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| EDITORIAL |
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| Year : 1992 | Volume
: 40
| Issue : 4 | Page : 99 |
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Expulsive haemorrhage
Noel Moniz
CBM Ophthalmic Institute, Little Flower Hospital, Angamally-683 572, Kerala, India
Correspondence Address:
Noel Moniz
CBM Ophthalmic Institute, Little Flower Hospital, Angamally-683 572, Kerala
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 1300305 
How to cite this article:
Moniz N. Expulsive haemorrhage. Indian J Ophthalmol 1992;40:99 |
Expulsive haemorrhage is a hidden danger in all intra ocular surgeries. Even though the incidence of this important complication of intra ocular surgery is very low, the outcome is often disastrous. The relevance of the study of this complication is that now a days eye surgeons are operating on many risky patients like diabetic, hypertensive and glaucomatous patients for a fairly longer time keeping the eye open. The incidence can still be kept low if the pre-existing conditions are well under control. Yet the hidden danger occasionally peeps from the vitreous chamber making the surgeons nervous and occasionally helpless. Once expulsive haemorrhage occurs it is the presence of mind of the surgeon which is most required. Even though many knew that a posterior sclerotomy done in time can in several occasions save the eye from total destruction very few surgeons really perform it in time. Those who have done it in time claim that they have enjoyed the fruits of their bold action.
There is perhaps nowhere else in ophthalmology the dictum `Prevention is better than cure'. This is most apt in expulsive haemorrhage and all efforts should be taken to prevent this dreaded complication. Besides keeping glaucoma and hypertension under control reduction in operating time is also essential. Once the eye is open the intra ocular pressure gets reduced to atmospheric pressure. Reduction in the duration of the eye being kept open is very important. Closed chamber surgeries are one of the best method to prevent expulsive haemorrhage and should be tried wherever possible. Since IOL implantation takes relatively more time, closed chamber cataract surgery along with IOL implantation perhaps may prevent this dreaded complication to some extent. Cataract being the most commonly performed intraocular surgery in almost all the eye hospitals in India it is of utmost importance to try closed chamber surgery for cataract.
Expulsive haemorrhage during corneal grafting is another alarming situation the corneal surgeons have to face. The occurrence of this complication increases when corneal surgery is performed along with cataract surgery(especially intra capsular) or when penetrating keratoplasty is done in an aphakic eye for bullous keratopathy. Posterior sclerotomy becomes more difficult to perform during this situation. If it occurs before the graft is sutured the surgeons control over the situation is very limited and often the whole contents of the eye ball comes out.
Research to prevent this dreaded complication should be encouraged by all of us and let us hope a day will come when we can forget about expulsive haemorrhage. Till then I wish you an expulsive haemorrhage free surgical career.
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