To investigate comorbidities and medications associated with acute (ASCH) and delayed (DSCH) suprachoroidal hemorrhage (SCH), and to explore visual outcomes and mortality following SCH.
Retrospective review of SCH cases diagnosed at a tertiary center between 2013 and 2019. Demographics, history, surgery type, visual acuity, intraocular pressure (IOP), and mortality data were reviewed.
Fifty eyes of 50 patients experienced SCH related to surgery: 15 (30%) ASCH and 35 (70%) DSCH. Glaucoma surgery was the most common preceding surgery, and SCH was more likely to be delayed in glaucoma surgery relative to other surgeries (p = 0.001). The proportions of patients on anticoagulant, antiplatelet, or NSAID medications were 30% (n = 15), 52% (n = 26), and 12% (n = 6), respectively. The mean preoperative IOP was 25.0 ± 10.2 mmHg. The mean final best corrected visual acuity did not significantly differ between DSCH and ASCH (logMAR 1.92 vs. 2.36; p = 0.39). After controlling for pre-drainage visual acuity, final visual acuity was not statistically significantly different between eyes that were drained versus those that were not drained (p = 0.06). Of all 50 patients, the mortality rate was 12% with a mean time to mortality after SCH of 754 ± 564 days for those who died.
DSCH was more common than ASCH, with glaucoma surgery being the most common procedure to result in SCH. Visual outcomes and mortality rate were comparable between ASCH and DSCH. Further research is needed regarding the role of surgical drainage on improving visual outcomes in eyes with SCH.
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Chu TG, Green RL (1999) Suprachoroidal hemorrhage. Surv Ophthalmol 43:471–486
Manschot WA (1955) The pathology of expulsive hemorrhage. Am J Ophthalmol 40:15–24. https://doi.org/10.1016/0002-9394(55)92116-4
Zauberman H (1982) Expulsive choroidal haemorrhage: an experimental study. Br J Ophthalmol 66:43–45. https://doi.org/10.1136/bjo.66.1.43
Beyer CF, Peyman GA, Hill JM (1989) Expulsive choroidal hemorrhage in rabbits: a histopathologic study. Arch Ophthalmol 107:1648–1653. https://doi.org/10.1001/archopht.1989.01070020726036
Wolter JR (1982) Expulsive hemorrhage: a study of histopathological details. Graefe’s Arch Clin Exp Ophthalmol 219:155–158. https://doi.org/10.1007/BF02156839
Taylor DM (1974) Expulsive hemorrhage: some observations and comments. Trans Am Ophthalmol Soc 72:157–169
Speaker MG, Guerriero PN, Met JA et al (1991) A case-control study of risk factors for intraoperative suprachoroidal expulsive hemorrhage. Ophthalmology 98:202–210. https://doi.org/10.1016/S0161-6420(91)32316-9
Davison JA (1986) Acute intraoperative suprachoroidal hemorrhage in extracapsular cataract surgery. J Cataract Refract Surg 12:606–622. https://doi.org/10.1016/S0886-3350(86)80075-X
Eriksson A, Koranyi G, Seregard S, Philipson B (1998) Risk of acute suprachoroidal hemorrhage with phacoemulsification. J Cataract Refract Surg 24:793–800. https://doi.org/10.1016/S0886-3350(98)80133-8
Holland EJ, Daya SM, Evangelista A et al (1992) Penetrating keratoplasty and transscleral fixation of posterior chamber lens. Am J Ophthalmol 114:182–187. https://doi.org/10.1016/S0002-9394(14)73982-0
Ingraham HJ, Donnenfeld ED, Perry HD (1989) Massive suprachoroidal hemorrhage in penetrating keratoplasty. Am J Ophthalmol 108:670–675. https://doi.org/10.1016/0002-9394(89)90859-3
Piper JG, Han DP, Abrams GW, Mieler WF (1993) Perioperative choroidal hemorrhage at pars plana vitrectomy: a case-control study. Ophthalmology 100:699–704. https://doi.org/10.1016/S0161-6420(93)31586-1
Sharma T, Virdi DS, Parikh S et al (1997) A case-control study of suprachoroidal hemorrhage during pars plana vitrectomy. Ophthalmic Surg Lasers 28:640–644
Givens K, Shields MB (1987) Suprachoroidal hemorrhage after glaucoma filtering surgery. Am J Ophthalmol 103:689–694. https://doi.org/10.1016/s0002-9394(14)74331-4
Paysse E, Lee PP, Lloyd MA et al (1996) Suprachoroidal hemorrhage after Molteno implantation. J Glaucoma 5:170–175. https://doi.org/10.1097/00061198-199606000-00004
Harbin TS, Campbell DG (1986) Postoperative suprachoroidal hemorrhage following filtration procedures. Arch Ophthalmol 104:201–205. https://doi.org/10.1001/archopht.1986.01050140055019
Mantopoulos D, Fine HF, Hariprasad SM (2019) Suprachoroidal hemorrhage: risk factors and diagnostic and treatment options. Ophthalmic Surg Lasers Imaging Retin 50:670–674. https://doi.org/10.3928/23258160-20191031-01
