Maive uprachoroidal hemorrhage during par plana vitrectomy aociated with Valalva maneuver

PURPOE: To report the intraoperative occurrence of maive intraocular uprachoroidal hemorrhage aociated with Valalva maneuver. METHOD: Retropective, multicenter tudy of patient who developed maive choroidal hemorrhage aociated with Valalva maneuver during vitrectomy. REULT: Maive intraoperative uprachoroidal hemorrhage in even patient (even eye) involved three men and four women with a median age of 52 year (range, 26 to 82 year). General anetheia wa ued in ix of even cae. Coughing or “bucking” on the endotracheal tube during general anetheia or evere coughing during the one vitrectomy performed under local anetheia wa aociated with maive uprachoroidal hemorrhage. In five of even eye, thi occurred near the end of urgery, after air-fluid exchange but before clerotomy cloure. cleral plug were immediately placed, and clerotomy cloure wa performed exigently. Immediate poterior clerotomy wa performed on five of even eye; an additional patient underwent poterior clerotomy potoperatively. After median follow-up of 18 month (range, 3 to 36 month), final viual acuity wa no light perception in four eye, light perception in one eye, 20/250 in one eye, and 20/20 in one eye. Four eye became phthiical. CONCLUION: Valalva maneuver during par plana vitrectomy may reult in maive uprachoroidal hemorrhage with diatrou viual conequence. Precautionary meaure to prevent coughing or “bucking” on the endotracheal tube during general anetheia, or a prolonged epiode of coughing during local anetheia, may prevent thi potentially devatating complication.