EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1291013
I MY WORST COMPLICATION N FOCUS 56 | EYEWORLD | OCTOBER 2020 vision. Worse outcomes are associated with eyes that have vitreous hemorrhage, hemorrhage behind the macula, and recurrent suprachoroi- dal hemorrhage. In these situations, one should consult a retina surgeon, they said. Case of a massive suprachoroidal hemorrhage One of the worst complications Christina Weng, MD, MBA, has ever managed happened in an 86-year-old monocular female who suf- fered a fall 3 days after her fourth penetrating keratoplasty (PK) surgery (done by an anterior segment colleague) that developed a massive suprachoroidal hemorrhage. She had previously lost right eye vision (no light perception) from congenital syphilis, and her left eye had already undergone the following surgeries: tube shunt, cataract surgery, four PKs, and a tarsorrhaphy for exposure keratopathy. The patient had hypertension, diabetes mellitus, and coronary artery disease status post-four heart surgeries, Dr. Weng said. She took multiple medications, including a full-dose aspirin daily. In other words, she had nearly all the risk factors for developing a suprachoroidal hemorrhage. In general, risk factors for suprachoroidal hemorrhage include: 1. Older age 2. Multiple ocular comorbidities 3. Recent intraocular surgery 4. Hypertension or other vasculopathy 5. Blood thinner use 6. Trauma 7. High myopia Three days after the patient's fourth, un- complicated PK, she suffered a fall. While she did not lose consciousness, she immediately had nausea and 10/10 eye pain in her left eye. Upon presenting to the emergency room, she was found to be systemically stable but had a decreased visual acuity of hand motion and an intraocular pressure of 85 mm Hg. Ocular exam revealed her iris and other ocular contents expulsed through her cornea host-graft junction, a completely flat anterior chamber, and no view of the posterior segment. B-scan ultrasonography revealed a diffuse su- prachoroidal hemorrhage. continued from page 55 Suprachoroidal hemorrhage on B-scan ultrasonography of left eye in a patient who fell in the immediate postop period following a penetrating keratoplasty Postoperatively, choroidals have nearly resolved, IOP normalized, and patient's visual acuity returned to baseline. Source (all): Christina Weng, MD, MBA