Expulsive choroidal haemorrhage—A clinical and pathological review

Abstract

This paper describes two cases of expulsive choroidal haemorrhage (ECH) where the final corrected visual acuity was 6/5. The management of one case consisted simply of vitrectomy; and the other of suprachoroidal drainage of blood followed by vitrectomy. The pathological findings in a series of eyes enucleated following ECH are also described. The literature is reviewed with regard to the aetiology, pathology and management of ECH.

Acute intraoperative suprachoroidal haemorrhage in ocular surgery

“…Optimum visual outcome following AISH depends on its early recognition, and prompt closure of the wound without incarceration of iris and vitreous. 4,5,9,26,27 If the eye cannot be closed effectively, a posterior sclerotomy to drain suprachoroidal blood is indicated. This opening should be quite posterior and at least 1.5 mm in diameter if the haemorrhage is to be successfully evacuated?8 Post-operative care includes adequate control of lOP and use of a topical antibiotic-corticosteroid preparation.…”

Reply: Anterior chamber cytokine production and postoperative macular edema in patients with diabetes undergoing FLACS

“…Accordingly, the Lanindar (light and nociceptive interaction noting distress and response) test was developed, utilized, and published by Figueira et al 4 The senior author of the letter, Dr Francis experienced and reported 3 cases of incomplete expulsive choroidal hemorrhage in the early days of extracapsular cataract extraction with ALA, all patients fortunately achieving CDVA 20/20 or better at 1 month. 5 The authors suspect that Dr. Osher would agree that having an expulsive choroidal hemorrhage is a defining experience for the surgeon, demanding rapid and definitive intervention, aiming to avoid losing the contents of the eye onto the drapes, let alone the floor of the operating room. These cases could only have been dealt with effectively by highquality intervention by the anesthetist.…”

The TAHITI approach to cataract surgery consent

“…5 We write down the mnemonic and demonstrate the meaning of each letter to the patient. For instance, respiratory arrest from a misdirected retrobulbar injection occurs rarely, as does expulsive choroidal hemorrhage.…”