Suprachoroidal hemorrhage associated with cataract surgery: A case series analysis

This study aimed to identify risk factors, evaluate management strategies, and assess visual outcomes of suprachoroidal hemorrhage during cataract surgery through a retrospective analysis of five clinical cases and a literature review. We analyzed five cases of suprachoroidal hemorrhage occurring during phacoemulsification cataract surgery with intraocular lens implantation or intrascleral fixation of intraocular lens haptics at our institution (January 2013-September 2024). Among 48,725 cataract surgeries, five cases of suprachoroidal hemorrhage were identified (incidence: 0.01%). Key risk factors included preoperative angle-closure glaucoma (two cases), prior cataract surgery with vitrectomy (two cases), and advanced age (one case, mid-70s). Intraoperative suprachoroidal hemorrhage occurred in two cases (one with posterior capsular rupture), whereas the condition developed postoperatively in three cases. Management strategies comprised pars plana vitrectomy with scleral drainage (three cases), vitrectomy combined with intravitreal triamcinolone injection (one case), and conservative treatment (one case). The mean preoperative visual acuity improved significantly from 2.22 LogMAR to 0.6 LogMAR at the final follow-up (P = 0.007). These findings suggest that, in addition to the previously reported major risk factors for suprachoroidal hemorrhage, such as advanced age, glaucoma, and multiple surgeries, secondary intraocular lens implantation is a major risk factor. Comprehensive preoperative evaluation and meticulous control of intraoperative intraocular pressure fluctuations are essential to mitigate suprachoroidal hemorrhage risks and optimize surgical outcomes.