A Case of Suprachoroidal Hemorrhage during Cataract Surgery- a Rare Complication

Abstract

A 58 year old female was planned for right eye small incision cataract surgery with corrected distance visual acuities of 6/18 and an intraocular pressure of 16mmHg in both eyes. However, during surgery, iris prolapse was noted, reposition attempted but not achieved due to large wound and deep scleral entry. Posterior chamber intraocular lens implantation was attempted when anterior chamber shallowing with intraocular pressure rise was noted. Persistent positive pressure was noted with vitreous in the wound. Posterior chamber intraocular lens was removed immediately. Before vitrectomy could be attempted, a dark mound was noted superonasally suspicious of suprachoroidal hemorrhage. Immediately, intravenous mannitol injection was given to lower the intraocular pressure and the wound was closed rapidly with Ethilon 10-0 sutures and the eye was left aphakic. The postoperative treatment regimen of intravenous dexamethasone 6mg three times a day, topical prednisolone hourly, moxifloxacin eye drops four times a day, timolol two times a day, brimonidine with brinzolamide eye drops two times a day, homide at night, oral acetazolamide two times a day and oral prednisolone 40 mg was commenced. 20 days postoperative USG B scan showed suprachoroidal hemorrhage (kissing choroids) with suspected choroidal and retinal detachment. 40 days postoperatively, choroidal drainage with pars plana vitrectomy was planned for the patient. Since there was an improvement in the vision and the suprachoroidal hemorrhage had reduced, the patient was continued on oral steroids and other topical medications as before. This study shows that with rapid diagnosis and intraoperative management and accurate postoperative intervention, it is possible to achieve good visual acuity after suprachoroidal hemorrhage.