Acute suprachoroidal hemorrhage during clear corneal phacoemulsification using topical and intracameral anesthesia

Abstract

Shallowing of the anterior chamber and hardening of the eye occurred just before commencement of irrigation/aspiration of cortex in an 80-year-old man having temporal clear corneal cataract surgery under topical and intracameral anesthesia. Nucleus removal had been completed and was uneventful. Intraoperative fundus examination with the indirect ophthalmoscope disclosed a choroidal hemorrhage. The wound was immediately closed with sutures, and intravenous mannitol was administered. The hemorrhage remained localized. The red reflex remained unchanged at all times, and there was no prolapse of intraocular contents. A high index of suspicion is critical to the early diagnosis and management of choroidal hemorrhage.

Anterior Chamber Shallowing from the Early Stage of Surgery and Suprachoroidal Effusion during Clear Corneal Small-Incision Cataract Surgery: A Case Report

“…SCE is reported to be caused by a rapid decrease and prominent change in IOP in phacoemulsification of lens nucleus and cortex removal [ 6 ]. Such large fluctuations can occur, especially when the wound does not self-seal and the phacoemulsification or irrigation/aspiration probe is withdrawn from the eye.…”

“…Risk factors for SCE include systemic factors, such as aging, hypertension, coughing, and arteriosclerosis; local ocular factors, such as glaucoma, long axial length, and short axial length (microphthalmia and nanophthalmia) [ 7 ]; and intraoperative factors, such as rapid decrease in IOP and coughing [ 6 , 8 , 9 ]. Our patient had glaucoma; however, the IOP on the day before the surgery was controlled to 12 mm Hg with the instillation of three eye drops and oral acetazolamide, with normal axial length and deep anterior chamber.…”

Topical and Intracameral Anaesthesia for Cataract Surgery

“…Topical anaesthesia has not been associated with a higher complication rate in published studies, but complications can nevertheless occur, as with peribulbar anaesthesia, and have to be managed safely and efficiently. Even suprachoroidal haemorrhages have been reported [10]. Posterior capsule rupture and anterior vitrectomy typically cause little or no additional pain.…”

When do you go back to the OR? A case of delayed IOL repositioning after suprachoroidal hemorrhage

“…Two previous reports of secondary surgery for IOL implantation after 4À17 weeks and cortex aspiration after 26 days all had good visual outcomes (20/20 to 20/30). 10,11 On the other hand, Bozkurt and Miller report a case of IOL optic prolapse out of the capsular bag as a complication of intraoperative SCH, which was managed with IOL repositioning only 1 hour after the initial surgery. 9 Final visual acuity was 20/25.…”