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First Author: S.Nikolashin RUSSIA
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To study the mechanism of development and to work out the preventive measures for expulsive hemorrhage in patients with risk factors for this complication in the intra- and postoperative periods
The Academician S.N. Fyodorov FSBI IRTC Eye Microsurgery Tambov branch, Tambov, Russia
During 2006-2012 8 patients with suprachoroidal hemorrhage were followed up at IRTC Eye Microsurgery, Tambov branch, (0.026% of total number of cataract and glaucoma surgeries). 95% of cataract surgery was performed according to phacoemulsification technology
We managed to preserve eyes after suprachoroidal hemorrhage in all patients. In one case after resolution of the suprachoroidal hemorrhage visual acuity improved and after intraocular lens implantation equaled to 0.45 with correction. One patient had pr.l. certa, two patients - pr.l. incerta, four patients - 0. Intraocular pressure (IOP) in the late postoperative period was within normal limits in 5 eyes, hypotony was observed in one eye, hypertension without any pain syndrome in 2 eyes. Surgery for patients with increased risk for expulsive hemorrhage requires: - general anesthesia with controlled hypotony for a total relief of pain syndrome and maximum reduction of IOP and blood pressure (anesthesia reduces the IOP approximately by 3 mm Hg), - preoperative hypotensive therapy, - the fastest intraoperative wound sealing with increased IOP, - a suprachoroidal space monitoring through the previously made sclerotomic foramen.
There was determined a basic mechanism of the development of suprachoroidal hemorrhage a sharp IOP reduction in the vitreous body and suprachoroidal space due to increasing in volume in the anterior segment of the eye ball while lens extracting and emptying of anterior chamber, combined with the increase in blood pressure. Fast decrease in IOP against the background of high blood pressure leads to a sharp increase in transmural pressure and to the risk of the posterior short ciliary arteries rupture. Maximum reduction of IOP and blood pressure in the pre- and intraoperative periods reduces the risk of the development of expulsive hemorrhage.