Case Report: Suprachoroidal Hemorrhage after Chiropractic Manipulation of the Neck.

SIGNIFICANCE: The case report highlights the possible complications of undergoing neck manipulation within a critical time period after intravitreal injection. PURPOSE: This study aimed to describe a case of traumatic hemorrhagic choroidal detachment after cervical manipulation during a chiropractic treatment session. CASE REPORT: A 43-year-old male patient with a history of complex rhegmatogenous retinal detachment repair and recurrent cystoid macular edema presented with decreased vision and sudden pain in the right eye after chiropractic manipulation of the neck, status post-intravitreal injection of triamcinolone, which was performed earlier that day. Vision in the right eye was hand motion and 20/20 in the left eye. IOPs were 8 and 11 mmHg, respectively. Slit lamp examination of the right eye revealed blood-tinged steroid residues in the anterior chamber. There was no view to the posterior pole. Ultrasonography showed a lobulated mass with heterogeneous echogenicity consistent with a large hemorrhagic choroidal detachment. No central kissing was observed. Left eye examination was unremarkable. CONCLUSIONS: With the increasing use of complementary and alternative medicine, a better understanding of potential complications to raise awareness is becoming essential.

Risk factors and outcomes of management of delayed suprachoroidal haemorrhage following Ahmed glaucoma valve implantation in children.

AIMS: To assess the incidence, risk factors and outcomes of management of delayed suprachoroidal haemorrhage (DSCH) in children who had undergone Ahmed glaucoma valve implantation. METHODS: A retrospective case-control study of eyes which developed DSCH in children <18 years of age who underwent surgery between January 2009 and December 2017 with a follow-up of at least 2 months was performed. Nine cases were compared with 27 age, gender and surgeon matched controls who had undergone surgery during this period. RESULTS: The incidence of DSCH was 4.7% (95% CL 1.5% to 7.7%, 9 eyes of 191 children). There were no significant differences between cases and controls in baseline details except for the number of intraocular pressure (IOP) lowering medications (p=0.01) and follow-up period (p=0.001). Risk factors identified on univariate analysis (p≤0.1) were axial length (p=0.02), diagnosis of primary congenital glaucoma (p=0.05), postoperative hypotony (p=0.07) and aphakia (p=0.1). None of them were found to be significant on multivariate analysis. Five eyes, three with retinal apposition and two with retinal detachment, underwent surgical drainage. There were no significant differences in the outcomes of eyes which underwent drainage compared with those which did not. Failures, defined as IOP>18 mm Hg despite use of medications, loss of light perception, phthisis or removal of the implant were more frequent in cases (three eyes, 33.3%) compared with controls (four eyes, 14.8%) (p=0.002). CONCLUSIONS: None of the risk factors analysed in our series proved to be significant. Failures were more common in eyes with choroidal haemorrhage, despite surgical intervention.

Ocular bleeding in an undiagnosed hemophiliac neonate causing irreversible loss of vision: A case report with review of the literature.

INTRODUCTION: Suprachoroidal hemorrhage is an unexpected complication after penetrating keratoplasty during childhood. We report the case of delayed suprachoroidal hemorrhage after penetrating keratoplasty in a neonate as the first manifestation of hemophilia. CASE REPORT: A 4-day-old neonate was referred to our hospital because of bilateral corneal opacities present since birth. A diagnosis of bilateral Peter's anomaly type 2 with right eye corneal perforation was made after examination. Appropriate treatment was commenced, and later, right eye therapeutic penetrating keratoplasty combined with lensectomy, and anterior vitrectomy was performed. This was complicated postoperatively with suprachoroidal hemorrhage and retinal detachment. Conservative management was advised due to poor visual prognosis. Three months later, the patient was found to have high intraocular pressure in the left eye and glaucoma surgery was recommended. Proper hematological investigations before glaucoma surgery in the left eye revealed a low level of factor VIII with normal levels of factor IX and von Willebrand's factor antigen. Therefore, a diagnosis of hemophilia type A was established. CONCLUSION: This case serves as a reminder that the occurrence of suprachoroidal hemorrhage, especially in the absence of other predisposing risk factors, should warrant detailed systemic assessment to exclude underlying bleeding disorders.

Delayed suprachoroidal hemorrhage following Nd:YAG laser goniopuncture: a case report.

