Video Presentation

Surgical management of massive suprachoroidal haemorrhage: Don’t play it blind!

Video Details

First Author: J.Sheth INDIA

Co Author(s):    A. Giridhar   S. Chandra                          

Abstract Details



Purpose:

Expulsive suprachoroidal haemorrhage (SCH) is a catastrophic complication of intraocular surgery. Current management includes drainage of SCH through external sclerotomies and intermittent fundus evaluation using indirect ophthalmoscopy till complete drainage is performed. We describe a novel surgical technique, as an educational tool, for management of massive suprachoroidal hemorrhage in a 62-year-old gentleman referred to the authors 12 days following the intraoperative complication occurred during a cataract surgery. In our surgical video, we illustrate chandelier-assisted wide-angled visualization of various steps in SCH drainage and subsequently performing a successful vitreous surgery and silicon oil injection.

Setting:

Tertiary care center, India

Methods:

PCIOL explantation was performed initially followed by 360° peritomy. Continuous infusion was achieved using an anterior chamber maintainer. A 25G chandelier was inserted inferiorly and a sclerotomy was done in superonasal quadrant 7mm behind the limbus. Using the wide-angles viewing system and 23G extrusion cannula through the sclerotomy, active drainage of suprachoroidal hemorrhage was performed under visualization. Beautiful separation of the kissing choroids could be illustrated with gradual unmasking of the macula and disc underneath. Similar sclerotomy was also performed in superotemporal quadrant for complete drainage of the SCH under endoillumination. Subsequently, a 23GPPV was performed with silicon oil injection.

Results:

Post-operatively, the retina was attached and the eye was successfully salvaged by timely surgical intervention using the novel technique.

Conclusions:

Our educational video demonstrates that drainage of massive suprachoroidal hemorrhage can be performed safely under chandelier-assisted endoillumination. It is an easy technique whereby controlled drainage of suprachoroidal hemorrhage can be achieved using active extrusion and under continuous visualization to achieve excellent anatomical outcomes and a better safety profile. This can be instrumental in training residents and fellows who can simultaneously visualize the operative steps along with the surgeon.

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