Suprachoroidal hemorrhage after micropulse cyclophotocoagulation diode therapy

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Complications

Background:

• Primary open-angle glaucoma (POAG) management often involves advanced therapies for refractory cases.
• Micropulse cyclophotocoagulation (MPCPC) is increasingly utilized for its perceived safety profile in glaucoma treatment.
• Patients with significant comorbidities, such as coronary artery disease on anticoagulation, present unique management challenges.

Observation:

• A 77-year-old male with end-stage POAG developed severe eye pain two weeks post-MPCPC.
• Ocular examination revealed elevated intraocular pressure (IOP) of 44 mmHg and a shallow anterior chamber.
• Fundus examination and ultrasound confirmed large, dome-shaped hemorrhagic choroidals indicative of suprachoroidal hemorrhage (SCH).

Findings:

• The patient was managed medically with IOP-lowering medications, analgesics, cycloplegics, and topical steroids.
• Serial ultrasound confirmed a decrease in SCH size without surgical intervention.
• Despite management, visual acuity remained severely impaired (count fingers at 2 feet).

Implications:

• Suprachoroidal hemorrhage (SCH) is a potential, albeit rare, complication following micropulse cyclophotocoagulation (MPCPC).
• This case underscores the risk of severe complications, including SCH, even with lower-energy cyclophotocoagulation, particularly in patients with risk factors like post-procedural hypotony.
• Emphasis on preventative strategies and careful patient selection is crucial for mitigating risks in high-risk glaucoma patients undergoing MPCPC.