Spontaneous suprachoroidal hemorrhage: Case report and review of the literature

Abstract

We present the clinical course, management, and final outcome of spontaneous suprachoroidal hemorrhage (SSCH) in an age-related macular degeneration (AMD) patient—a 64-year-old male receiving antiplatelet therapy who developed SSCH during the Valsalva maneuver. In addition to our case study, we discuss the results of a systemic review of the literature and reference lists of retrieved studies published from January 2001 to December 2013. Among a total of 31 patients (32 eyes), acute secondary glaucoma was a complication in 87.5% of the cases, and over half of the cases (20 eyes, 62.5%) received surgery. Twenty cases (64.5%) were characterized by systemic hypertension (HTN), followed by cardiovascular or cerebral vascular disease in 17 cases (54.8%). The Valsalva maneuver was performed in five cases (16.1%) prior to the episode. Twenty-three cases (74.2%) had abnormal hemostasis, including use of anticoagulants or thrombolytic agents (18 cases), chronic renal failure (CRF, 5 cases), and blood dyscrasia (3 cases). AMD was the most common (17 eyes of 16 patients, 53.1%) ocular disease. Visual acuity was classified as hand motion (HM) or worse in 20 eyes (of 28 eyes, 71.4%) at initial presentation and in 24 eyes (of 30 eyes, 80%) upon final examination. Anticoagulated patients with AMD should be informed of the risk of intraocular hemorrhage. Medical therapy usually fails in the treatment of glaucoma. Surgical intervention provides an option for the purpose of pain relief. Even so, the final visual prognosis is usually poor.

Sub-Tenon’s urokinase injection-assisted vitrectomy in early treatment of suprachoroidal hemorrhage: Four cases report

“…Local or systemic application of corticosteroids to reduce intraocular inflammation, and the use of carbonic anhydrase inhibitors, sedatives, etc ., can be applied according to systemic conditions. Surgical treatment should be taken in the cases with a large amount of bleeding in the suprachoroidal space, especially the generation of kiss signs, difficult to control high IOP, persistent pain, and patients with other vitreoretinal complications (such as a large amount of vitreous hemorrhage, retinal detachment, or retinal incarceration)[18,19].…”

Suprachoroidal Hemorrhage with Delayed Rebleeding as the First Presentation of Bullous Pemphigoid Associated Acquired Hemophilia

“…The risk factors for spontaneous SCH are almost identical to postoperative SCH, with the exception of anti-coagulant use. A meta-analysis showed that abnormal coagulopathy and the use of anti-coagulants were both major risk factors in spontaneous SCH in patients aged over 60, associated with 82.6% and 69.6% of the cases respectively [32]. With regards to use of warfarin, spontaneous SCH can occur when the INR is within or over therapeutic range [33,34].…”

Spontaneous suprachoroidal haemorrhage with exudative retinal detachment in pregnancy-induced hypertension

“…Spontaneous suprachoroidal haemorrhage (SSCH) is a rare entity and has been known to be associated with anticoagulation therapies (including warfarin, aspirin, clopidogrel, heparin), thrombolytic drugs (streptokinase, tissue plasminogen activator), blood dyscrasias, haemodialysis and Valsalva manoeuvre 2. Systemic predispositions include hypertension, atherosclerosis, cerebrovascular attack, coronary artery disease, diabetes mellitus, chronic renal failure, hepatic failure and disseminated intravascular coagulation 2.…”

“…Systemic predispositions include hypertension, atherosclerosis, cerebrovascular attack, coronary artery disease, diabetes mellitus, chronic renal failure, hepatic failure and disseminated intravascular coagulation 2. Ocular associations are age-related macular degeneration, glaucoma, high myopia and proliferative diabetic retinopathy 2. Hypertension alone has been reported to cause SSCH with secondary angle closure glaucoma 3.…”