Expulsive Hemorrhage During Cataract Surgery: Modern Manifestations and Outcomes

Monday, April 28, 2014: 3:46 PM
Room 151A (Boston Convention and Exhibition Center)
Zinaida Kataeva, MD, IRTC Eye Microsurgery Ekaterinburg Center, Ekaterinburg, Russia
Oleg V. Shilovskikh, MD, IRTC Eye Microsurgery Ekaterinburg Center, Ekaterinburg, Russia
Igor Idov, MD, IRTC Eye Microsurgery Ekaterinburg Center, Ekaterinburg, Russia
Pavel Rylov, MD, IRTC Eye Microsurgery Ekaterinburg Center, Ekaterinburg, Russia

Narrative Responses:

Purpose
To analyze reasons, manifestations and treatment outcomes in patients with expulsive hemorrhage (EH).

Methods
Retrospective analysis of 32 EH cases during cataract surgery from 2003 till 2012 – 0.02% of cataract operations. Mean age - 78±3.6 years.  Preop visual acuity was from light perception to 0.6; AL from 20.14 to 32.08 mm.  Glaucoma was present in 15 eyes; in 10 eyes IOP was over 21 mm Hg.  In 9 eyes there was lens subluxation, in 10 eyes – grade 5 cataract density. There were 3 cases of ICCE, 1 ECCE, 17 mechanical phacofragmentations, 11 phacoemulsifications.  EH grade 1 was in 4 eyes, grade 2 – 6, grade 3 – 19, grade 4 – 3.

Results
In remote postop period up to 2 years visual acuity was from 0.01 to0.05 in 5 eyes, from  0.1 to 0.75 in20, in 7 eyes vision was absent: 2 had AL over28 mm, 4 – lens subluxation, 4 – IOP over 36 mm Hg., 5 eyes -5.2 mm incision, 2 -7 mm. In 11 eyes with EH during phaco visual acuity was 0.01 in1 eye, 0.1 to 0.95- in 10 eyes. Significant influence of incision size (р<0.001) and IOP level (р<0.05) on the outcome was found.

Conclusion
Use of small self-sealing incisions in cataract surgery results in reduction of negative functional results in case of EH. If EH occurs during phaco, more frequently it has grades 1-2. Main risk factors of visual loss in case of EH are high IOP before operation and incisions over 3 mm.