Choroidal Effusion and Suprachoroidal Hemorrhage during Phacoemulsification: Intraoperative Management to Prevent Expulsive Hemorrhage

2015 ◽  
Vol 26 (4) ◽  
pp. 338-341 ◽  
Author(s):  
Alfonso Savastano ◽  
Stanislao Rizzo ◽  
Maria Cristina Savastano ◽  
Valerio Piccirillo ◽  
Renato Forte ◽  
...  
Keyword(s):  
Intraoperative Management ◽  
Suprachoroidal Hemorrhage ◽  
Expulsive Hemorrhage ◽  
Choroidal Effusion

Choroidal Effusion and Hemorrhage

2013 ◽  
Author(s):  
Ronald L. Fellman
Keyword(s):  
Poor Prognosis ◽  
Visual Loss ◽  
Perioperative Period ◽  
Glaucoma Surgery ◽  
Severe Bleeding ◽  
Suprachoroidal Space ◽  
Suprachoroidal Hemorrhage ◽  
Shallow Anterior Chamber ◽  
Choroidal Hemorrhage ◽  
Choroidal Effusion

Every intraocular surgery carries risk of a serious complication. One of the most worrisome is an intraoperative suprachoroidal hemorrhage. For a variety of reasons, especially hypotony, these hemorrhages occur more frequently in glaucoma patients, may develop at any time during the perioperative period, and may cause considerable visual loss. When a severe choroidal hemorrhage does occur, it can be visually devastating and may be very painful. A large perioperative choroidal effusion is also worrisome because it may be the initiating factor that precipitates a choroidal hemorrhage. Even after a “simple bleb needling” or postoperative suture lysis for uncontrolled intraocular pressure (IOP), a suprachoroidal hemorrhage may develop, leading to catastrophic visual loss. In spite of best efforts, choroidal events will still occur and should be managed in a highly expeditious fashion. Proper prevention and management of a choroidal event is the best chance for saving vision. An intraoperative choroidal event is typically a spontaneous collection of either fluid and/or blood in the suprachoroidal space. This potential space is located between the choroid and the sclera. The fluid within a chronic choroidal effusion typically has a straw color due to the accumulation of proteins. Choroidal events are most common following glaucoma surgery, and choroidal hemorrhage or effusion may lead to complicated surgery with resulting visual loss. A spontaneous intraoperative choroidal effusion may initiate a shallow anterior chamber and a firm eye. The mechanisms are complex and variable. A spontaneous collection of blood into the suprachoroidal space may occur when the IOP is low, as seen during filtration surgery. Severe bleeding that breaks through into the vitreous is typically associated with a poor prognosis, as are bleeds that reach the optic nerve head. These eyes commonly end up with a pale optic disc and poor visual function. Every attempt is made to avoid these situations (see Table 6.1); nevertheless, the surgeon must remain calm during such an event and immediately close the eye to minimize visual harm.

A rare case of spontaneous expulsive suprachoroidal haemorrhage in a glaucomatous eye treated with topical alpha-adrenergic agonist

2021 ◽  
pp. 112067212110632
Author(s):  
Manju R Pillai ◽  
Hariharasubramanian Kasthuribai ◽  
Deeba Ishrath ◽  
Subathra Gnanavelu
Keyword(s):  
Allergic Reaction ◽  
Inflammatory Reaction ◽  
Rare Case ◽  
Glaucoma Patient ◽  
Adrenergic Agonist ◽  
Suprachoroidal Hemorrhage ◽  
Expulsive Hemorrhage ◽  
Alpha Adrenergic Agonist

Spontaneous expulsive suprachoroidal hemorrhage is a rare ocular condition, which usually occurs after sudden decompression of the eyewall. Most of the cases of expulsive hemorrhage reported had a predisposing glaucoma with the combination of corneal pathology. We are reporting a case of spontaneous expulsive suprachoroidal hemorrhage in a glaucoma patient probably due to perpetuated inflammatory reaction and frequent eye rubbing induced by allergic reaction to topical alpha adrenergic agonist in a compromised cornea.

Tube Shunt Related Complications of the Retina and Vitreous

2013 ◽  
Author(s):  
Judianne Kellaway ◽  
Garvin H. Davis
Keyword(s):  
Retinal Detachment ◽  
Vitreous Hemorrhage ◽  
Shunt Implantation ◽  
Suprachoroidal Hemorrhage ◽  
Pars Plana ◽  
One Year ◽  
Tube Shunt ◽  
Choroidal Effusion ◽  
Retinal Complications

