Every intraocular surgery carries risk of a serious complication. One of the most worrisome is an intraoperative suprachoroidal hemorrhage. For a variety of reasons, especially hypotony, these hemorrhages occur more frequently in glaucoma patients, may develop at any time during the perioperative period, and may cause considerable visual loss. When a severe choroidal hemorrhage does occur, it can be visually devastating and may be very painful. A large perioperative choroidal effusion is also worrisome because it may be the initiating factor that precipitates a choroidal hemorrhage. Even after a “simple bleb needling” or postoperative suture lysis for uncontrolled intraocular pressure (IOP), a suprachoroidal hemorrhage may develop, leading to catastrophic visual loss. In spite of best efforts, choroidal events will still occur and should be managed in a highly expeditious fashion. Proper prevention and management of a choroidal event is the best chance for saving vision. An intraoperative choroidal event is typically a spontaneous collection of either fluid and/or blood in the suprachoroidal space. This potential space is located between the choroid and the sclera. The fluid within a chronic choroidal effusion typically has a straw color due to the accumulation of proteins. Choroidal events are most common following glaucoma surgery, and choroidal hemorrhage or effusion may lead to complicated surgery with resulting visual loss. A spontaneous intraoperative choroidal effusion may initiate a shallow anterior chamber and a firm eye. The mechanisms are complex and variable. A spontaneous collection of blood into the suprachoroidal space may occur when the IOP is low, as seen during filtration surgery. Severe bleeding that breaks through into the vitreous is typically associated with a poor prognosis, as are bleeds that reach the optic nerve head. These eyes commonly end up with a pale optic disc and poor visual function. Every attempt is made to avoid these situations (see Table 6.1); nevertheless, the surgeon must remain calm during such an event and immediately close the eye to minimize visual harm.
Pseudomelanoma: Spontaneous Myopic Choroidal Hemorrhage
