A Case of Suprachoroidal Hemorrhage After 25 Gauge Transconjunctival Sutureless Vitrectomy for Rhegmatogenous Retinal Detachment Associated with General Anesthesia by Min Hwan Kim, Younghoon Lee, South Korea



Suprachoroidal hemorrhage is a rare but potentially fetal complication of intraocular surgery. This report presents a case of suprachoroidal hemorrhage after 25-gauge transconjunctival sutureless vitrectomy for rhegmatogenous retinal detachment by Valsalva maneuver at the end of general anesthesia.

Case Summary:

A 60 – year – old female patient visited our clinic with nasal visual field defect of her right eye from 7 days ago. The best corrected visual acuity was 20/20 and the temporal side of retinal detachment with multiple tears at 9 o’clock was observed on fundus examination. She underwent 25-gauge transconjunctival sutureless vitrectomy under general anesthesia. Peripheral vitreous was removed by indentation. The surgery was completed without any problems and 20% sulfur hexafluoride (SF6) tamponade was performed. The sclerotomy wounds were sealed well and not leaked. During awakening from general anesthesia, the patient showed severe coughing and bucking reflex. After 3 hours after surgery, severe conjunctival chemosis was observed in the operated eye. Intraocular pressure (IOP) was as high as 35 mmHg, and anterior chamber was shallow. Fundus examination showed severe choroidal elevation and only about 30% gas remained. The patient was treated conservatively with sys temic steroid, topical steroids and cycloplegics. No glaucoma drug was used. After 3 days, IOP was adjusted to 24mmHg and the choroidal elevation gradually decreased. After 1 week after surgery, IOP was decreased to 19mmHg and elevated choroid decreased more. About 20% gas was remained. Two weeks after the operation, only temporal side of choroid was elelvated and the rest was flattened. One month later, fundus showed no choroidal elevation and detached retina was attached well. Her best corrected visual acuity was 20/20.


Valsalva maneuver during transconjunctival sutureless vitrectomy may result in massive suprachoroidal hemorrhage with disastrous visual consequences. Precautionary measures to prevent coughing or bucking reflex on the endotracheal tube during general anesthesia may prevent this potentially devastating complication. We report a case of acute suprachoroidal hemorrhage after vitrectomy by Valsalva maneuver at the end of general anesthesia.


Min Hwan Kim, Younghoon Lee
Konyang University Hospital
South Korea
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