Tube shunt complications of the retina and vitreous can threaten vision. It is important to understand how to recognize, prevent, and manage these complications. While many retrospective studies regarding retinal complications of tube shunts are in the literature, there are now 2 major prospective studies that can be looked to for the incidence of retinal complications. In the Tube Versus Trabeculectomy (TVT) Study, at 3 years of follow-up, 4 eyes out of 107 total eyes (4%) with tube shunts had required pars plana vitrectomies due to a retinal complication (e.g., vitreous occlusion of the tube, retinal detachment, choroidal detachment). Drainage of a choroidal effusion was performed in 2 patients. Early postoperative retinal complications (onset at 1 month or less after tube shunt implantation) included choroidal effusion (15 eyes; 14%), suprachoroidal hemorrhage (2 eyes; 2%), and vitreous hemorrhage (1 eye; 1%). Late postoperative retinal complications (onset more than 1 month after tube shunt implantation) included choroidal effusion (2 eyes; 2%) and retinal detachment (1 eye; 1%). In the Ahmed Baerveldt Comparison (ABC) Study, at one year of follow-up, one eye of 276 total eyes (0.4%) required a pars plana vitrectomy to clear a postoperative hemorrhage and one eye (0.4%) required reoperation for drainage of a suprachoroidal hemorrhage. Early postoperative retinal complications (3 months of less after implantation of the tube shunt) reported included choroidal effusion (34 eyes; 12%), suprachoroidal hemorrhage (2 eyes; 1%), endophthalmitis (1 eye; 0.4%), and vitreous hemorrhage (5 eyes; 2%). Late retinal postoperative complications (more than 3 months after tube shunt implantation) included choroidal effusion (3 eyes; 1%), endophthalmitis (2 eyes; 1%), vitreous hemorrhage (3 eyes; 1%), and retinal detachment (2 eyes; 1%). Both of these studies indicate a similar incidence of retinal complications after tube shunt implantation. Tube shunt surgery is performed in cases of uncontrolled glaucoma where medications are inadequate. A pars plana tube is most often indicated for anatomic reasons, such as a small eye, or an eye that already has coexisting corneal disease.

scholarly journals A System Review and Meta-Analysis of Canaloplasty Outcomes in Glaucoma Treatment in Comparison with Trabeculectomy

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Bing Zhang ◽  
Jie Kang ◽  
Xiaoming Chen
Keyword(s):  
Meta Analysis ◽  
Average Difference ◽  
Success Rates ◽  
High Quality ◽  
Suprachoroidal Hemorrhage ◽  
System Review ◽  
Glaucoma Treatment ◽  
One Year ◽  
Choroidal Effusion ◽  
Descemet Membrane Detachment

Purpose. This system review studied the efficiency and safety of canaloplasty (CP) and compared the outcomes between CP and trabeculectomy (TE). Methods. Literatures were searched in PubMed and EMBASE. The meta-analysis was conducted on the postoperative outcomes in CP and then on the differences of outcomes between CP and TE. Results. In the meta-analysis, IOP decreased by 9.94 (95% CI 8.42 to 11.45) mmHg with an average AGM reduction of 2.11 (95% CI 1.80 to 2.42) one year after CP. The IOP reduction was significantly higher after TE than after CP, with an average difference of 3.61 (95% CI 1.69 to 5.53) mmHg at 12 months postoperationally. For complications, the incidence of hyphema was significantly higher in CP and the Descemet membrane detachment was just reported in CP, with an incidence of 3%. However, the incidence was significantly lower in CP of hypotony and of choroidal effusion/detachment. Meanwhile, suprachoroidal hemorrhage and bleb needling were only reported in TE. Conclusions. CP was less effective in IOP reduction than TE, but CP was able to achieve similar postoperative success rates and reduce the number of AGMs likewise. CP was also associated with lower incidence of complications. More high-quality researches are needed in the future to verify our findings in this system review.

Sphenoorbital Meningioma: Surgical Series and Design of Intraoperative Management Paradigm

2016 ◽  
Vol 77 (S 01) ◽  
Author(s):  
Lior Gonen ◽  
Eytan Nov ◽  
Nir Shimony ◽  
Ben Shofty ◽  
Georgios Klironomos ◽  
...  
Keyword(s):  
Intraoperative Management ◽  
Sphenoorbital Meningioma

POSTOPERATIVE PERICARDIAL EFFUSION SYNDROME

2012 ◽  
pp. 66-71
Author(s):  
Quang Thuu Le
Keyword(s):  
Pericardial Effusion ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Diagnostic Methods ◽  
Open Heart ◽  
Cross Sectional ◽  
Pericardial Drainage ◽  
Results Of Treatment ◽  
Intraoperative Management ◽  
Minimal Problems

