Expulsive Hemorrhage During Cataract Surgery: Modern Manifestations and Outcomes (Presented in Russian)
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.