Choroidal Effusion and Suprachoroidal Hemorrhage during Phacoemulsification: Intraoperative Management to Prevent Expulsive Hemorrhage

Savastano, Alfonso; Rizzo, Stanislao; Savastano, Maria Cristina; Piccirillo, Valerio; Forte, Renato; Sbordone, Sandro; Diurno, Francesco; Savastano, Silvio

doi:10.5301/ejo.5000707

Cited by 18 publications

(25 citation statements)

References 22 publications

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“…Patients are more likely to have pain during second eye surgery, which may be related to higher pre‐operative anxiety . Other intra‐operative factors that influence pain include: choroidal effusion; suprachoroidal haemorrhage; and aqueous misdirection syndrome . Pain during surgery will generally affect patient satisfaction but can usually be controlled with additional measures (e.g.…”

Section: Selection Of Anaesthetic Techniquementioning

confidence: 99%

Peri‐operative considerations for sedation‐analgesia during cataract surgery: a narrative review

et al. 2019

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Summary Cataract surgery is usually of short duration and is associated with minimal pain when employing topical or regional anaesthesia. Patient education regarding the peri‐operative process may help alleviate anxiety and avoid the need for sedation. However, sedation may be required, and we discuss the various options. Many consider that pre‐operative fasting is necessary due to the risk of aspiration but fasting may not be required if minimal sedation is administered. If the use of sedatives, hypnotics or analgesics is required, then their associated adverse events should be considered.

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Section: Selection Of Anaesthetic Techniquementioning

confidence: 99%

Peri‐operative considerations for sedation‐analgesia during cataract surgery: a narrative review

et al. 2019

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“…Uveal effusion is the accumulation of fluid in the suprachoroidal layers, with subsequent choroidal and retinal detachment, and is considered a precursor of suprachoroidal hemorrhage and expulsive hemorrhage [ 1 ]. It is noteworthy that expulsive hemorrhage can result in permanent vision loss.…”

Section: Introductionmentioning

confidence: 99%

Acute uveal effusion during phacoemulsification with preoperative central serous chorioretinopathy: a case report

Chang

Zhou

et al. 2017

BMC Ophthalmol

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BackgroundWe report a case of acute uveal effusion during phacoemulsification in an eye with preoperative chronic central serous chorioretinopathy (CSC).Case presentationA 55-year-old man with a history of chronic CSC for >18 months presented with bilateral opaque lenses. A preoperative ophthalmic examination showed suspected lenticonus and risky anatomical features, including a thick ciliary body, and anterior rotation of the ciliary process and iris root in both eyes. Optical coherence tomography (OCT) detected CSC in the left eye, but the results of fundus photography and B-scan ultrasonography were unremarkable. The anterior chamber flattened during phacoemulsification. Anterior vitrectomy was quickly performed for suspected infusion misdirection syndrome, and was followed by uneventful surgery. On postoperative day 1, fundus photography, type B ultrasound, and OCT revealed uveal exudation in the macula of the left eye. On postoperative day 50, the patient’s visual acuity recovered to 20/32, and fundus photography, ultrasonography, and OCT revealed complete resolution of the uveal effusion.ConclusionsThis case suggests an association between preoperative CSC and uveal effusion during surgery, because choroidal hyperperfusion and hyperpermeability were present in the patient’s CSC-affected eyes.

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“…Early recognition of intraoperative suprachoroidal haemorrhage also plays an important role, allowing appropriate countermeasures to be initiated and possibly preventing the development of extensive haemorrhage. Some authors recommend immediate anti-Trendelenburg positioning of the patient combined with lowering of the blood pressure with medication, anxiolysis and intravenous mannitol infusion [40].…”

Section: Surgical Treatment Of Suprachoroidal Haemorrhagementioning

confidence: 99%

“…Eine wichtige Rolle spielt auch das frühzeitige Erkennen einer intraoperativen Suprachorioidalblutung, wodurch entsprechende Gegenmaßnahmen eingeleitet und das Entstehen ausgedehnter Hämorrhagien möglicherweise verhindert werden kann. Einige Autoren empfehlen hierzu eine umgehende Anti-Trendelenburg-Lagerung des Patienten in Kombination mit einer medikamentösen Senkung des Blutdrucks, Anxiolyse und intravenöser Mannitolinfusion [40].…”

Section: Chirurgische Therapie Bei Suprachorioidalblutungunclassified

Surgical Management of Choroidal Diseases

Hattenbach

Bopp

Strobel

et al. 2021

Klin Monbl Augenheilkd

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Accumulation of serous fluid in the suprachoroidal space, known as uveal effusion, and choroidal or suprachoroidal haemorrhage (SCH) following rupture of ciliary blood vessels are considered rare, but serious, events with extremely poor functional prognosis. As a result, uveal effusion, and expulsive suprachoroidal haemorrhage in particular, continue to be considered as more or less fatal complications. However, clinical experience demonstrates that both clinical entities can be managed by conservative as well as surgical strategies, depending on their severity and localisation, with sometimes surprisingly favourable visual outcome. In addition to prognostic factors, timely recognition and prompt, if possible preventive, acute care, as well as carefully considered timing of adequate surgical measures taking advantage of the specific characteristics of the choroidal tissue, are crucial to treatment success. Along with technical advances in the field of vitreoretinal surgery, numerous variants of therapeutic approaches to the treatment of choroidal effusion and suprachoroidal haemorrhage have been proposed to date. This review presents some of the most important surgical techniques and strategies in the field.

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Choroidal Effusion and Suprachoroidal Hemorrhage during Phacoemulsification: Intraoperative Management to Prevent Expulsive Hemorrhage

Abstract: Choroidal effusion or SCH can be intraoperatively managed to avoid expulsive hemorrhage and maintain the possibility of completing the surgery.

Cited by 18 publications

References 22 publications

Peri‐operative considerations for sedation‐analgesia during cataract surgery: a narrative review

Peri‐operative considerations for sedation‐analgesia during cataract surgery: a narrative review

Acute uveal effusion during phacoemulsification with preoperative central serous chorioretinopathy: a case report

Surgical Management of Choroidal Diseases

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