1. In the name of God

2. Suprachoroidal Hemorrhage
Farid Daneshgar M.D
Associate professor
K.U.M.S

3. A hemorrhage in the suprachoroidal space that occurs spontaneously, intraoperatively, or traumatically, or is associated with intraocular vascular anomalies.

4. One or more dome-shaped choroidal protrusions.
Forward movement of the iris, lens, and vitreous body.
Elevated intraocular pressure.

6. Choroidal hemorrhage occurs in :
3% of ICCE,
2.2% of nucleus-expression ECCE,
0.04% of phaco-surgery and
0.73% of glaucoma filtering procedures.

7. Causes of SCH
Impeding vortex vein outflow. (retrobulbar hemorrhage, retrobulbar anesthesia, pressure during surgery, scleral buckle)
Fluctuations in intraocular fluid dynamics and pressure. (sudden compression and decompression events)
Hypotony (leads to choriocapillaris effusion and stretching of suprachoroidal space, tension on and rupture of posterior ciliary vessels).

8. Differential diagnosis
Choroidal effusion
Retinal detachment
Melanoma or metastatic tumor of choroid or ciliary body

9. Serous choroidal detachment Hemorrhagic choroidal detachment
low IOP
transilluminates
usually no pain
usually pre equatorial
resolution within three weeks
resorbs without change in visual aquity
high IOP
no transillumination
almost always painful
may be more voluminous posteriorly
liquifies in 6_26 days and resorbs in 1 to several months
usually results in vision loss

10. Risk factors
Systemic:
Advanced age, arteriosclerosis, DM, HTN, anticoagulation,
ischemic heart disease
Ocular:
Previous laser photocoagulation, ocular surgery (PPV), aphakia
glaucoma,uveitis, high myopia, recent trauma
Intraoperative:
High IOP, open sky procedures, valsalva maneuvers,
intraoperative tachycardia, sudden drop in IOP, vitreous loss
Post Op:
Postoperative trauma, ocular hypotony,

11. Intraoperative signs and symptoms
sudden unset of sever intraoperative pain
excessive iris movement and iris prolapse
forward movement of lens and vitreous body
darkening / loss of red reflex
excessive bleeding of conjunctiva and episclera
vitreous hemorrhage
tachycardia
retinal detachment
choroidal elevation protruding into operative field
expulsion of intraocular content

12. Management of intraoperative massive suprachoroidal hemorrhage
Rapid wound closure (prevents loss of intraocular contents and incarceration)
reform anterior chamber with viscoelastic
After PK consider the use of temporary keratoprosthesis
Posterior sclerotomy only if necessary to allow for wound closure (reduces tamponading effect of sealing the eye and may result in larger SCH)
Post op: control IOP, inflamation and pain

13. When to operate on SCH Lens-cornea touch kissing choroidals
massive choroidal hemorrhage with sever pain
persistently elevated IOP
persistently flat AC
SCH under macula
extension of hemorrhage into subretinal space or vitreous cavity
significant vitreous incarceration
retinal incarceration

15. Course and outcome Good prognosis more likely in:
delayed, limited hemorrhage especially > 7 days after inciting surgery
SCH resulting from cataract surgery
higher visual aquity just after SCH
poor prognosis more likely if:
retinal detachment hemorrhage in 4 quadrants
extension into posterior pole
vitreous and/or retinal incarceration
low visual aquity just after SCH

16. THANKS