Postoperative suprachoroidal hemorrhage in a glaucoma patient on low molecular weight heparin

Suprachoroidal Hemorrhage

Suprachoroidal hemorrhage (SCH) refers to the accumulation of blood in the suprachoroidal space, a relatively uncommon but significant complication that can occur spontaneously, during ophthalmic surgery, or as a consequence of ocular trauma. If left undiagnosed and untreated, SCH can lead to severe vision loss or even blindness. Therefore, it is crucial for ophthalmologists to have a thorough understanding of this complication, taking proactive measures to prevent it during surgery and being knowledgeable about effective management strategies for patients with SCH. This review article aimed to provide a comprehensive overview of SCH, covering its risk factors, diagnostic approaches, and the best practices for its management. By enhancing awareness and knowledge in this area, we can improve patient outcomes and minimize the impact of SCH in ophthalmic practice.

Clinical features, management and outcomes of expulsive choroidal hemorrhage during cataract surgery: 13 years experience from a tertiary eye center

PURPOSE

To study the risk factors, clinical features, management, and outcomes of intraoperative expulsive choroidal hemorrhage (ECH) during cataract surgery.

SETTING

Aravind eye hospital, Madurai, Tamil Nadu, India.

DESIGN

Retrospective hospital-based study.

METHODS

Of the 1167250 patients who underwent cataract surgery between 2008 to 2020, patients diagnosed with intraoperative ECH were included. Demography, ocular and systemic risk factors, visual acuity, type of ocular anesthesia, intraoperative and postoperative records, management, and surgical outcomes were analyzed.

RESULTS

A total of 52 eyes (0.004%) of 1167250 patients had ECH. Of the 52 cases, 43 cases (incidence rate 0.006%) were reported in the years 2008 to 2015 and 9 cases (incidence rate 0.002%) in the years 2016 to 2020. The change in the ocular anesthesia from peribulbar and retrobulbar anesthesia (2008-2015) to sub-Tenon's anesthesia (2016-2020) was associated with a reduced rate of ECH (p-value 0.002). Twenty-eight eyes (53.8%) were having limited ECH and 24 eyes (46.2%) were having full-blown ECH. The visual outcome was better in eyes with limited ECH compared to full-blown SCH in all follow-up visits. The median vision (IQR) before the cataract surgery and immediate postoperative day 1 were 1.30 (0.78 - 2.60) and 2.45 (1 - 2.75) respectively. The median final vision (IQR) after the secondary surgical intervention was 2.2 (0.60 - 2.60).

CONCLUSIONS

This series included 52 eyes with ECH, recognized associations of ECH with different types of anaesthesia as well as with different cataract surgical procedures, and described management of ECH. Postoperative visual outcome was poor.