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First Author: L.Langsaeter UK
Co Author(s): S. Nadarajah
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To report the visual outcome in a patient who underwent early controlled drainage of massive suprachoroidal haemorrhage occurring during cataract surgery.
RL, an 82 year old male with hypertension, diabetes, hypercholesterolaemia and primary open angle glaucoma was listed for a left cataract surgery in December 2012. His preoperative vision was 6/9 right eye and 6/60 left eye. He developed a suprachoroidal haemorrhage during routine phacoemulsification done under topical anaesthesia carried out on 2nd December 2012. The operation was abandoned and the patient started on oral Acetazolamide. Day one post operatively, the patient was noted to have a massive suprachoroidal haemorrhage involving the macula. (Bscan attached) Drainage of the suprachoroidal haemorrhage was carried out on the same day under local anaesthesia.
Intraoperatively, two full thickness triangular scleral flaps were created in the inferotemporal and inferonasal quadrants around the equator of the eye. Partial drainage of the haemorrhage was carried out intra operatively. The flaps were left unsutured but covered with conjunctiva which was closed with 7 `0` Vicryl suture. Approximately 0.3ml of 100% perfluropropane gas was injected into the vitreous cavity to facilitate further drainage of the haemorrhage post operatively. The suprachoroidal haemorrhage continued to drain over the next few days. The patient developed pupilllary block glaucoma four weeks after surgery. Laser iridotomy was performed and the patient scheduled for further surgery the following week. An anterior vitrectomy and anterior chamber lens implant was carried out on 8th January 2013. On follow up on 17th January 2013 the left vision improved to 6/18.The intraocular pressure however remained high at 36mmHg. The patient was advised to continue the Latanoprost eyedrops and Brimonidine was started.
The patients left vision improved from hand movement post massive suprachoroidal haemorrhage to 6/12 when he was last seen on the 14th of March 2013. Intraocular pressures were maintained at 20 mmHg in both eyes with Latanoprost and Brimonidine. (Photographs of fundus and anterior chamber lens attached).
Early drainage of massive suprachoroidal haemorrhage did lead to excellent visual outcome. This can be facilitated with the use of an expanding perfluropropane gas bubble. The expanding gas bubble helps maintain a positive pressure and therefore facilitate continuous drainage of the blood clot as it lyses. Early drainage leads to early restoration of anatomic structures, which may explain the excellent visual outcome.