title: [Expulsive hemorrhage in perforating keratoplasty--incidence and risk factors].
abstract: BACKGROUND
  Expulsive hemorrhage is a severe complication of intraocular surgery. In a retrospective study we looked up surgical records of all penetrating keratoplasties (PK) performed in our department between 1989 and 1998. In all patients suffering from expulsive or preexpulsive choroidal hemorrhage we intended to find out possible risk factors and to report on the final outcome of these eyes.
  
  
  METHODS
  Between January 1989 and November 1998 a total of 2421 PKs were performed. Nine preexpulsive and three expulsive hemorrhages occurred. The group of patients with preexpulsive hemorrhage consists of four females and five males (mean age 57 +/- 6.5 years). Three patients (one female, 2 males; mean age 67 +/- 8.5 years) suffered from expulsive hemorrhage.
  
  
  RESULTS
  Incidence of expulsive hemorrhage was 0.1% (preexpulsive hemorrhage 0.4%). All twelve operations were performed under general anesthesia. Risk factors for preexpulsive hemorrhage were: previous ocular surgery (three patients), ocular trauma (2 patients) and internal diseases (five patients): arterial hypertension, coronary heart disease, diabetes. Preoperative visual acuity was light perception to 4/20, visual acuity at the last postoperative examination after a mean follow-up of 41.0 +/- 22.6 months ranged from light perception to 12/20. Risk-factors for expulsive hemorrhage were: previous ocular surgery (two patients), primary open angle glaucoma (two patients), coronary heart disease (one patient) und asthma bronchiale (one patient). One of the patients awoke from general anesthesia during the "open-sky" situation. Preoperative visual acuity was light perception to 2/400, visual acuity at the last postoperative examination (mean follow-up 14.0 +/- 1.0 months) was light perception in all eyes.
  
  
  CONCLUSIONS
  The incidence of an expulsive hemorrhage was 0.1% in 2412 Pks. Risk factors are ocular and internal predispositions which can hardly be controlled, although arterial blood pressure was not significantly elevated during opening of the globe.
authors.affiliation: Augenklinik mit Poliklinik, Universität Erlangen-Nürnberg. michael.groh@augen.med.uni-erlangen.de
authors.forename: M J
authors.initials: MJ
authors.lastname: Groh
authors.forename: B
authors.initials: B
authors.lastname: Seitz
authors.forename: A
authors.initials: A
authors.lastname: Händel
authors.forename: G O
authors.initials: GO
authors.lastname: Naumann
mesh_terms: D000328:Adult; D000368:Aged; D002832:Choroid Hemorrhage / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012086:Reoperation; D012307:Risk Factors; D014792:Visual Acuity