Reibaldi M, Longo A, Romano MR et al (2015) Delayed suprachoroidal hemorrhage after pars plana vitrectomy: five-year results of a retrospective multicenter cohort study. Am J Ophthalmol 160:1235-1242.e1. https://doi.org/10.1016/j.ajo.2015.08.035
Chandra A, Xing W, Kadhim MR, Williamson TH (2014) Suprachoroidal hemorrhage in pars plana vitrectomy: risk factors and outcomes over 10 years. Ophthalmology 121:311–317. https://doi.org/10.1016/j.ophtha.2013.06.021
Tuli SS, WuDunn D, Ciulla TA, Cantor LB (2001) Delayed suprachoroidal hemorrhage after glaucoma filtration procedures. Ophthalmology 108:1808–1811. https://doi.org/10.1016/S0161-6420(01)00763-1
Obuchowska I, Mariak Z (2005) Risk factors of massive suprachoroidal hemorrhage during extracapsular cataract extraction surgery. Eur J Ophthalmol 15:712–717. https://doi.org/10.1177/112067210501500609
Tabandeh H, Sullivan PM, Smahliuk P et al (1999) Suprachoroidal hemorrhage during pars plana vitrectomy: risk factors and outcomes. Ophthalmology 106:236–242. https://doi.org/10.1016/S0161-6420(99)90062-3
Alward W, Farrell T, Hayreh S et al (1992) Risk factors for suprachoroidal hemorrhage after filtering surgery. Am J Ophthalmol 113:501–507. https://doi.org/10.1016/S0002-9394(14)74720-8
Arnold PN (1992) Study of acute intraoperative suprachoroidal hemorrhage. J Cataract Refract Surg 18:489–494. https://doi.org/10.1016/S0886-3350(13)80104-6
Mason JO, Gupta SR, Compton CJ et al (2011) Comparison of hemorrhagic complications of warfarin and clopidogrel bisulfate in 25-gauge vitrectomy versus a control group. Ophthalmology 118:543–547. https://doi.org/10.1016/j.ophtha.2010.07.005
Fu AD, Mcdonald HR, Williams DF et al (2007) Anticoagulation with warfarin in vitreoretinal surgery. Retina 27:290–295
Wirostko W, Han D, Mieler W et al (1998) Suprachorodal hemorrhage: outcome of surgical management according to hemmorhage severity. Ophthalmology 105:2271–2275. https://doi.org/10.1016/s0161-6420(98)91228-3
Qureshi A, Jalil A, Sousa DC, et al (2020) Outcomes of suprachoroidal haemorrhage drainage with and without vitrectomy: a 10-year study. Eye 1–7. https://doi.org/10.1038/s41433-020-01170-w
Moshfeghi DM, Kim BY, Kaiser PK et al (2004) Appositional suprachoroidal hemorrhage: a case-control study. Am J Ophthalmol 138:959–963. https://doi.org/10.1016/j.ajo.2004.07.002
Ivascu FA, Howells GA, Junn FS et al (2005) Rapid warfarin reversal in anticoagulated patients with traumatic intracranial hemorrhage reduces hemorrhage progression and mortality. J Trauma - Inj Infect Crit Care 59:1131–1139. https://doi.org/10.1097/01.ta.0000189067.16368.83
Lakhanpal V, Schocket SS, Elman MJ, Nirankari VS (1989) A new modified vitreoretinal surgical approach in the management of massive suprachoroidal hemorrhage. Ophthalmology 96:793–800. https://doi.org/10.1016/S0161-6420(89)32819-3
Scott IU, Flynn J, Schiffman J et al (1997) Visual acuity outcomes among patients with appositional suprachoroidal hemorrhage. Ophthalmology 104:2039–2046. https://doi.org/10.1016/S0161-6420(97)30042-6
Millman KJ, Aivazis M (2011) Python for scientists and engineers. Comput Sci Eng 13:9–12. https://doi.org/10.1109/MCSE.2011.36
Seabold S, Perktold J, ChadFulton, et al (2017) statsmodels/statsmodels: Version 0.9.0 Release
An SJ, Wen JC, Quist MS et al (2019) Scheduled postoperative ripcord removal in Baerveldt 350 implants: a prospective, randomized trial. J Glaucoma 28:165–171
Dr. Thompson is supported by a grant from the National Eye Institute (1K23EY030897-01). There are no other acknowledgements to disclose.
Dr. Thompson is supported by a grant from the National Eye Institute (1K23EY030897-01) and the American Glaucoma Society.
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This retrospective review was conducted with approval from the Duke Institutional Review Board and in accordance with the tenets of the Declaration of Helsinki.
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Financial disclosures: T.L.: none. A.C.T.: none. C.E.W.: none. M.G.H.: none. E.A.P.: Alcon (P), Phase5Creative, Arctic DX (I), L.H.: Glaukos (F), Aeri (F), Alcon (F), Allergan (F), Sight Sciences (F), New World Medical (F), Ocular Therapeutix (F).
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Lee, T., Thompson, A.C., Wisely, C.E. et al. Clinical characteristics and mortality rates for suprachoroidal hemorrhage: seven-year experience at a tertiary eye center. Graefes Arch Clin Exp Ophthalmol (2021). https://doi.org/10.1007/s00417-021-05290-1
- Suprachoroidal hemorrhage
- Visual outcomes