Histopathology of acute intraoperative suprachoroidal hemorrhage associated with transscleral intraocular lens fixation

An 83-year-old hypertensive female had penetrating keratoplasty with insertion of a transsclerally fixated posterior chamber intraocular lens for pseudophakic corneal edema associated with a closed-loop, semiflexible anterior chamber intraocular lens. An acute intraoperative suprachoroidal hemorrhage developed five minutes after passage of the transscleral sutures. The eye became blind and painful and was enucleated three weeks later. Histopathologic examination showed an idiopathic suprachoroidal hemorrhage with no evidence of disruption of the ciliary body vasculature. Acute intraocular hemorrhage resulting from a needle pass through the highly vascularized ciliary body has been a greatly feared, though as yet unreported, complication of this procedure. Damage to the anterior uveal circulation was not implicated as a cause of the hemorrhage in this case.