Elsevier

Ophthalmology

Volume 108, Issue 10, October 2001, Pages 1808-1811
Ophthalmology

Delayed suprachoroidal hemorrhage after glaucoma filtration procedures1 ,

https://doi.org/10.1016/S0161-6420(01)00763-1Get rights and content

Abstract

Objectives

To determine the incidence of, risk factors for, and outcomes of delayed suprachoroidal hemorrhage (DSCH) after glaucoma filtration surgery.

Design

Retrospective case-control study.

Participants

All patients undergoing glaucoma filtration procedures between 1986 and 2000 at Indiana University who were diagnosed postoperatively with suprachoroidal hemorrhage. A total of 66 patients with DSCH were identified. These were compared with a randomly selected group of patients who underwent similar procedures but did not have suprachoroidal hemorrhage.

Methods

Total cases of DSCH were initially compared with the total number of glaucoma surgeries to determine the overall incidence and the incidence in the different procedures. Subsequently, a case-control study was performed comparing the group with hemorrhage to the control group to identify risk factors. Finally, outcomes and prognostic factors were determined by comparing vision preoperatively and postoperatively and parameters of patients with good and poor outcomes.

Main outcome measures

Incidence of DSCH, risk factors associated with its occurrence, visual outcomes, and factors important for prognosis.

Results

Of a total of 2285 glaucoma filtration procedures, 66 (2.9%) cases of DSCH were identified. It developed in 9 of 615 (1.5%) trabeculectomies without antimetabolite, 30 of 1248 (2.4%) trabeculectomies with antimetabolite, 2 of 72 (2.8%) valved tube shunt implantations, and 25 of 350 (7.1%) nonvalved tube shunt implantations. The increased incidence of DSCH after tube shunts compared with trabeculectomy-associated DSCH was significant (P < 0.0001) with an odds ratio of 3.2. The risk factors for DSCH after glaucoma surgery include white race (P = 0.012), anticoagulation (P = 0.034), severe postoperative hypotony (P = 0.033), and aphakia/anterior chamber intraocular lens (P = 0.002). The visual outcomes of patients with hemorrhage were poor, with a decrease in logarithm of the minimum angle of resolution visual acuity from 0.72 to 1.36, which was statistically significant compared with the controls (P < 0.009).

Conclusions

Delayed suprachoroidal hemorrhage occurs more frequently after tube shunt implantation than after trabeculectomy. Caution should be exercised when operating on patients with known risk factors, because the visual outcomes after DSCH are poor.

Section snippets

Materials and methods

The charts of all patients who underwent glaucoma filtration procedures by one glaucoma surgeon (LBC) who were diagnosed with postoperative suprachoroidal hemorrhage between 1986 and 2000 were reviewed. Patients were identified by searching through a database of patient records in the Glaucoma Department at Indiana University. Only those patients with confirmation of their diagnosis by echography or by ophthalmoscopic visualization of the hemorrhage were included in the study. Patients who had

Results

Of 2285 glaucoma filtration procedures, 66 (2.9%) DSCHs were identified. With regard to the type of filtration procedure, DSCH developed in 9 of 615 (1.5%) cases of trabeculectomy without antimetabolite, 30 of 1248 (2.4%) cases of trabeculectomy with antimetabolite, 2 of 72 (2.8%) valved tube shunt implantations, and 25 of 350 (7.1%) nonvalved tube shunt implantations (Table 1). The increased incidence of DSCH after tube shunts compared with trabeculectomy-associated DSCH was statistically

Discussion

The literature describing DSCH after glaucoma filtration surgery is limited. There is a scarcity of large single-surgeon case series comparing the incidence of DSCH after various types of glaucoma filtration procedures. The largest study to our knowledge involves a consecutive series of 500 glaucoma operations in which DSCH developed in 10 eyes (2%).6 In another prior study of 432 consecutive cases of trabeculectomy or tube shunt, DSCH developed in 13 cases (3.0%),7 similar to the incidence

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    Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York. Dr. Ciulla is a recipient of a career development grant from Research to Prevent Blindness, Inc.

    1

    The authors have no financial or proprietary interest in any aspect of this study.

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