Massive suprachoroidal hemorrhage during pars plana vitrectomy associated with Valsalva maneuver
| Autor: | Aryeh L Pollack, M. Gilbert Grand, Everett Ai, Ronald D. Miller, James C. Folk, H. Michael Lambert, Pravin U. Dugel, Steven D. Schwartz, H. Richard McDonald, Robert N. Johnson |
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| Rok vydání: | 2001 |
| Předmět: |
Adult
Choroid Hemorrhage Male Pars plana medicine.medical_specialty Visual acuity genetic structures Valsalva Maneuver medicine.medical_treatment Eye disease Visual Acuity Vitrectomy Valsalva maneuver medicine Humans Local anesthesia Intraoperative Complications Aged Retrospective Studies Aged 80 and over business.industry Middle Aged medicine.disease eye diseases Surgery Ophthalmology medicine.anatomical_structure Cough Anesthesia Sclerostomy Female sense organs Choroid medicine.symptom Complication business Follow-Up Studies |
| Zdroj: | American Journal of Ophthalmology. 132:383-387 |
| ISSN: | 0002-9394 |
| DOI: | 10.1016/s0002-9394(01)01049-2 |
| Popis: | PURPOSE: To report the intraoperative occurrence of massive intraocular suprachoroidal hemorrhage associated with Valsalva maneuver. METHODS: Retrospective, multicenter study of patients who developed massive choroidal hemorrhage associated with Valsalva maneuver during vitrectomy. RESULTS: Massive intraoperative suprachoroidal hemorrhage in seven patients (seven eyes) involved three men and four women with a median age of 52 years (range, 26 to 82 years). General anesthesia was used in six of seven cases. Coughing or “bucking” on the endotracheal tube during general anesthesia or severe coughing during the one vitrectomy performed under local anesthesia was associated with massive suprachoroidal hemorrhage. In five of seven eyes, this occurred near the end of surgery, after air-fluid exchange but before sclerotomy closure. Scleral plugs were immediately placed, and sclerotomy closure was performed exigently. Immediate posterior sclerotomy was performed on five of seven eyes; an additional patient underwent posterior sclerotomy postoperatively. After median follow-up of 18 months (range, 3 to 36 months), final visual acuity was no light perception in four eyes, light perception in one eye, 20/250 in one eye, and 20/20 in one eye. Four eyes became phthisical. CONCLUSIONS: Valsalva maneuver during pars plana vitrectomy may result in massive suprachoroidal hemorrhage with disastrous visual consequences. Precautionary measures to prevent coughing or “bucking” on the endotracheal tube during general anesthesia, or a prolonged episode of coughing during local anesthesia, may prevent this potentially devastating complication. |
| Databáze: | OpenAIRE |
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