Postoperative suprachoroidal hemorrhage following filtration procedures

We reviewed the charts of 500 patients who underwent filtration procedures and found ten patients who developed postoperative suprachoroidal hemorrhage (PSCH) following surgery. The incidence (2% overall) is especially high in those patients who were aphakic (6.6%) or who had high myopia (10%). Nine patients developed PSCH within the first four postoperative days. Pain, nausea, and vomiting were common presenting symptoms of PSCH although not invariably present. Postoperative suprachoroidal hemorrhage is related to prolonged hypotonia and inflammation; prevention centers on proper case selection and on avoiding a precipitous rise in postoperative intravascular pressure. Initial treatment consisted of anterior chamber reformation and drainage of suprachoroidal blood, often followed by vitrectomy and scleral buckling procedures. Four eyes (40%) obtained final visual acuities of 20/200 or better, four (40%) were reduced to counting fingers or hand motions, and two (20%) lost all light perception.