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GH.Naderian , M.D.

GH.Naderian , M.D. Supra choroidal hemorrhage Cystoid macular edema Retinal detachment. Supra choroidal hemorrhage . Intraoprative Delayed post operative. More common in patients with glaucoma

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GH.Naderian , M.D.

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  1. GH.Naderian , M.D.

  2. Supra choroidal hemorrhageCystoid macular edemaRetinal detachment

  3. Supra choroidal hemorrhage • Intraoprative • Delayed post operative

  4. More common in patients with glaucoma • Incidence of supra choroidal H. following modern cataract surgery is reported to be between 0.03% and 0.06%

  5. The incidence of this complication following glaucoma surgery is reported to be 1.6% to 2% • Source of hemorrhage : One of the short or long posterior ciliary arteries

  6. Acute intraoperative expulsive hemorrhage there is most likely a rupture of a necrotic or weakened vessels wall associated with hypotony during the procedure

  7. Advanced aged Hypertension Arteriosclerosis Blood dyscrasias Anticoagulation Glaucoma High myopia Hypotony Trauma Uveitis Suprachoroidal H. in fellow eye IOP  Valsalva Prolonged hypotony ( wound leakage) Inadequate local anesthesia Predisposing conditions:

  8. Intraoperative supra choroidal hemorrhage : • Iris prolapse • Shallowing of AC • Vitreous prolapse • Graping of the incision • Firmness of the globe • Striae in the cornea • Change in the red reflex • *sudden pain *

  9. The first priority following recognition of a possible intraoperative suprachoroidal H. is secure closure of the incision

  10. Delayed supra choroidal H. • This type of H. usually occurs between the third to fifth postoperative day and in most cases is preceded by hypotony and the development of ciliochoroidal serous effusions

  11. The patient will generally have a history of sudden onset of eye pain , often with nausea , vomiting , decreased vision , headache , tearing and possible lid swelling or chemosis

  12. At times the patient may be awakened from sleep with these symptoms

  13. On examination • IOP ( may be ) • Shallowing of the AC ( often) • Vitreous prolapsed • Loss of the red reflex

  14. If the supra choroidal H. is large , the choroidal detachments may be visible on slit lamp examination behind the lens

  15. The presence of blood in the vitreous or the AC should be noted

  16. If there has been break through bleeding to beneath or through the retina , the prognosis for recovery of vision is diminished

  17. Initial treatment • Analgesics • Control of IOP • Cycloplegics • Topical and oral steroids

  18. The diagnosis of a suprachoroidal H. is usually made based on the clinical presentation and ophthalmic examination

  19. The use of ultrasonography may aid in the diagnosis , especially when there is media opacification or blood present

  20. Complete clot lysis will generally require 5 to 14 days , although this time may be variable in different individuals

  21. Several factors may influence the decision to consider drainage of a supra choroidal effusion

  22. It is well established that most suprachoroidal H. will eventually clear spontaneously

  23. It also appears that the final visual outcome may be similar whether early drainage is performed or the hemorrhage is allowed to resolve on its own

  24. Indication of drainage • Massive kissing effusion • Intractable pain • Persistent or recurrent flat AC • Prolapse of intraocular contents • Suspicion of RD • Vit. H • Retained lens fragments

  25. Cystoid Macula Edema • Irvine – Gass syndrome = CME following cataract surgery

  26. Risk factors • Post capsular rupture • Vitreous loss and incarceration • Anterior chamber and secondary IOL • Diabetes • History of CME in other eye • Uveitis

  27. Peak incidence is at 6-10 weeks • Spontaneous resolution occurring clinically in approximately 95% of uncomplicated cases usually within 6 months

  28. CME diagnosed by clinical exam , FA & OCT

  29. Treatment • Correction of the underlying cases • Systemic carbonic anhydrase inhibitors • Topical & systemic Indometacine • Steriods ( topical , oral , subtenon) • IVB & IVT • Parsplana vitrectomy

  30. Retinal detachment • The incidence of retinal detachment following cataract surgery is approximately 1%

  31. When cataract surgery is accompanied by vitreous loss, the incidence of RD increase to 5% or more

  32. Another risk factor for pseudophakic RD is YAG capsulotomy • In one reported study the performances of YAG laser capsulatomy doubled the incidence of RD

  33. Flashing and floatering are important

  34. What to do for this problem ? 1- Complete fundus examination before surgery 2- Any predisposing pathology must be treated 3- Decreased any manipulation during surgery 4- Any complication  retinal surgeon examination

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