Incidence of postoperative suprachoroidal hemorrhage after glaucoma filtration surgeries in the United States

Abstract

Kamyar Vaziri,1 Stephen G Schwartz,1 Krishna S Kishor,1 Jorge A Fortun,1 Darius M Moshfeghi,2 Andrew A Moshfeghi,3 Harry W Flynn Jr1 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; 2Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA; 3Department of Ophthalmology, USC Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, CA, USA Purpose: To report the 3-month incidence rates of postoperative suprachoroidal hemorrhage after glaucoma filtration surgeries and to examine the subsequent surgical treatments in these eyes.Methods: This is a retrospective study using the nationally pooled, insurance claim-based MarketScan databases from the years 2007–2011. Patients with records of trabeculectomy and/or tube shunt procedures were identified, and all cases of “definite” (ie, properly coded) and “suspected” (possibly miscoded) postoperative suprachoroidal hemorrhage occurring within 3 months of their glaucoma filtration procedures were captured along with the surgical interventions used for this condition. Kaplan–Meier survival analysis was used to evaluate the 3-month incidence rates of suprachoroidal hemorrhage, and regression analysis was applied to calculate the odds ratios, confidence intervals, and P-values.Results: There were 17,843 trabeculectomies and 9,597 tube shunt surgeries identified. Among these, there were 107 cases (247 including “suspected” cases) of postoperative suprachoroidal hemorrhage within 3 months of trabeculectomy and 113 cases (255 including “suspected” cases) within 3 months of tube shunt procedures. The 3-month cumulative incidence rate of postoperative suprachoroidal hemorrhage ranged from 0.6%±0.06% to 1.4%±0.09% after trabeculectomy and 1.2%±0.11% to 2.7%±0.16% after tube shunt surgery. Postoperative suprachoroidal hemorrhage was almost twice as likely to occur after tube shunt surgeries than after trabeculectomies for both “definite” and “definite” plus “suspected” cases (odds ratio, 1.98; 95% confidence interval, 1.51–2.58; P<0.001; and odds ratio, 1.95; 95% confidence interval, 1.63–2.32; P<0.001, respectively). Among the 502 “definite” and “suspected” cases of postoperative suprachoroidal hemorrhage, 32.9% (165 cases) had a treatment record of choroidal tap and 8.8% (44 cases) had a treatment record of pars plana vitrectomy.Conclusion: In this sample, the 3-month cumulative incidence rate of postoperative suprachoroidal hemorrhage was 0.6%–1.4% after trabeculectomy and 1.2%–2.7% after tube shunt procedures, and the majority of the cases appeared to be managed without further surgery. Postoperative suprachoroidal hemorrhage was almost twice as likely to occur after tube shunt surgeries as after trabeculectomies. Keywords: suprachoroidal hemorrhage, choroidal effusion, trabeculectomy, tube shunt, choroidal tap, pars plana vitrectomy