Outcomes in Patients with Suprachoroidal Hemorrhage After Anterior Segment Surgery

Suprachoroidal hemorrhage associated with cataract surgery: A case series analysis

This study aimed to identify risk factors, evaluate management strategies, and assess visual outcomes of suprachoroidal hemorrhage during cataract surgery through a retrospective analysis of five clinical cases and a literature review. We analyzed five cases of suprachoroidal hemorrhage occurring during phacoemulsification cataract surgery with intraocular lens implantation or intrascleral fixation of intraocular lens haptics at our institution (January 2013-September 2024). Among 48,725 cataract surgeries, five cases of suprachoroidal hemorrhage were identified (incidence: 0.01%). Key risk factors included preoperative angle-closure glaucoma (two cases), prior cataract surgery with vitrectomy (two cases), and advanced age (one case, mid-70s). Intraoperative suprachoroidal hemorrhage occurred in two cases (one with posterior capsular rupture), whereas the condition developed postoperatively in three cases. Management strategies comprised pars plana vitrectomy with scleral drainage (three cases), vitrectomy combined with intravitreal triamcinolone injection (one case), and conservative treatment (one case). The mean preoperative visual acuity improved significantly from 2.22 LogMAR to 0.6 LogMAR at the final follow-up (P = 0.007). These findings suggest that, in addition to the previously reported major risk factors for suprachoroidal hemorrhage, such as advanced age, glaucoma, and multiple surgeries, secondary intraocular lens implantation is a major risk factor. Comprehensive preoperative evaluation and meticulous control of intraoperative intraocular pressure fluctuations are essential to mitigate suprachoroidal hemorrhage risks and optimize surgical outcomes.

Perioperative suprachoroidal hemorrhage and its surgical management: a systematic review

PURPOSE

Suprachoroidal hemorrhage (SCH) is a rare but severely feared sight-threatening complication of intraocular surgery, and its management remains debatable. We intended to summarize the existing surgical management options regarding perioperative SCH, describing different techniques and their respective visual outcomes.

METHODS

A systematic literature search of articles published since 1st January 2011 until 31st December 2022 was performed using MEDLINE (PubMed) and Scopus. Eligibility criteria included the adult population with SCH related to intraocular surgery.

RESULTS

Thirty-eight studies enrolling 393 patients/eyes were assessed after a selection process among 525 records. We included 5 retrospective cohort studies, 15 case series and 18 case reports. We documented cases of acute SCH diagnosed intraoperatively and delayed SCH, treated until a maximum of 120 days after the diagnosis. Best corrected visual acuity at diagnosis was generally poor, with variable final visual outcomes. Techniques of external drainage with or without combined pars plana vitrectomy (PPV), type of endotamponade (if PPV performed), anterior chamber maintainer and reports of the use of recombinant tissue plasminogen activator were described.

CONCLUSION

To the best of our knowledge, this is the first systematic review assessing perioperative SCH and its surgical management. There is no standardized surgical approach of SCH and longitudinal intervention studies are lacking. To ensure that patients achieve the best possible visual outcome, prompt diagnosis and treatment are crucial. Therefore, further clinical research is on demand to improve the management of this clinical sight-threatening entity.

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.

Aseptic Orbital Cellulitis as a Complication of Suprachoroidal Hemorrhage

Suprachoroidal hemorrhage is a rare and potentially devastating clinical entity seen in individuals on anticoagulation presenting with severe unilateral eye pain, sudden vision loss, and elevated intraocular pressures. Herein, we report the first case of aseptic orbital cellulitis caused by recurrent spontaneous suprachoroidal hemorrhage. This case highlights an example of non-infectious orbital cellulitis arising from choroidal pathology in the setting of uncontrolled intraocular pressures and recurrent intraocular bleeding. Surgical intervention with blood drainage should be considered to prevent complications and preserve the globe.