Suprachoroidal Hemorrhage: Risk Factors and Diagnostic and Treatment Options

Abstract

from the Geisel School of Medicine at Dartmouth and the Rutgers Robert Wood Johnson Medical School, respectively, discuss the risk factors and diagnostic and treatment options for managing suprachoroidal hemorrhage. We are all aware that there is great discussion and wide variability in thinking among our colleagues regarding approaches to diagnose and manage suprachoroidal hemorrhage. Common discussion includes definitive differentiation of tumors, congenital retinal pigment epithelial hypertrophy, and suprachoroidal hemorrhage. Acute intra-and perioperative management of this condition is frequently debated. Additionally, discussion frequently takes place regarding early versus delayed drainage. Drs. Mantopoulos and Fine tackle this topic in a concise and logical manner. They will provide a thorough review of the literature and provide opinions based on their clinical experience and strength of the evidence in the literature. I am certain that their insights will be very valuable for optimizing outcomes in patients with this unfortunate condition.

Management of suprachoroidal hemorrhage during cataract surgery

“…Tightening and rupture of the choroidal vessels due to rapid reduction or fluctuation of IOP precipitates the event. SCH can occur with any intraocular surgery, mostly after glaucoma surgery and rarely after vitrectomy and keratoplasty surgeries ( 8 – 10 ). Hypotonia after glaucoma surgery, aphakia, systemic hypertension, anticoagulant medication, high myopia and high axial length, presence of retinal detachment, previous history of vitrectomy, and postoperative emesis are among risk factors for SCH development ( 11 , 12 ).…”

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

“…Suprachoroidal hemorrhage (SCH) is a rare but vision-threatening complication of intraocular surgery and trauma whereby extensive hemorrhaging in the potential space between the choroid and sclera mechanically brings the retina into near or complete apposition and in severe cases, extrudes intraocular contents through open wounds. 1 Suprachoroidal hemorrhage typically occurs secondarily to intraocular surgery, both intraoperatively and postoperatively, and in patients experiencing physical trauma. 1 Although rare, SCH has also been described to occur spontaneously but typically occurs in association with specific ocular or systemic risk factors.…”

“…1 Suprachoroidal hemorrhage typically occurs secondarily to intraocular surgery, both intraoperatively and postoperatively, and in patients experiencing physical trauma. 1 Although rare, SCH has also been described to occur spontaneously but typically occurs in association with specific ocular or systemic risk factors. 1,2 Commonly encountered systemic risk factors include old age, increased venous pressure during the Valsalva maneuver and coughing, hypertension, and the use of antiplatelets, anticoagulants, and thrombocytopenia.…”

“…1 Although rare, SCH has also been described to occur spontaneously but typically occurs in association with specific ocular or systemic risk factors. 1,2 Commonly encountered systemic risk factors include old age, increased venous pressure during the Valsalva maneuver and coughing, hypertension, and the use of antiplatelets, anticoagulants, and thrombocytopenia. Intraocular risk factors include high myopia, acute hypotony, glaucoma, and choroidal lesions, such as hemangiomas and melanoma.…”

Management of Suprachoroidal Hemorrhage in a Patient With Boston Type I Keratoprosthesis

“…This is often achieved via the placement of a Lewicky anterior chamber (AC) maintainer or infusion cannula, with injection of saline, perfluorocarbon liquid, or viscoelastic. 4,5 However, the crowded AC and limited view of the periphery through the KPro titanium backplate presents a significant challenge to standard techniques. This is the first report to our knowledge of using a viscoelastic tamponade technique in a KPro eye.…”