title: Massive suprachoroidal hemorrhage during pars plana vitrectomy associated with Valsalva maneuver.
abstract: OBJECTIVE
  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.
authors.affiliation: Retina Research Fund, St. Mary's Medical Center, San Francisco, CA 94109, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Pollack
authors.forename: H R
authors.initials: HR
authors.lastname: McDonald
authors.forename: E
authors.initials: E
authors.lastname: Ai
authors.forename: R N
authors.initials: RN
authors.lastname: Johnson
authors.forename: P U
authors.initials: PU
authors.lastname: Dugel
authors.forename: J
authors.initials: J
authors.lastname: Folk
authors.forename: M G
authors.initials: MG
authors.lastname: Grand
authors.forename: H M
authors.initials: HM
authors.lastname: Lambert
authors.forename: S
authors.initials: S
authors.lastname: Schwartz
authors.forename: R D
authors.initials: RD
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002832:Choroid Hemorrhage / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery; D003371:Cough / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012599:Sclerostomy; D014636:Valsalva Maneuver; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects*