Risk Factors and Treatments of Suprachoroidal Hemorrhage

Abstract

Suprachoroidal hemorrhage (SCH) is a rare but serious sight-threatening complication of inner eye surgery. Despite continuous advances in treatment, visual prognosis remains poor. The disease has a more typical clinical presentation, the etiology and pathogenesis are not well defined, and intraoperative ocular and systemic factors may induce fulminant SCH. To investigate risk factors and treatments of SCH-associated intraocular surgeries, summarize diagnosis, characteristics, management, and prevention of SCH developed during and after intraocular surgeries. A retrospective study of SCH occurred in six cases of intraocular surgeries including cataract, glaucoma, pars plana vitrectomy (PPV), and silicone oil removal surgery. Assess baseline systemic and ocular characteristics of SCH eyes. Analyze the second surgery timing and technique, and visual outcomes were measured. SCH occurred in six patients including five eyes during surgeries and one eye after the surgery. Three eyes that underwent cataract surgery had hard nucleuses (nuclear sclerotic 4+). One eye was due to hypotony during the vitrectomy procedure. One eye developed SCH when silicone oil was extracted from the eyeball. One eye developed delayed SCH after glaucoma surgery. Incision closure and anterior chamber deepening were performed. B-scan ultrasonography was used to diagnose SCH, and determine the timing and location of sclerotomy for the second surgery. Vitrectomy and sclerotomy were performed in five eyes. The median follow-up time was six months. The final best-corrected visual acuity (BCVA) was 0.3 in one eye, one eye had light perception with retinal adherence, and four eyes had no light perception with retinal detachment. The results showed that risk factors including advanced age, hypertension, taking anticoagulants, antiplatelet drugs, and cardiovascular drugs were systemic risk factors, and hard nucleus (nuclear sclerosis 4 +) cataract, long-term uncontrolled ocular hypertension glaucoma, vitrectomy, silicone oil removal, high myopia, aphakia, previous intraocular surgery, intraocular pressure during surgery, and others were ocular risk factors. The most important risk factor is a sudden drop in intraocular pressure during or after surgery. The outcome of visual acuity depends on retinal status. Because of the poor prognosis, the prevention of SCH is of utmost importance during intraocular surgery.

Ocular Vascular Events following COVID-19 Vaccines: A Systematic Review

“…This was also true when comparing ischemic optic neuropathy versus optic neuritis in patients that developed optic neuropathy after COVID-19 vaccination [61]. Ocular hemorrhagic events were also specifically linked to advanced age [66], which is the case in our population. Older patients (74.2 ± 9.11) had a higher incidence of hemorrhagic vascular complications.…”

Management of Suprachoroidal Hemorrhage during Phacoemulsification: A Comprehensive Review

“…As cataract surgery is widely accepted as an elective procedure, several authors have suggested that adopting certain preventive measures that may be performed before, during, or after surgery could avoid the occurrence of SCH [ 1 , 5 , 13 ].…”

“…First of all, patients recommended for cataract surgery, especially when considered to be high-risk cases, should be thoroughly evaluated in advance, paying particular attention to both systemic and ocular risk factors for SCH [ 1 , 5 , 13 ]. In this regard, a comprehensive examination should be undertaken, looking for cardiovascular disease, liver failure, coagulation abnormalities, and the use of cardiovascular medication [ 5 ].…”

“…Moreover, although not specifically addressed in the literature of phacoemulsification-related SCH, risk factors identified for glaucoma and vitrectomy-related SCH such as anticoagulant therapies should be taken into consideration as well. The bleeding risk should be assessed before the surgery through a complete blood count and coagulation panels; blood values with an emphasis on INR levels should be studied and stabilized before the procedure [ 1 , 13 ]. Finally, ocular risk factors, including high myopia and a history of glaucoma or IOP increase, should be documented and treated accordingly [ 1 , 5 ].…”

“…Suprachoroidal hemorrhage (SCH)—namely, a hemorrhage involving the suprachoroidal space—is a rare but severe complication reported in association with several intraocular surgeries, including glaucoma filtration procedures, pars plana vitrectomy (PPV), keratoplasty, and cataract surgery [ 1 , 2 , 3 , 4 ]. It is thought to be related to acute changes in intraocular pressure (IOP), either during surgery (acute SCH) or postoperatively (delayed SCH), causing the rupture of the ciliary arteries or smaller vessels and the subsequent accumulation of blood in the suprachoroidal space [ 5 , 6 ].…”