PURPOSE: To report a delayed suprachoroidal hemorrhage following Nd:YAG laser goniopuncture (LGP) in an eye with a previous deep sclerectomy. METHODS: Case report. RESULTS: A 75-year-old woman with advanced primary open-angle glaucoma underwent LGP due to unsatisfactory intraocular pressure (IOP) in her left eye, 1 month after undergoing deep sclerectomy in the same eye. Delayed suprachoroidal hemorrhage occurred the day after LGP execution. CONCLUSIONS: Nd:YAG laser goniopuncture is often performed to enhance IOP control following deep sclerectomy. Although LGP is usually effective and safe, severe complications, such as delayed suprachoroidal hemorrhage, may occur after its execution.

Hemorrhagic choroidal detachment after use of anti-glaucomatous eye drops: case report.

Eighty-two-year-old patient with a pacemaker using warfarin due to arrhythmia and having an intraocular lens in the right eye, developed spontaneous hemorrhagic choroidal detachment one day after the use of combined preparation of 0.5% timolol maleate and 0.004% travoprost, due to primary open-angle glaucoma. Hemorrhagic detachment was detected by anterior and posterior segment examination, as well as B-scan ultrasonography. After the detachment, excessive increased intraocular pressure was controlled with oral carbonic anhydrase inhibitor, cycloplegic and steroid therapy. After four months, visual acuity was 20/20 and the intraocular pressure was under control with 0.5% timolol maleate and 1% brinzolamide. Controlled reduction of the intraocular pressure should be considered, particularly in older patients under anticoagulant therapy and that had undergone prior ocular surgery.

Angle-closure glaucoma due to suprachoroidal hemorrhage secondary to disseminated intravascular coagulation.

Secondary AACG can be associated with intumescent lens, choroidal melanoma, and aqueous misdirection. Here, we would like to report a unique case of acute angle-closure glaucoma secondary to suprachoroidal hemorrhage, resulting from disseminated intravascular coagulation, not previously reported.

[Spontaneous subretinal isolated hematomas or associated with macular degeneration: a retrospective review of 95 cases]. / Diagnostic des hématomes sous-rétiniens spontanés isolés ou associés à une dégénérescence maculaire liée à l'âge. Etude rétrospective de 95 cas.

INTRODUCTION: Diagnosis of choroidal hematoma, either spontaneous or associated with age-related macular degeneration, is clinical. In some cases of expansive or posterior lesion, hematoma may be misdiagnosed as a tumor. MRI and color Doppler imaging (CDI) are important in ruling out uveal melanoma in these cases. PATIENTS AND METHODS: We reviewed the clinical, MRI, and ultrasonographic characteristics of 95 patients sent to the Curie Institute for suspected uveal melanoma between 1998 and 2006, whose final diagnosis was a choroidal hematoma. Imaging differences with melanomas are discussed. RESULTS: A total of 95 patients with a diagnosis of hematoma were seen; the age varied from 54 to 92 years with a median age of 77 years; there was a history of macular degeneration in 27 cases and 11 patients were taking an anticoagulant. Intravitreous hemorrhage was noted in 18 cases and the lesion was located in the posterior pole in 28 cases. The thickness of the lesions measured by B scan ultrasonography varied between 1 and 7.8mm, with a mean thickness of 2.86mm. MRI was performed in 27 cases and CDI in ten cases. On CDI, hematomas appeared as linear or regular bulging lesions with no intralesional blood flow. On MRI, hematomas appeared as a high-intensity signal on T1-weighted images, heterogeneous on T2-weigted images in relation to the progression of the clot, but no contrast enhancement was noted inside the lesion. Follow-up examinations showed the progressive involvement of the clot and delayed decreasing size of the lesion. CONCLUSION: The diagnosis of choroidal hematoma is usually made by fundus examination. In some posterior locations with pseudo-tumoral appearance, CDI and MRI are useful to rule out a uveal tumor.

Suprachoroidal hemorrhage caused by breakage of a 25-gauge cannula.

A 72-year-old woman had vitreous surgery for epiretinal membrane using the 25-gauge vitrectomy system. During the removal of the cannula at the end of the surgery, half of its tip was noted to be missing. The following day, a severe choroidal detachment associated with a hypotony was found. A second surgery was performed, including drainage of suprachoroidal hemorrhage and choroidal fluid and the removal of the tip of the 25-gauge cannula stuck inside the sclerotomy. The retained cannula tip might have acted as a channel allowing vitreous fluid into the suprachoroidal space, resulting in choroidal detachment, hemorrhage, and hypotony.

