ABSTRACT

Introduction:

Suprachoroidal Hemorrhage (SCH) is a potentially devastating complication of both anterior and posterior segment surgery. Although rare, it can occur following corneal transplants, glaucoma or cataract surgery, and vitreoretinal surgery or trauma. SCH may occur when a fragile vessel is exposed to sudden compression and decompression forces. Systemic risk factors include advanced age, arteriosclerosis, hypertension and diabetes. Ocular risk factors may be aphakia, glaucoma, high myopia, trauma and vitreous loss. Examples of intraoperative risk factors are increased IOP, open-sky procedures and Valsava maneuvers. Management of intraoperative SCH involves closing the eye rapidly to prevent the risk of the expulsion of ocular contents. Postoperative SCH, however, can be managed medically or surgically. Medical management includes cycloplegia, topical and oral steroids and pain treatment, with many cases of SCH resolving spontaneously. In the case of appositional SCH, nonresolving or with retinal detachment, surgical drainage will likely improve the anatomical and functional outcomes. The timing of drainage is critical as the blood must have time to liquify. The appropriate timing of drainage is 2 to 3 weeks after the initial complication, and ultrasound is very useful to show us this liquefaction. Surgical management consists of a conjunctival peritomy, placement of either an anterior segment or pars plana in fusion line and scleral drainage through a sclerotomy in the involved quadrants.

Clinical Cases:

Case 1: 67-year-old female patient, that underwent a phaco-vitrectomy with ILM-peeling and gas tamponade for a macular hole. The day after the procedure, we observed a large choroidal detachment with kissing choroidals. We opted for a close surveillance with ultrasound and report a complete resorption of the hemorrhage after one month.

Case 2: 77-year-old male patient, 3 weeks post-phacoemulsification with a posterior capsule rupture and sulcus-IOL placement, presented with a retinal detachment with hypotony and an hemorrhagic choroidal detachment. He underwent a simultaneous scleral drainage of the hemorrhage and 23-gauge vitrectomy and silicone oil tamponade, with a good anatomical and functional outcome.

Case 3: 54 year-old male with an hemorrhagic choroidal detachment the day after a vitrectomy for a macula-ON uncomplicated retinal detachment under general anaesthesia, presumably due to 3 episodes of bucking due to accidental emergence during the procedure and severe coughing during the night due to endotracheal irritation. 3 weeks later, after confirming that there was no improvement of the SCH, the patient had to undergo a successful drainage of the detachments.

Conclusions:

Suprachoroidal Hemorrhages have variable presentations and are a possibly severe sight-threatening complication of any intraocular procedure. Management may include emergent action, early surgical procedures or close observation alone. Knowledge of the main risk factors, its pathophysiology and management is critical to decide the best course of action for each patient and aim for the best possible outcome.


CONTACT DETAILS

 

David Martins & Pedro NEVES, Pedro GOMES, Silvia DINIZ, Ines MATIAS, Margarida SANTOS, Mario ORNELAS
Setubal Hospital Center
Setubal, Portugal
Email : drdavidmartins@hotmail.com
Cell Phone: +351964029156
Work Phone: +351964029156