Can The Flip Technique Be A Risk Factor For Suprachoroidal Hemorrhage (Sch) During Phacoemulsification?

To demonstrate a case of timely detection and successful management of SCH during phacoemulsification using the flip technique in a non-risk patient.

Opthalmological Center “Vistamet”, Povazska Bystrica, Slovakia

A 57 y.o. female without any comorbidities or therapy underwent uneventful cataract surgery under topical anesthesia (TA) using the stop&chop technique (nucleus gr 3). A week later, phacoemulsification was performed on the other eye under TA by the same experienced surgeon using the same phaco machine (Centurion, Alcon) & the same IOL. Considering relatively soft (gr 2) though big nucleus, the flip technique was used. After the nucleus removal and extraction of the phaco tip from the eye, the patient felt a sharp pain, the eye hardened, the anterior chamber (AC) decreased promptly, but the reflex remained red.The patient’s blood pressure (BP) at this time was 140/80. Anticipating acute local SCH, dispersive viscoelastic was injected into the AC, and the operation was suspended. OCT revealed macular folds and a paracentral dome-shaped retinal-choroidal elevation. The patient was given mannitol i.v. After 1 and 2 hours, AC puncture was performed through operative paracentesis. After 3.5 hours, when IOP was 24 mm Hg and BP was 130/70, the operation was completed with cortical mass removal, IOL implantation, incision hydration, AB injection into the AC, and subconjunctival betamethasone injection. On the 2nd day the operated eye was calm, NCDVA=0.6, IOP 25 mmHg, B-scan US revealed grade I SCH in the superior temporal quadrant. At 2 weeks postop NCDVA=0.9, IOP=22, at 1 month NCDVA=1.0, IOP=17, with preservation of minimal folds in the macular region and gradual resorption of SCH.

In patients without concomitant general and ocular pathology phacoemulsification of a soft but large nucleus using flip technique, which involves a sharp change in anatomical relationships in the eye and, as a result, a sharp change in hydrodynamics in it, may be a risk factor for the occurrence of SCH.