Risk Factors For Suprachoroidal Haemorrhage During Cataract Surgery: A Report From The Royal College Of Ophthalmologists’ National Ophthalmology Database.
Published 2023 - 41st Congress of the ESCRS
Reference: FP21.04 | Type: Free paper | DOI: 10.82333/zb32-q432
Authors: Stephen Stewart 1 , Marta Gruszka-Goh 2 , Yan Ning Neo 3 , Alice Braga 4 , Timothy de Klerk 5 , Dan Lindfield 6 , Achim Nestel 7 , Paul Donachie 8 , John Buchan 9 , Christopher Ashton* 10
1Department of Ophthalmology,Belfast Health and Social Care Trust,Belfast,United Kingdom, 2National Ophthalmology Database Audit,The Royal College of Ophthalmologists,London,United Kingdom, 3Department of Ophthalmology,Imperial College Healthcare NHS Trust,London,United Kingdom, 4Department of Anaesthetics,Worcestershire Acute Hospitals NHS ,Worcester,United Kingdom, 5Department of Ophthalmology,Manchester University NHS Foundation Trust,Manchester,United Kingdom, 6Department of Ophthalmology,Royal Surrey County Hospital NHS Foundation Trust,Guildford,United Kingdom, 7Department of Ophthalmology,Royal Devon University Healthcare NHS Foundation Trust,Exeter,United Kingdom, 8Department of Ophthalmology,Gloucestershire Hospitals NHS Foundation Trust,Cheltenham,United Kingdom, 9Department of Ophthalmology,Leeds Teaching Hospitals NHS Trust,Leeds,United Kingdom, 10Moorfields Eye Hospital,London,United Kingdom
Purpose
To establish the incidence of acute intraoperative suprachoroidal haemorrhage (AISH) during cataract surgery and identify the risk factors for this complication.
Setting
The Royal College of Ophthalmologists' National Ophthalmology Database Audit, United Kingdom
Methods
Data from the Royal College of Ophthalmologists’ National Ophthalmology Database was analysed. During the 11-year study period, from 01/04/2010 to 31/03/2021, 709 083 cataract surgeries performed on 498 170 patients from 65 centres were eligible for inclusion. Logistic regression was used to model the factors influencing the risk of developing suprachoroidal haemorrhage where all candidate variables were assessed by fitting a univariate model for each variable and performing a chi square test.
Results
AISH occurred in 0.03% of eligible cataract operations performed during the study period. Posterior capsule rupture was the risk factor most strongly associated with AISH (OR: 17.6, 95% CI: 12.4–24.9, p<0.001). Other ocular risk factors identified were raised intraocular pressure (IOP) preoperatively (OR: 3.7, 95% CI: 2.5–5.5, p<0.001), glaucoma (OR: 1.7, 95% CI: 1.2–2.4, p=0.004). Risk increased with age and patients aged over 90 years were at greatest risk (OR: 6.7, 95% CI: 3.5–12.8, p<0.001). The addition of intracameral anaesthetic when performing surgery under topical anaesthetic appears to be protective (OR: 0.5, 95% CI: 0.3-0.8, p=0.003). There was a 16-fold increase in the incidence of vision loss when AISH occurred.
Conclusions
The risk of AISH during modern cataract surgery is approximately 1 in 3 500 and is associated with a significant increase in the risk of vision loss should it occur. Posterior capsule rupture is the risk factor most strongly associated with AISH. Preoperative IOP control is a modifiable risk factor. The use of intracameral anaesthesia may reduce the risk of AISH.