older age and short axial length of the eye have been reported to be risk factors for postoperative hypotony and suprachoroidal hemorrhage after glaucoma surgery. This pilot study, the first of its type, was conducted to determine the clinical outcome of intraoperative Baerveldt implant plate size reduction in elderly patients (≥80 years) with short axial length (<22 mm). Methods This was a retrospective study with a minimum 18-month follow-up involving 24 consecutive uncontrolled glaucoma patients who had previously undergone Baerveldt implantation with implant plate size reduction. Success was defined as intraocular pressure (IOP) < 21 mmHg with at least a 30% reduction in IOP from baseline on two consecutive follow-up visits, IOP > 5 mm Hg on two consecutive follow-up visits, and neither reoperation of glaucoma nor loss of light perception. The distance between the rectus muscles at the equator of the eyeball was measured using a surgical caliper. The Baerveldt implant plate was cut with straight dissecting scissors considering the distance between the muscles. Results The mean ±SD preoperative IOP before GDI was 30.2 ± 6.9 mmHg, and the mean IOP at the last follow-up visit was 13.3 ± 5.1 mmHg, the mean pressure drop being 16.9 mmHg (56%) (P<0.001). The number of antiglaucoma medications declined from mean 3.7 ± 1.0 (range 2-5) to 1.6 ± 1.1 (range 0-3) at the last visit (P<0.001). The success rate at the last follow-up visit was 79% (19 of 24 eyes). Fourteen (58%) eyes were classified as qualified success and five eyes (21%) were complete success. Complications included intraoperative suprachoroidal hemorrhage (1) and postoperative hyphema (2). Conclusion Baerveldt implantation with customized plate downsizing can be an effective treatment option for difficult glaucoma in elderly people with short eyes.
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Affiliation(s)
- Juha Välimäki
- Department of Ophthalmology, Päijät-Häme Central Hospital, Wellbeing Services County of Päijät-Häme, Lahti, 15850, Finland
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Shen R, Li VSW, Wong MOM, Chan PPM. Pediatric Glaucoma-From Screening, Early Detection to Management. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020181. [PMID: 36832310 PMCID: PMC9954748 DOI: 10.3390/children10020181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Pediatric glaucoma (PG) covers a rare and heterogeneous group of diseases with variable causes and presentations. Delayed diagnosis of PG could lead to blindness, bringing emotional and psychological burdens to patients' caregivers. Recent genetic studies identified novel causative genes, which may provide new insight into the etiology of PG. More effective screening strategies could be beneficial for timely diagnosis and treatment. New findings on clinical characteristics and the latest examination instruments have provided additional evidence for diagnosing PG. In addition to IOP-lowering therapy, managing concomitant amblyopia and other associated ocular pathologies is essential to achieve a better visual outcome. Surgical treatment is usually required although medication is often used before surgery. These include angle surgeries, filtering surgeries, minimally invasive glaucoma surgeries, cyclophotocoagulation, and deep sclerectomy. Several advanced surgical therapies have been developed to increase success rates and decrease postoperative complications. Here, we review the classification and diagnosis, etiology, screening, clinical characteristics, examinations, and management of PG.
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Affiliation(s)
- Ruyue Shen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Venice S. W. Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Mandy O. M. Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Poemen P. M. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, China
- Correspondence: ; Tel.: +852-3943-5807
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Williams KJ, Scholle T, Leung EH. Management of Serous and Hemorrhagic Choroidal Detachments and Complications. Int Ophthalmol Clin 2022; 62:119-130. [PMID: 35752890 DOI: 10.1097/iio.0000000000000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sisodia VPS, Krishnamurthy R. Aurolab Aqueous Drainage Implant (AADI): Review of Indications, Mechanism, Surgical Technique, Outcomes, Impact and Limitations. Semin Ophthalmol 2022; 37:856-868. [PMID: 35656796 DOI: 10.1080/08820538.2022.2082254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this review is to place together all the knowledge available on aurolab aqueous drainage implant (AADI) in one place for the benefit of all glaucoma specialists who are interested in low-cost implants in developing world with desired results. METHODS A comprehensive literature search was done on AADI and its use in glaucoma management. 35 results were obtained from the literature search. Out of these 35, 2 were commentaries, 6 were case reports and rest 27 were studies (prospective and retrospective) discussing the surgical outcomes, modifications and comparison of AADI with other glaucoma drainage devices (GDDs). Out of these, 2 commentaries were excluded and rest 33 articles were included, cited and discussed appropriately in this review. RESULTS AADI resulted in a significant reduction in the intra ocular pressure (IOP) and also in the number of antiglaucoma medications. AADI can be implanted alone or combined with cataract surgery. It was found to be beneficial in both pediatric and adult refractory glaucoma. There was no significant difference seen in the pre and post operative visual acuity. But AADI was also associated with various hypotony related and tube related early and late onset complications. Some of these complications were managed conservatively and some needed surgical intervention. CONCLUSIONS AADI is a low-cost non-valved GDD with successful results in both adult as well as pediatric refractory glaucomas. Early and late onset complications are common and can be managed with appropriate and timely medical or surgical intervention.
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