Keywords :
Case report, Delayed suprachoroidal hemorrhage, Early drainage, Hypotony, Trabeculectomy, Trocar
Citation Information :
Beri N, Verma S, Bukke AN, Une S, Agarwal A, Dada T. Early Drainage of Suprachoroidal Hemorrhage Combined with Surgical Correction of Hypotony after Trabeculectomy. J Curr Glaucoma Pract 2024; 18 (1):23-27.
Aims and background: Delayed suprachoroidal hemorrhage (DSCH) is a vision-threatening complication of intraocular surgeries with a higher prevalence in postglaucoma filtering surgeries. Through these case series of trabeculectomy complicated with DSCH, we aim to emphasize that correction of hypotony (inciting factor) is fundamental for complete resolution and prevention of recurrence.
Case description: All three glaucoma patients underwent trabeculectomy surgery followed by DSCH on postoperative day 1. Drainage of DSCH using a 23 gauge trocar cannula within 48 hours of onset was performed along with exploration for the cause of hypotony. All three patients had satisfactory visual and anatomical outcomes.
Conclusion: Early drainage using 23 gauge trocar cannulas gives good results in DSCH. The cause of hypotony must simultaneously be corrected during the drainage of DSCH. Preventive measures against hypotony should be taken while doing glaucoma filtering surgery.
Clinical significance: Surgical exploration for the cause of hypotony must simultaneously be performed during drainage of DSCH. Primary preventive measures against hypotony and bleeding during glaucoma filtering surgeries, like the use of releasable sutures, viscoelastic in the anterior chamber, and discontinuation of anticoagulants, can be done. Early drainage using trocar cannulas gives satisfactory results in DSCH postglaucoma surgeries.
Mantopoulos D, Hariprasad SM, Fine HF. Suprachoroidal hemorrhage: risk factors and diagnostic and treatment options. Ophthalmic Surg Lasers Imaging Retina 2019;50(11):670–674. DOI: 10.3928/23258160-20191031-01
Tuli SS, WuDunn D, Ciulla TA, et al. Delayed suprachoroidal hemorrhage after glaucoma filtration procedures. Ophthalmology 2001;108(10):1808–1811. DOI: 10.1016/s0161-6420(01)00763-1
Learned D, Eliott D. Management of delayed suprachoroidal hemorrhage after glaucoma surgery. Semin Ophthalmol 2018;33(1):59–63. DOI: 10.1080/08820538.2017.1353814
Wolter JR, Garfinkel RA. Ciliochoroidal effusion as precursor of suprachoroidal hemorrhage: a pathologic study. Ophthalmic Surg 1988;19(5):344–349. DOI: 10.3928/1542-8877-19880501-11
Rossi T, Boccassini B, Iossa M, et al. Choroidal hemorrhage drainage through 23-gauge vitrectomy cannulas. Retina 2010;30(1):174–176. DOI: 10.1097/IAE.0b013e3181bdfa5e
Rezende FA, Kickinger MC, Li G, et al. Transconjunctival drainage of serous and hemorrhagic choroidal detachment. Retina 2012;32(2):242–249. DOI: 10.1097/IAE.0b013e31821c4087
Pakravan M, Yazdani S, Afroozifar M, et al. An alternative approach for management of delayed suprachoroidal hemorrhage after glaucoma procedures. J Glaucoma 2014;23(1):37–40. DOI: 10.1097/IJG.0b013e31825afb25
Abrams GW, Thomas MA, Williams GA, et al. Management of postoperative suprachoroidal hemorrhage with continuous-infusion air pump. Arch Ophthalmol 1986;104(10):1455–1458. DOI: 10.1001/archopht.1986.01050220049024
Meier P, Wiedemann P. Massive suprachoroidal hemorrhage: secondary treatment and outcome. Graefes Arch Clin Exp Ophthalmol 2000;238(1):28–32. DOI: 10.1007/s004170050005
Cobb CJ, Chakrabarti S, Chadha V, et al. The effect of aspirin and warfarin therapy in trabeculectomy. Eye (Lond) 2007;21(5):598–603. DOI: 10.1038/sj.eye.6702277
Beyer CF, Peyman GA, Hill JM. Expulsive choroidal hemorrhage in rabbits. A histopathologic study. Arch Ophthalmol 1989;107(11):1648–1653. DOI: 10.1001/archopht.1989.01070020726036
Weinberg DV, Rosenberg LI. Retina to retina adhesions following suprachoroidal haemorrhage. Br J Ophthalmol 1996;80(7):674. DOI: 10.1136/bjo.80.7.674
Jin W, Xing Y, Xu Y, et al. Management of delayed suprachoriodal haemorrhage after intraocular surgery and trauma. Graefes Arch Clin Exp Ophthalmol 2014;252(8):1189–1193. DOI: 10.1007/s00417-013-2550-x
Boral SK, Agarwal D. Modified posterior drainage of post-operative suprachoroidal hemorrhage. Indian J Ophthalmol 2021;69(12):3584–3590. DOI: 10.4103/ijo.IJO_3533_20