Vitreous management in massive suprachoroidal hemorrhage

To establish whether total vitrectomy with posterior hyaloid removal and choroidal hemorrhage drainage posterior sclerotomies improved the outcome of eyes with massive postoperative suprachoroidal hemorrhage (kissing choroidals).

We reviewed the medical records of five patients with massive suprachoroidal hemorrhage (MSCH) who had received the same medical and surgical management.

Three eyes had MSCH secondary to surgery of the anterior segment and two after ocular trauma. All had hemorrhagic choroidal detachment with retinal apposition, producing vitreous changes and adherence of the "kissing" retina. Surgery was delayed one to three weeks to allow liquefaction of the blood clot. All eyes had complete ocular evaluation including ultrasound, and were treated with steroids before surgical treatment. The procedure consisted of anterior chamber fluid infusion, posterior drainage sclerotomies, and primary total pars plana vitrectomy with posterior hyaloid removal. Mean follow-up was 9.4 months. Visual acuity after surgery improved in all eyes from light perception to 20/60. One patient without light perception improved to 20/200.

Total vitrectomy may be indicated in selected cases with MSCH. The successful outcome of these patients comes from the combination of vitrectomy and external drainage.