Beatty S, Lotery A, Kent D, O'Driscoll A, Kilmartin D J, Wallace D, Baglivo E
Birmingham and Midland Eye Centre, UK.
Eye (Lond). 1998;12 ( Pt 5):815-20. doi: 10.1038/eye.1998.210.
PURPOSE/BACKGROUND: Acute intraoperative suprachoroidal haemorrhage (AISH) is the most sight-threatening complication of ocular surgery. We investigated the visual outcomes following this intraoperative event, patient characteristics that may predispose to it and the clinical features that may be of prognostic significance.
The records of 45 cases of AISH collected from ophthalmic centres in the United Kingdom, Republic of Ireland and Switzerland were reviewed. Two satisfactory controls in terms of operative procedure, surgeon, age (+/- 5 years) and gender were found for each of 33 of our cases. Systemic and ocular characteristics were compared for cases and controls, and the visual results of all cases of AISH are analysed.
Cases and controls differed only in terms of axial length and pre-operative intraocular pressure, both of which were significantly greater for eyes that experienced an AISH (p < 0.05). Ten eyes (22.2%) achieved a final Snellen acuity of 6/12 or better. Statistically significant associations with a final acuity of counting fingers or worse included spontaneous nuclear expression (p = 0.02), retinal detachment (p < 0.0001), four-quadrant suprachoroidal haemorrhage (p = 0.007) and vision of perception of light or worse at the first dressing (p = 0.0001). Four of the 6 eyes that experienced an AISH during phacoemulsification surgery had a visual outcome of 6/12 or better, and this was significantly greater than for cases involving extracapsular cataract surgery (p = 0.004).
The results indicate that longer axial length and higher pre-operative intraocular pressure are associated with increased risk of AISH. Poor visual results are more likely following spontaneous nuclear expression, retinal detachment, four-quadrant suprachoroidal haemorrhage or vision of perception of light or worse at the first dressing. The results also suggest that AISH complicating a phacoemulsification procedure has a more favourable visual prognosis than AISH that occurs during extracapsular cataract surgery.
目的/背景：急性术中脉络膜上腔出血（AISH）是眼科手术中最具视力威胁的并发症。我们研究了这一术中事件后的视力预后、可能易患该疾病的患者特征以及可能具有预后意义的临床特征。
回顾了从英国、爱尔兰共和国和瑞士的眼科中心收集的45例AISH病例记录。为我们的33例病例中的每一例找到了在手术程序、外科医生、年龄（±5岁）和性别方面令人满意的两个对照。比较了病例组和对照组的全身和眼部特征，并分析了所有AISH病例的视力结果。
病例组和对照组仅在眼轴长度和术前眼压方面存在差异，发生AISH的眼睛这两项指标均显著更高（p<0.05）。10只眼（22.2%）最终的Snellen视力达到6/12或更好。与最终视力为指数或更差有统计学显著关联的因素包括自发核脱出（p=0.02）、视网膜脱离（p<0.0001）、四象限脉络膜上腔出血（p=0.007）以及首次换药时视力为光感或更差（p=0.0001）。在白内障超声乳化手术期间发生AISH的6只眼中，有4只眼的视力预后为6/12或更好，这显著高于囊外白内障手术病例（p=0.004）。
结果表明，较长的眼轴长度和较高的术前眼压与AISH风险增加有关。自发核脱出、视网膜脱离、四象限脉络膜上腔出血或首次换药时视力为光感或更差后，视力预后较差的可能性更大。结果还表明，白内障超声乳化手术并发AISH的视力预后比囊外白内障手术期间发生的AISH更有利。
