• Written By: Rahul Khurana, MD

    This large retrospective analysis suggests novel risk factors for developing suprachoroidal hemorrhage after vitrectomy and confirms known risks. 

    The authors retrospectively analyzed the rate and risk factors of suprachoroidal hemorrhage during 20-gauge PPV over a 10-year period in three surgical centers.

    In 5,459 patients, the incidence of this complication was low (1.03 percent). Risk factors for developing intraoperative suprachoroidal hemorrhage included male sex (odds ratio, 2.38), advancing age (OR, 1.04), rhegtamogenous retinal detachment (OR, 5.92), a scleral explant (OR, 5.63), a dropped lens fragment (OR, 6.94) and the use of aspiring or warfarin (OR, 2.29).

    The finding that men had a significantly greater risk of developing this complication may be due to their longer axial lengths, as increased axial length is thought to be a risk factor for suprachoroidal hemorrhage. Men also have a higher rate of retinal detachment, which may have contributed to the increased rate of suprachoroidal hemorrhage.

    Another novel finding was the increased risk of developing phthisis or hypotony after suprachoroidal hemorrhage. Hypotony may be secondary to ciliary body detachment, which has been described in association with suprachoroidal hemorrhage. However, they note that the rates of both phthisis and ocular hypertension must be interpreted with caution because the follow-up period for those patients with suprachoroidal hemorrhage was greater than for controls.

    In contrast to previous reports, spherical equivalence, preoperative systemic hypertension and glaucoma were not found to be significant risk factors. The role that increased IOP plays in the development of suprachoroidal hemorrhage is unclear and systemic hypertension is controversial.

    They write that the conflict of these results with some previous articles investigating suprachoroidal hemorrhage in PPV may be due to an increased awareness of this complication or to surgical advances over the past decade that have improved diagnosis and management.