Suprachoroidal hemorrhage after PPV characterized
medwireNews: UK researchers have identified six risk factors for developing suprachoroidal hemorrhage (SCH) in patients undergoing pars plana vitrectomy (PPV) and shown a link between this complication and key patient outcomes.
Male gender, older age, rhegmatogenous retinal detachment, sclera explants, dropped lens fragments, and use of anticlotting drugs were each associated with a greater likelihood for intraoperative SCH, which in turn raised the risk for ocular hypertension and phthisis.
“Suprachoroidal hemorrhage remains a destructive complication of PPV,” remark Tom Williamson (St Thomas’ Hospital, London) and co-authors in Ophthalmology. They believe that their study “has suggested novel risk factors.”
The team retrospectively studied information on 5459 patients who underwent PPV over a 10-year period for a variety of indications. In all, 56 patients developed intraoperative SCH, giving a rate of 1.03%.
Williamson et al assessed a wide range of demographic, medical, surgical, and ophthalmic variables and used logistic regression analysis to identify risk factors for SCH. These were older age (odds ratio [OR]=1.04), male gender (OR=2.38), presence of rhegmatogenous retinal detachment (OR=5.92), presence of a dropped lens fragment (OR=6.94), application of an explant (OR=5.63), and the use of antiplatelet or anticoagulant drugs (OR=2.29).
The mean follow-up duration was 2.02 years for patients who developed SCH and 0.7 years for those who did not. Visual acuity improved following PPV in the latter group and deteriorated in the former group, but the between-group difference was not statistically significant. “The most important determinant of visual outcome was preoperative visual acuity,” note the authors.
With regard to complications, phthisis and ocular hypertension were both significantly more common in people with than without SCH, at 7.1% versus 0.9% and 14.3% versus 7.2%, respectively.
The increased frequency of ocular hypertension in the SCH patients was “probably secondary to increased use of oil and heavy perfluorocarbon liquids,” Williamson and colleagues state. However, they admit that rates of both these outcomes must be interpreted cautiously because of the different follow-up periods for patients with and without SCH.
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By Joanna Lyford, Senior medwireNews Reporter