Introduction:

Intraoperative suprachoroidal hemorrhages are a feared complication of ophthalmological surgery. Caused by the rupture of posterior cilliary vessels, its rarity is only matched by its urgent need for immediate action. Although most frequently associated with glaucoma surgery and intra/extracapsular cataract extraction, it may rarely occur in the context of any intraocular procedure. In this paper, the authors present the case of an expulsive haemorrhage caught on tape, during a traumatic cataract extraction, and its subsequent management through a scleral drainage on a second intervention.

Case Report:

The authors present the case of a 79-year old patient, submitted to surgery for a traumatic subluxated cataract. During the procedure, after intracapsular removal of the lens, and just before the insertion of the IOL, the patient had an episode of tachycardia and increased arterial pressure. Shortly after, a rapidly increasing choroidal detachment was noticed, accompanied by a greatly increased intraocular pressure, preventing any anterior chamber formation. The surgical team immediately applied pressure to the surgical wound and sutured it, requiring a vicryl suture, successfully preventing expulsion of the intraocular contents. After 2 weeks, due to a persistently increased intraocular pressure with hyphema and intractable pain, the patient had to undergo an anterior chamber lavage, scleral drainage with an anterior chamber infusion and 23-gauge vitrectomy. A complete retinal detachment with a dire visual prognosis was diagnosed intraoperatively, justifying the decision to withhold any further measures.

Conclusion:

Intraoperative expulsive haemorrhage is a rare complication that worsens the prognosis of any procedure, most frequently determining irreversible loss of vision. The immediate management of this disastrous event should be well present in the arsenal of techniques of any and all eye surgeons. In our case, even the immediate successful closure of the corneal wound was not enough to prevent irreparable retinal function loss.

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David da Fonseca Martins

 

 

 

 

 

 

 

 

 

 

Pedro Neves