Massive Spontaneous Suprachoroidal Hemorrhage in a Patient With Type 1 Chronic Myeloid Leukemia and Lymphoplasmacytic Lymphoma: Case Report and Review of the Literature

Abstract

Purpose: This work reports a rare case of spontaneous suprachoroidal hemorrhage (SSCH) and summarizes the literature on its treatment options and outcomes. Methods: A case report and comprehensive literature review are presented on the medical and surgical management of SSCH on PubMed from 1998 to 2021. Results: The literature search revealed 58 studies, 33 of which included 52 eyes of 47 patients. Surgical treatment typically consisted of choroidal drainage with posterior sclerotomies combined with pars plana vitrectomy and silicone oil placement. Medical therapy involved intraocular pressure control with laser peripheral iridotomy and topical, oral, and intravenous medication. Conclusions: In cases of SSCH, conservative management and a prompt workup should be initiated to identify the cause before proceeding with surgery. If the initial workup does not reveal a cause, medical and surgical treatments are both viable and the decision is at the discretion of the treating physician.

Spontaneous Expulsive Suprachoroidal Hemorrhage in a Middle-Aged Patient With Hypertension, Type II Diabetes, and Associated Retinopathy

“…Reportedly, various systemic and ocular conditions are risk factors for SESCH [ 1 ]. Systemic conditions include advanced age (>60 years), hypertension, diabetes mellitus, anemia, thrombocytopenia, cardiovascular diseases, and associated medications for anticoagulation therapy and Valsalva maneuvers [ 1 ]. Ocular conditions include age-related macular degeneration, glaucoma, pseudophakia, and longer axial length [ 1 ].…”

“…Systemic conditions include advanced age (>60 years), hypertension, diabetes mellitus, anemia, thrombocytopenia, cardiovascular diseases, and associated medications for anticoagulation therapy and Valsalva maneuvers [ 1 ]. Ocular conditions include age-related macular degeneration, glaucoma, pseudophakia, and longer axial length [ 1 ]. Our patient had unmedicated hypertension, type II diabetes, and diabetic retinopathy with subretinal and vitreous hemorrhages.…”

Suprachoroidal Hemorrhage

“…The most important is ocular hypotony. The other risk factors which increase the likelihood of SCH include longer axial length, previous intraocular surgery, vitrectomized eyes, uncontrolled high IOP, aphakia, pseudophakia, prior SCH in the presenting or fellow eye, choroidal lesions, intraocular malignancy, age-related macular degeneration (AMD), hard nucleus cataract surgery, ocular comorbidities such as uveitis or past trauma [5,[22][23][24].…”

“…Several reports of spontaneous cases were predisposed to bleeding because of systemic antithrombotic therapy in subjects treated with warfarin, heparin, thrombolytic agents, or bleeding tendency [2,22,23,25,[28][29][30][31][32][33][34]. Combining systemic antithrombotic agents with the Valsalva maneuver may further increase the risk of spontaneous SCH [2,23,28,35].…”

Diagnostic and Therapeutic Challenges

“…Proposed intraocular risk factors for SSCH include acute hypotony, high myopia, glaucoma, and choroidal lesions, including hemangiomas and melanomas. 6 In addition to the previously mentioned workup, one should assess the patient's blood pressure and eye pressure, ask about any history of valsalva, and test for coagulopathies, particularly in a young patient with no other risk factors. His increased antithrombin III activity (1.37 IU/mL) indicated a theoretical bleeding tendency and may have contributed to the worsened hemorrhagic transformation.…”