Plausible reasons of an expulsive hemorrhage development in cataract surgery and its consequence

Poster Details

First Author: I.Tereshchenko RUSSIA

Co Author(s):    E. Sorokin              

Abstract Details

Purpose:

The profound retrospective analysis of plausible reasons of the developed expulsive hemorrhage at cataract surgery.

Setting:

State Institution Eye Microsurgery Complex named after S.N. Fyodorov, the Khabarovsk Branch, Russia.

Methods:

From 1994 till 2006 it has been executed 44.5 thousand of cataract extractions in our clinic. Among them there were 18 cases of expulsive hemorrhage development that has made 0.04%. Among patients with expulsive hemorrhage there were 10 females and 8 males with an age range of 67-82 years (on the average 75 years). Overwhelming number of expulsive hemorrhage cases (15 from 18 cases) have occurred during the period 1994-2001 when the technique of extracapsular cataract extraction was still applied. Presence of burdening somatic and intraocular risk factors, specialties of operations, variants of expulsive hemorrhage development and its outcomes were investigated.

Results:

At all patients initial lens subluxation of I-II degrees, caused by exfoliative syndrome was noted. In 5 eyes earlier anti-glaucoma interventions were executed. At 6 patients glaucoma was combined with diabetic retinopathy. In 6 eyes myopic staphylomas were available. In 2 cases the intraocular pressure was moderately raised. All 18 patients had chronic vascular and metabolic pathology in subindemnification stage. 14 persons had idiopathic hypertensia of II-III stages combined with a type 2 diabetes at 6 patients. In 5 cases the chronic bronchitis with coughing took place. At 3 persons thrombocytopenia of an obscure genesis isn'ted. Blood pressure level has been raised at 16 people (160/90 mmHg - 200/130 mmHg). In 9 eyes it was carried out extracapsular cataract extraction, in 4 eyes – intracapsular, in 2 eyes – their combination, in one eye the luxated IOL was removed from vitreous cavity. In 2 eyes it was carried out cataract phacoemulsification. In 15 eyes the wide corneal access (9-12 mm) was carried out. In all cases the rupture of posterior capsule with loss of vitreous body into the anterior chamber took place. In 3 cases expulsive hemorrhage was promoted by uneasy behavior of patients (insufficient anesthesia – one patient, coughing – 2 cases).

Conclusions:

1. An expulsive hemorrhage developed in 0.04% of cases after cataract surgery with a wide cut. 2. All patients with an expulsive hemorrhage had the advanced age, burdening somatic and intraocular risk factors. 3. A lens subluxation promoting rupture of a posterior capsule with loss of vitreous body took place in all cases of an expulsive hemorrhage. 4. At some patients development of an expulsive hemorrhage was promoted also by underestimation of their initial condition, insufficiently careful preoperative preparation and inadequate anesthesia. 5. For preventive maintenance of an expulsive hemorrhage development it is necessary to carry out more carefully preoperative selection of patients with effective correction of the arterial hypertensia, glycemia level at their sub - and decompensation. 6. An essential way of preventive maintenance of the expulsive hemorrhage is use of surgery of small cuts with phacoemulsification technique. FINANCIAL DISCLOSURE?: No