Management of Suprachoroidal Hemorrhage during Phacoemulsification: A Comprehensive Review

Suprachoroidal hemorrhage associated with cataract surgery: A case series analysis

This study aimed to identify risk factors, evaluate management strategies, and assess visual outcomes of suprachoroidal hemorrhage during cataract surgery through a retrospective analysis of five clinical cases and a literature review. We analyzed five cases of suprachoroidal hemorrhage occurring during phacoemulsification cataract surgery with intraocular lens implantation or intrascleral fixation of intraocular lens haptics at our institution (January 2013-September 2024). Among 48,725 cataract surgeries, five cases of suprachoroidal hemorrhage were identified (incidence: 0.01%). Key risk factors included preoperative angle-closure glaucoma (two cases), prior cataract surgery with vitrectomy (two cases), and advanced age (one case, mid-70s). Intraoperative suprachoroidal hemorrhage occurred in two cases (one with posterior capsular rupture), whereas the condition developed postoperatively in three cases. Management strategies comprised pars plana vitrectomy with scleral drainage (three cases), vitrectomy combined with intravitreal triamcinolone injection (one case), and conservative treatment (one case). The mean preoperative visual acuity improved significantly from 2.22 LogMAR to 0.6 LogMAR at the final follow-up (P = 0.007). These findings suggest that, in addition to the previously reported major risk factors for suprachoroidal hemorrhage, such as advanced age, glaucoma, and multiple surgeries, secondary intraocular lens implantation is a major risk factor. Comprehensive preoperative evaluation and meticulous control of intraoperative intraocular pressure fluctuations are essential to mitigate suprachoroidal hemorrhage risks and optimize surgical outcomes.

Incidence and risk factors of perioperative suprachoroidal hemorrhage: A systematic review and meta-analysis

Suprachoroidal hemorrhage (SCH) is a potentially visually devastating complication of intraocular surgery, but estimates of perioperative SCH incidence vary. We performed a systematic review and meta-analysis of perioperative SCH incidence among population-based studies published between 1990 and 2023. Thirty-five studies collectively reported 1657 cases of perioperative SCH from a population of 3,028,911 surgeries. The estimated incidence of SCH was 0.12 % (95 % CI, 0.10-0.14 %), or about 1 in every 800 surgeries. The estimated incidence of perioperative massive SCH was 0.06 % (95 % CI, 0.04-0.08 %). In multivariable meta-regression, greater SCH incidence was significantly associated with smaller study population size, comparative study design, multicenter study setting, and intraoperative or delayed SCH timing (vs intraoperative alone), while lower SCH incidence was significantly associated with vitreoretinal or mixed surgery type (vs. cataract) (all P < 0.05). Study year was not a significant predictor of SCH incidence, suggesting that the incidence of SCH has not decreased over the past 3 decades despite improvements in surgical technologies and techniques. Given the rarity of SCH, and the strong effect of study population size on reported SCH incidence rates, future studies of SCH incidence should include a minimum population size of at least 1000 surgeries to obtain an accurate estimate of SCH incidence.

The Protective Effect of Rho-Associated Kinase Inhibitor Eye Drops (Ripasudil) on Corneal Endothelial Cells After Cataract Surgery: A Prospective Comparative Study

INTRODUCTION

Cataract surgery poses a risk to corneal endothelial cells. This study aimed to assess the protective effect of rho-associated kinase inhibitor eye drop (ripasudil) on corneal endothelial cells after cataract surgery over 12 months.

METHODS

We conducted a prospective, non-randomized, non-blinded comparative study including 43 patients divided into two groups: the ripasudil group (22 patients, 23 eyes) and the control group (21 patients, 21 eyes). All patients had grade 3 nuclear cataract and underwent uneventful phacoemulsification with intraocular lens implantation. In the ripasudil group, one drop of ripasudil hydrochloride hydrate (Glanatec® ophthalmic solution 0.4%) was administered three times a day for 5 days. Outcome measures included central corneal thickness (CCT) and endothelial cell density (ECD), which were evaluated preoperatively and 12 months postoperatively.

RESULTS

In the ripasudil group, the median ECD was 2398 (interquartile range [IQR] 410, 2201-2611) cells/mm2 at baseline and 2262 (IQR 298, 2195-2493) cells/mm2 at 12 months postoperatively. In the control group, the median ECD was 2503 (IQR 390, 2340-2730) cells/mm2 at baseline and 2170 (IQR 324, 2049-2373) cells/mm2 at 12 months postoperatively. Endothelial cell loss (ECL) was 12.8% in the control group, significantly reduced to 4.5% in the ripasudil group (p = 0.001*). CCT (p = 0.042), age (p = 0.383), sex (p = 0.944), and duration of surgery (p = 0.319) were not significant factors. No adverse effects were observed in either of the groups.

CONCLUSIONS

Incorporating ripasudil into postoperative management could help maintain corneal endothelial cell integrity and reduce cell loss after cataract surgery, potentially decreasing the need for endothelial transplantation in patients who have undergone intraocular surgeries.

Suprachoroidal Hemorrhage

Suprachoroidal hemorrhage (SCH) refers to the accumulation of blood in the suprachoroidal space, a relatively uncommon but significant complication that can occur spontaneously, during ophthalmic surgery, or as a consequence of ocular trauma. If left undiagnosed and untreated, SCH can lead to severe vision loss or even blindness. Therefore, it is crucial for ophthalmologists to have a thorough understanding of this complication, taking proactive measures to prevent it during surgery and being knowledgeable about effective management strategies for patients with SCH. This review article aimed to provide a comprehensive overview of SCH, covering its risk factors, diagnostic approaches, and the best practices for its management. By enhancing awareness and knowledge in this area, we can improve patient outcomes and minimize the impact of SCH in ophthalmic practice.