Suprachoroidal Haemorrhage in Postoperative Period of Antiglaucoma Surgery, Case Report

Abstract

Suprachoroidal haemorrhage (SCH) is a serious complication of intraocular procedures. Physiologically there is only a minimal amount of fluid in the suprachoroid space, pathologically the fluid volume increases, which causes ablation of the choroid. SCH could be divided into different cathegories, according to the character of the fluid into serous and haemorrhagic; by the time of occurrence in relation to the surgery into peroperative and postoperative. Diagnosis is based on biomicroscopic and ultrasound examinations. The ocular risk factors for SCH are glaucoma, myopia and aphakia; systemic risk factors include vascular fragility, arterial hypertension and blood coagulation disorders. In the pathogenesis hypotonia of the eye, that causes rupture of the ciliary vessels, plays a very important role. SCH can be treated both conservatively and surgically. As to pharmacotherapy we use gabapentin to suppress neuropathic pain and prednisone, topical mydriatics and anti-inflammatory agents. The type of surgical treatment differs according to time of occurrence, if SCH occurs during the operation, the intervention consists mainly in the wound closure and the repositioning of the weakening tissues; in postoperative forms, we choose drainage procedures, possibly vitreoretinal procedures. Our patient, an 80-year-old myop and chronic glaucomatic treated intensively both topically and systematically underwent trabeculectomy on his left eye due to unsatisfactory intraocular pressure (IOP) and significant glaucoma progression. The surgical intervention went without any complications. In the early post-operative period, there was persisting elevation of IOP, therefore sclera lap was discontinued and 5-fluorouracil was applied under the filter blister. Subsequent hypotonia caused a hemorrhagic SCH with intraocular hypertension, which was resolved by draining the blood with sclerotomias and thus releasing intraocular hypertension. The visual acuity of the left eye gradually improved to almost original values. Intraocular pressure, however, is not well compensated despite many following antiglaucoma surgeries. Therefore, even with the patient‘s maximum therapy, glaucoma continues to progress. In our case, we confirm that it is possible to solve even the relatively most complicated cases of SCH. We stress the necessity to consider the presence of risk factors of the occurrence of SCH before indicating intraocular procedures and also recommend thinking carefully about other less invasive surgical techniques. In glaucoma, it is appropriate taking in account the prediction of life compared to the expected rate of progression of vision loss.