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Choroidal (Expulsive) Hemorrhage

  • One of the most devastated complication of ocular surgeries
  • May occur during any form of intraocular surgery or in eyes with a recent history of ocular surgeries such as cataract extraction, glaucoma surgeries, vitreoretinal surgeries and penetrating keratoplasty
  • It may be minimal and limited to one or two quadrant, but can be massive enough to cause expulsive hemorrhage with protrusion of intraocular contents and retinal surfaces apposition
  • Risk factors:
    • General: advanced age, high myopia, cardiovascular disease, diabetes, chronic hypertension, atherosclerosis
    • Intraoperative: ocular pain, hypertension, cough reflex, vitreous loss
  • Clinical features:
    • Symptoms: severe ocular pain and loss of vision
    • Signs:
      • Dark choroidal mass with or without vitreous hemorrhage
      • Shallowing of the anterior chamber
      • Hypotony during or after intraocular surgery
      • Firmness of the globe
      • Bleeding through the surgical wound
  • Management:
  • Immediate closure of the globe once intraoperative hemorrhage occurs
  • Anterior chamber reformed with viscoelastic material
  • Surgical drainage of the blood
  • Surgical evacuation of the blood clot after it has been liquefied as determined by serial B-scan ultrasonography
  • Visual outcome can be excellent with prompt and proper management

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