Suprachoroidal hemorrhage following removal of releasable suture after combined phacoemulsification-trabeculectomy.

We report a case of suprachoroidal hemorrhage following removal of a releasable suture after combined phacoemulsification-trabeculectomy.

Healon5 in the management of intraoperative expulsive hemorrhage.

We present a patient with systemic hypertension, glaucoma, and previous vitrectomy who experienced a large expulsive choroidal hemorrhage during a procedure to reposition and iris fixate a subluxated intraocular lens. Liberal use of sodium hyaluronate 2.3% (Healon5) resulted in cessation of the hemorrhage, allowing completion of the case. Healon5 may cause cessation of bleeding through a tamponade effect and thus be useful in treating patients experiencing an intraoperative expulsive hemorrhage.

Secondary management and outcome of massive suprachoroidal hemorrhage.

PURPOSE: To present the results of secondary surgical treatment of five patients with massive suprachoroidal hemorrhage (MSCH), which occurred intraoperatively, postoperatively, or following ocular trauma. METHODS: Five patients presenting with MSCH were included in this study during or after phacoemulsification surgery (1 patient), glaucoma surgery (1 patient), combined glaucoma and phacoemulsification surgery (2 patients), and after traumatic sclera rupture (1 patient). Diagnosis was confirmed by ophthalmoscopy and B-scan ultrasonography. Pre-existing risk factors and distance visual acuity were documented. All cases received medical therapy and underwent secondary surgical intervention with radial sclerotomies combined with vitrectomy, use of perfluorocarbon, and silicone oil. Postoperative assessment included visual acuity measurement, ocular examination, and ultrasonography. RESULTS: In all cases, anatomic restoration of ocular structures was achieved. Distance visual acuity improved in all cases (preoperative Snellen visual acuity ranged from light perception to hand motions; postoperative Snellen visual acuity ranged from 0.05 to 0.3). The mean follow-up period was 17 months. CONCLUSIONS: In general, despite the advanced surgical techniques, the prognosis of MSCH remains guarded and the visual outcome poor. However, secondary surgical treatment with combined radial sclerotomies and vitrectomy should be considered in order to minimize the damaging effect and maximize the anatomic and functional restoration.

Suprachoroidal haemorrhage following Nd:YAG laser posterior capsulotomy.

Nd:YAG laser posterior capsulotomy is the commonest procedure for posterior capsule thickening following cataract surgery. Complications following this laser surgery are relatively few, and this is ordinarily a safe and effective procedure. Herein a case is described of suprachoroidal haemorrhage following Nd:YAG laser posterior capsulotomy. To the best of the authors' knowledge, this is the first report of this complication. Patients undergoing this procedure should be warned of this rare but potentially devastating complication.

[The role of ultrasound examinations in diagnosis of massive suprachoroidal hemorrhage occurring as a postoperative complication of intraocular surgery ]. / Rola badan ultrasonograficznych w diagnostyce masywnego krwotoku nadnaczyniówkowego, wystepujacego jako powiklanie operacji wewnatrzgalkowych.

This article presents importance of the ultrasound examinations (standard A- and B-scan ultrasonography, Colour Doppler and Power Doppler ultrasonography) in early and late diagnosis of massive intraoperative suprachoroidal hemorrhage. Standardized echography can help establish an accurate diagnosis. Echography can determine the location and extent of expulsive hemorrhage, as well as determine the status of the retina and vitreous. Furthermore, differentiation between hemorrhagic choroidal detachment and serous choroidal effusion can be made only by A- and B-scans. Colour and Power Doppler imagings of orbital vessels are relatively new sonography methods of ocular diagnosis. Using them, we can evaluate all blood flow disturbance, which occur in eye with massive suprachoroidal hemorrhage. These methods are also useful in differentiation of retina from other tissues, especially in the presence of opaque media.

Delayed suprachoroidal hemorrhage following viscocanalostomy.

Delayed suprachoroidal hemorrhage is a rare complication of conventional glaucoma surgery. Viscocanalostomy is one of the new surgical techniques used in glaucoma surgery that may theoretically protect against suprachoroidal effusion and hemorrhage due to the nonpenetrating nature of the procedure. Delayed suprachoroidal hemorrhage developed in a 92-year-old white woman following viscocanalostomy. This case demonstrates that the risk of suprachoroidal hemorrhage may not be completely eliminated after a nonpenetrating glaucoma procedure such as viscocanalostomy.

