Suprachoroidal hemorrhage during pars plana vitrectomy. Risk factors and outcomes

Abstract

Objective: Suprachoroidal hemorrhage (SCH) is an uncommon but serious complication of pars plana vitrectomy (PPV) that can be associated with a guarded visual prognosis. The purpose of this study is to document the risk factors and outcomes of this complication.

Design: Case-control study of consecutive cases of intraoperative SCH occurring during PPV (n = 36) and controls of PPV uncomplicated by SCH (n = 116).

Main outcome measures: Baseline systemic and ocular characteristics, intraoperative findings, surgical procedures, and final anatomic and visual outcomes were measured.

Results: Significant risk factors for the development of SCH during PPV included high myopia (22% of cases vs. 5% of controls), history of retinal detachment (RD) surgery (61% vs. 22%), rhegmatogenous RD (97% vs. 60%), use of cryotherapy (75% vs. 33%), scleral buckling at the time of PPV (50% vs. 19%), external drainage of the subretinal fluid (22% vs. 2%), and intraoperative systemic hypertension. In the 34 SCH cases with 3 months' or more follow-up, the final visual acuity was 20/200 or greater in 11 (32%), count fingers in 5 (15%), hand movement in 7 (21%), light perception in 7 (21%), and no light perception in 4 (12%). In the 106 controls with 3 months' or more follow-up, the final visual acuity was 20/200 or greater in 79 (75%), count fingers in 20 (19%), hand movement in 5 (5%), light perception in 1 (1%), and no light perception in 1 (1%). In the eyes with SCH, 17 (50%) had persistent RD, 10 (33%) had secondary glaucoma develop, and 8 (24%) became hypotonic. The visual and anatomic outcomes of the SCH cases were significantly worse than those in the control group (P < 0.001). The visual outcome was more favorable if the SCH did not extend into the posterior pole (P = 0.002). Attempted intraoperative drainage of SCH was not associated with a better outcome.

Conclusion: Risk factors for the development of intraoperative SCH during PPV are high myopia, previous RD surgery, rhegmatogenous RD, cryotherapy, scleral buckling, external drainage of subretinal fluid, and intraoperative systemic hypertension. Anatomic and visual outcomes are significantly worsened after this complication.