Objective: Today, despite many recent improvements in intraoperative management and postoperative care, late pericardial effusions remain an important cause of morbidity after cardiac surgery. Because of widespread use of chronic anticoagulation and increased complexity of operations, the incidence of effusion may be higher. Thus we need to update the information on the symptoms, risk factors, diagnostic methods and treatment of Postoperative pericardial effusion syndrome. Patients and methods: A cross-sectional and prospective study of all patients admitted to hospital because of pericardial effusion after open heart surgery from 1/2010 to 9/2012. Study the clinical characteristics, paraclinicals, evaluate the results of treatment of pericardial effusion after open heart surgery. Results: Symptoms of pericardial effusion are nonspecific. Some patients with pericardial effusion report minimal problems. In the present study, few patients have the classic presentation of tamponade. Echocardiography is the diagnostic accuracy pericardial effusion after open heart surgery. This treatment mainly is pericardial drainage with 100%. Conclusion: Pericardial effusion is a common complication after open-heart surgery, symptoms of pericardial effusion are nonspecific to diagnostic method is echocardiographic surveillance.patients can be treated with internal medicine if has no tamponade and less fliuds. Pericardial drainage is absolute only in patients with pericardial effusion with signs of cardiac tamponade or pericardial many of effusion.

scholarly journals Anesthetic management of a patient with situs inversus totalis undergoing coronary artery bypass grafting surgery: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Chigusa Nakasone ◽  
Masafumi Kanamoto ◽  
Wataru Tatsuishi ◽  
Tomonobu Abe ◽  
Shigeru Saito
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Situs Inversus ◽  
Anesthetic Management ◽  
Artery Bypass ◽  
Situs Inversus Totalis ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Intraoperative Management

Abstract Background Anesthetic management of coronary artery bypass grafting surgery (CABG) in a dextrocardia patient with situs inversus totalis is rarely encountered and seldom reported in the literature. Case presentation A 76-year-old Japanese female patient had been diagnosed with situs inversus totalis and coronary artery disease of 3 vessels, and she subsequently underwent elective CABG. A preoperative examination showed almost normal results. ECG showed right deviation with the normal lead position. In the operating room, ECG leads were applied in reverse. Pulmonary artery catheterization was performed via the left internal jugular vein. A transesophageal echocardiography (TEE) probe was introduced without difficulty. A different angle was needed to acquire the desired views because of her atypical anatomy. Conclusion Careful perioperative evaluation, intraoperative management, and inspection of multiplane angle and probe adjustments in TEE are needed for anatomically abnormal patients.

Management of Suprachoroidal Hemorrhage

2007 ◽  
Vol 16 (6) ◽  
pp. 577-579 ◽  
Author(s):  
Paul R. Healey ◽  
Leon Herndon ◽  
William Smiddy
Keyword(s):  
Suprachoroidal Hemorrhage

Ahmed glaucoma valve in vitrectomized eyes: An implantation technique to minimize early postoperative fluid-loss hypotony

2021 ◽  
pp. 112067212110122
Author(s):  
Paolo Arpa ◽  
Cristina Arpa
Keyword(s):  
Surgical Technique ◽  
Anterior Chamber ◽  
Previous History ◽  
Implantation Technique ◽  
Fluid Loss ◽  
Ahmed Glaucoma Valve ◽  
Intraocular Hemorrhage ◽  
Hemorrhagic Complications ◽  
History Of ◽  
Choroidal Effusion

Purpose: To describe the application of a modified Ahmed glaucoma valve (AGV) surgical implantation technique in vitrectomized eyes, in order to minimize the risk of early postoperative hypotony, which leads to hemorrhagic complications. Materials and methods: Data of patients implanted with AGV using the surgical technique described were retrospectively reviewed. Inclusion criterion: glaucomatous eyes with previous history of pars plana vitrectomy. Intraocular pressure (IOP) measurement and ophthalmic examination were performed preoperatively and postoperatively weekly for 1 month for the detection of early hypotony, choroidal effusion/detachment, intraocular hemorrhage. The surgical technique consisted in creating a 5 mm long scleral tunnel with a 23 G needle reaching the anterior chamber at the iridocorneal angle, in which the Ahmed glaucoma valve tube was inserted. Results: Ten eyes of 10 patients were included. Median preoperative IOP was 30.5 mmHg [interquartile range (IQR) 28.3–33.0]; median postoperative IOP was 12.0 mmHg (IQR 9.3–13.0) at 1 week, and 12.5 mmHg (IQR 11.0–15.0) at 1 month. In no cases postoperative IOP was <8 mmHg. On the first postoperative day, five (50%) eyes showed few blood clots in the anterior chamber. On the second-week appointment, moderate choroidal effusion was observed in two eyes (20%). No hemorrhagic complications were observed. Conclusions: The creation of a long intrascleral tunnel with a 23 G needle for AGV implantation in vitrectomized eyes could be effective in decreasing leakage through the space between the valve tube and the sclerocorneal tissue. This technique is safe, easy to perform, feasible and fast. Due to its advantages and good postoperative results, it could also be adopted in non-vitrectomized eyes.

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