High-frequency ultrasonographic imaging in suprachoroidal hemorrhage after filtering surgery.

A 64-year-old woman with glaucoma had suprachoroidal hemorrhage approximately 6 hours after trabeculectomy. High-frequency ultrasonography revealed high reflectivity in the inner space of a kissing choroidal detachment, which facilitated the differential diagnosis of suprachoroidal hemorrhage resulting from serous choroidal detachment. The ciliary process and iris were anteriorly displaced due to the ciliary detachment and forward pressure of the anterior vitreous. On the basis of the diagnosis, transscleral choroidal drainage was performed without delay and the patient's vision was preserved. After surgery, suprachoroidal hemorrhage disappeared clinically, but high-frequency ultrasonography detected persistence of the choroidal detachment in the peripheral area.

[Delayed massive suprachoroidal hemorrhage after retinal detachment surgery: case report]. / Opózniony w czasie masywny krwotok nadnaczyniówkowy po operacji odwarstwienia siatkówki--opis przypadku.

Massive suprachoroidal hemorrhage may occur at surgery, early postoperatively or may be delayed. The authors describe a case of 79-year-old woman, who developed a massive suprachoroidal hemorrhage in 72 hours after retinal detachment surgery. In our case, the main reason of suprachoroidal hemorrhage development was postoperative hypotony and occurrence of a lot of factors such hypertension, diabetes, high myopia, pseudophakia, which predispose to hemorrhage. This case is very rare but interesting because of its multifocal pathogenetical mechanism.

Expulsive hemorrhage before phacoemulsification.

A 65-year-old white man who was scheduled for cataract extraction experienced a sudden increase in intraocular pressure (IOP) with flattening of the anterior chamber immediately after the anterior capsule incision. The eye was sutured, and because no decrease in pressure was noted, surgery was postponed. The presence of the cataract prevented ophthalmoscopic examination. Echographic examination revealed a hemorrhagic choroidal detachment with involvement of the ciliary body. The patient was examined regularly until the choroidal detachment disappeared 4 weeks later. He then had uneventful phacoemulsification and intraocular lens implantation.

Bilateral massive choroidal hemorrhage secondary to Glanzmann's syndrome.

Characteristics of intraocular bleeding and its management in association with blood dyscrasias are discussed. We present a patient with massive bilateral choroidal hemorrhage secondary to Glanzmann's syndrome. Magnetic resonance imaging and ultrasonographic findings were ordered. During the clinical course, bilateral intravitreal hemorrhage and tractional retinal detachment occurred. Left pars plana vitrectomy was performed under general anaesthesia. The procedure was unsuccessful because of intraoperative uncontrolled bleeding.

[Massive suprachoroidal hemorrhage during cataract surgery: case report]. / Masywny krwotok nadnaczyniówkowy jako powiklanie operacji usuniecia zacmy--opis przypadku.

A massive suprachoroidal hemorrhage is defined as a hemorrhage in the suprachoroidal space of sufficient volume either to cause extrusion of intraocular contents outside of the eye or to force the inner retinal surfaces into apposition ('kissing'). This is a very rare but one of the most serious complications of the intraocular surgeries. The authors describe a case of 84-year-old woman, who developed a massive suprachoroidal hemorrhage during cataract surgery. In our case, the main reason of expulsive hemorrhage development was a Valsalva effect, caused by unexpected cough during surgery. In a Valsalva maneuver, a sudden increase in venous pressure may lead to vessel-wall rupture, by an apparently excessive pressure gradient across the vessel wall. We present clinical and echographical study of this patient.

[Idiopathic polypoidal choroidal vasculopathy leading to blindness]. / Forme cécitante de vasculopathie choroïdienne polypoïdale idiopathique.

Idiopathic polypoidal choroidal vasculopathy (IPCV) has recently been recognized as a distinct cause of recurrent subretinal hemorrhages and exudates as well as multiple hemorrhagic retinal pigment epithelium detachments in the macula. IPCV is usually considered to have a good visual prognosis. We report the case of a 44-year-old woman with particularly severe bilateral macular and peripheral IPCV. The patient was followed for 13 years and had final visual acuity of counting fingers in the right eye and 20/400 in the left eye. Patients with IPCV with macular choroidal neovascularization tend to have a poor visual prognosis. This case of IPCV should alert the physician to be particularly attentive to the follow-up of these patients.