Tabandeh H, Sullivan P M, Smahliuk P, Flynn H W, Schiffman J
Moorfields Eye Hospital, London, England.
Ophthalmology. 1999 Feb;106(2):236-42. doi: 10.1016/S0161-6420(99)90062-3.
Suprachoroidal hemorrhage (SCH) is an uncommon but serious complication of pars plana vitrectomy (PPV) that can be associated with a guarded visual prognosis. The purpose of this study is to document the risk factors and outcomes of this complication.
Case-control study of consecutive cases of intraoperative SCH occurring during PPV (n = 36) and controls of PPV uncomplicated by SCH (n = 116).
Baseline systemic and ocular characteristics, intraoperative findings, surgical procedures, and final anatomic and visual outcomes were measured.
Significant risk factors for the development of SCH during PPV included high myopia (22% of cases vs. 5% of controls), history of retinal detachment (RD) surgery (61% vs. 22%), rhegmatogenous RD (97% vs. 60%), use of cryotherapy (75% vs. 33%), scleral buckling at the time of PPV (50% vs. 19%), external drainage of the subretinal fluid (22% vs. 2%), and intraoperative systemic hypertension. In the 34 SCH cases with 3 months' or more follow-up, the final visual acuity was 20/200 or greater in 11 (32%), count fingers in 5 (15%), hand movement in 7 (21%), light perception in 7 (21%), and no light perception in 4 (12%). In the 106 controls with 3 months' or more follow-up, the final visual acuity was 20/200 or greater in 79 (75%), count fingers in 20 (19%), hand movement in 5 (5%), light perception in 1 (1%), and no light perception in 1 (1%). In the eyes with SCH, 17 (50%) had persistent RD, 10 (33%) had secondary glaucoma develop, and 8 (24%) became hypotonic. The visual and anatomic outcomes of the SCH cases were significantly worse than those in the control group (P < 0.001). The visual outcome was more favorable if the SCH did not extend into the posterior pole (P = 0.002). Attempted intraoperative drainage of SCH was not associated with a better outcome.
Risk factors for the development of intraoperative SCH during PPV are high myopia, previous RD surgery, rhegmatogenous RD, cryotherapy, scleral buckling, external drainage of subretinal fluid, and intraoperative systemic hypertension. Anatomic and visual outcomes are significantly worsened after this complication.
脉络膜上腔出血（SCH）是玻璃体切割术（PPV）一种罕见但严重的并发症，可能与视力预后不佳相关。本研究旨在记录该并发症的危险因素和预后情况。
对PPV术中发生的连续性术中SCH病例（n = 36）及未发生SCH的PPV对照病例（n = 116）进行病例对照研究。
测量基线全身和眼部特征、术中发现、手术操作以及最终的解剖和视力预后情况。
PPV术中发生SCH的显著危险因素包括高度近视（病例组22%，对照组5%）、视网膜脱离（RD）手术史（61%对22%）、孔源性RD（97%对60%）、使用冷冻疗法（75%对33%）、PPV时巩膜扣带术（50%对19%）、视网膜下液外引流（22%对2%）以及术中系统性高血压。在34例随访3个月及以上的SCH病例中，最终视力在20/200或更好的有11例（32%），能数指的有5例（15%），能手动的有7例（21%），有光感的有7例（21%），无光感的有4例（12%）。在106例随访3个月及以上的对照病例中，最终视力在20/200或更好的有79例（75%），能数指的有20例（19%），能手动的有5例（5%），有光感的有1例（1%），无光感的有1例（1%）。在发生SCH的眼中，17例（50%）存在持续性RD，10例（33%）继发青光眼，8例（24%）出现低眼压。SCH病例的视力和解剖预后明显比对照组差（P < 0.001）。如果SCH未累及后极部，视力预后更有利（P = 0.002）。术中尝试引流SCH与更好的预后无关。
PPV术中发生SCH的危险因素为高度近视、既往RD手术史、孔源性RD、冷冻疗法、巩膜扣带术、视网膜下液外引流以及术中系统性高血压。该并发症发生后解剖和视力预后明显恶化。
