Prevention and management of delayed suprachoroidal hemorrhage after filtration surgery
R. E. Frenkel and D. H. Shin
We report two new cases of massive delayed nonexpulsive suprachoroidal
hemorrhage (DNSH) following a filtering operation in the aphakic eyes of
elderly patients with glaucoma. A timely surgical drainage resulted in full
recovery of preoperative visual acuity in both of our patients. As we
combine our cases with a series of 18 similar cases of others in the
literature, the following conclusions emerge. Limited DNSH does not require
surgical intervention for a favorable visual outcome. Massive DNSH,
however, requires timely and appropriate surgical intervention to achieve a
favorable visual outcome and to avoid persistent hypotony. The most
effective surgical intervention is drainage of the suprachoroidal
hemorrhage and re-formation of the anterior chamber, but without
concomitant vitrectomy. In both limited and massive DNSH, the final visual
outcome is not determined by the worst vision at the time of DNSH. Some of
the known and suspected risk factors of DNSH following filtering surgery
are old age, aphakia, postoperative hypotony, a history of vitreous
manipulation or complication, general anesthesia, increased venous
pressure, use of fluorouracil, and high myopia. In view of these risk
factors, we recommend several preventive measures for decreasing the
incidence of DNSH following filtering surgery.
