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This 63 year-old woman
underwent an extracapsular cataract extraction. During the
operation, there was a sudden loss of red reflex and the eye
became tense and painful.
a. What is the most likely diagnosis?
Suprachoroidal haemorrhage.
The history and the clinical appearance (solid retinal
detachment) are indicative of suprachoroidal haemorrhage. It
is caused by rupture of the choroidal vessels resulting in an
accumulation of blood in the suprachoroidal space between the
choroid and the sclera. Suprachoroidal haemorrhage can be
classified into expulsive and non-expulsive depending if the
intraocular contents are displaced from the eye. The incidence
of this complication is estimated to be about 0.19% during
intraocular surgery.
b. What are the risk factors for
this condition?
The following risk factors are
recognized:
• Conditions related to atherosclerosis such as diabetes,
systemic hypertension and old age.
• Conditions related to sudden globe decompression such as
bigger wound exposure, glaucoma and raised intraocular
pressures of any causes.
• Other conditions including high myopia and previous
suprachoroidal haemorrhage in the fellow eye.
c. How may the risks of this
complication be prevented if you were to operate
on the fellow eye?
To prevent similar complication
occurring in the fellow eye, it is important to reduce the
risk of those controllable factors that can contribute to
suprachoroidal haemorrhage. These include:
• Reduction of intraocular pressure by controlling glaucoma
and avoid operation on eye with high intraocular pressure.
• Control hypertension prior to surgery.
• Use small incision to avoid a sudden drop of intraocular
pressure. Therefore, it is preferable to perform
phacoemulsification rather than extracapsular cataract
operation.
Reference:
Ling R, Kamalarajah S, Cole M, James C, Shaw S. Suprachoroidal
haemorrhage complicating cataract surgery in the UK: a case
control study of risk factors. Br J Ophthalmol. 2004
Apr;88(4):474-7.
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