Alfonso Savastano1,2, Stanislao Rizzo1, Maria Cristina Savastano2,3, Valerio Piccirillo4, Renato Forte5, Sandro Sbordone6, Francesco Diurno7, Silvio Savastano2. 1. Azienda Ospedaliero-Universitaria Careggi, Florence - Italy. 2. Studio Medico Associato Savastano, Cassino (Frosinone) - Italy. 3. Università Cattolica del Sacro Cuore, Policlinico Gemelli, Rome - Italy. 4. S. Maria della Pietà Hospital, Casoria (Naples) - Italy. 5. Spallanzani Hospital, Frosinone - Italy. 6. Seconda Università degli Studi di Napoli (SUN), Naples - Italy. 7. Moscati Hospital, Anesthesia Department, Aversa (Caserta) - Italy.
Abstract
PURPOSE: To describe the intraoperative management of choroidal effusion (CE) or suprachoroidal hemorrhage (SCH) during cataract surgery with the phacoemulsification technique. METHODS: The study is a retrospective interventional study through which we describe the intraoperative management adopted in 6 cases of CE or SCH during cataract surgery. The study involved 6,400 eyes (phacoemulsification) in 6 years observational time (incidence rate 0.094%). The surgical time at which these complications happened differed: nucleolus phacoemulsification in 2 eyes, cortex removal by bimanual irrigation-aspiration in 3 eyes, and intraocular lens implant for 1 eye. Once the complication was recognized, each patient was quickly moved to an extreme reverse Trendelenburg position and pharmacologically treated to manage high blood pressure, pain, and anxiety (150 mL of an 18% mannitol solution delivered in rapid infusion intravenously; 1-3 mg intravenous midazolam; 5 nifedipine sublingual drops). RESULTS: In all the cases reported, the surgery was completed after resolution of the acute choroidal exudation or SCH. In the follow-up evaluation, the intraocular pressure was normal at each examination. The visual acuity of the patients was between 6/7.5 and 5/6 Snellen after 4 weeks. We observed a statistically significant reduction in endothelial cells in the 2 eyes in which the CE or SCH happened during the phacoemulsification compared with the other cases; this finding likely results from mechanical damage (p = 0.04 [95% confidence interval]). CONCLUSIONS: Choroidal effusion or SCH can be intraoperatively managed to avoid expulsive hemorrhage and maintain the possibility of completing the surgery.
PURPOSE: To describe the intraoperative management of choroidal effusion (CE) or suprachoroidal hemorrhage (SCH) during cataract surgery with the phacoemulsification technique. METHODS: The study is a retrospective interventional study through which we describe the intraoperative management adopted in 6 cases of CE or SCH during cataract surgery. The study involved 6,400 eyes (phacoemulsification) in 6 years observational time (incidence rate 0.094%). The surgical time at which these complications happened differed: nucleolus phacoemulsification in 2 eyes, cortex removal by bimanual irrigation-aspiration in 3 eyes, and intraocular lens implant for 1 eye. Once the complication was recognized, each patient was quickly moved to an extreme reverse Trendelenburg position and pharmacologically treated to manage high blood pressure, pain, and anxiety (150 mL of an 18% mannitol solution delivered in rapid infusion intravenously; 1-3 mg intravenous midazolam; 5 nifedipine sublingual drops). RESULTS: In all the cases reported, the surgery was completed after resolution of the acute choroidal exudation or SCH. In the follow-up evaluation, the intraocular pressure was normal at each examination. The visual acuity of the patients was between 6/7.5 and 5/6 Snellen after 4 weeks. We observed a statistically significant reduction in endothelial cells in the 2 eyes in which the CE or SCH happened during the phacoemulsification compared with the other cases; this finding likely results from mechanical damage (p = 0.04 [95% confidence interval]). CONCLUSIONS:Choroidal effusion or SCH can be intraoperatively managed to avoid expulsive hemorrhage and maintain the possibility of completing the surgery.