1/14. Acute suprachoroidal hemorrhage during phacoemulsification.We present a case of acute suprachoroidal hemorrhage that developed during routine phacoemulsification in an 85-year-old patient after uneventful administration of periocular anesthesia. Pre-existing risk factors included advanced age, glaucoma, myopia, and hypertension. The scleral tunnel prevented major expulsion of intraocular contents; however, raised intraocular pressure prevented intraocular lens implantation. The rarity of this condition raises questions regarding the further management and precautions related to it.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/14. Massive suprachoroidal hemorrhage with retinal and vitreous incarceration; a vitreoretinal surgical approach.Suprachoroidal hemorrhage(SH) may cause the expulsion of the intraocular contents. Vitreous incarceration in the wound and retinal detachment with SH are extremely poor prognostic signs. Treatment modalities depend on the severity of eye damage. This particular patient had "kissing" hemorrhagic choroidal detachment which completely filled the vitreous cavity after cataract surgery. It seemed to be inoperable. Secondary surgery was delayed 3 days to lower IOP to normal levels. The eye underwent anterior drainage sclerotomy under constantly-maintained limbal or pars plana infusion fluid line pressure. The authors performed a pars plana vitrectomy, followed by perfluorocarbon liquid injection and a silicone oil tamponade. After this surgical approach, the patient attained an attached retina and a visual acuity of 5/200 at the 3 month follow-up.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/14. Spontaneous expulsive suprachoroidal hemorrhage.PURPOSE: To present a 90-year-old patient with spontaneous expulsive suprachoroidal hemorrhage (SESCH). This unique case suggests a mechanism of SESCH, which is still under debate. methods: The patient, who had corneal inflammatory disease and diabetes mellitus, atherosclerosis, and glaucoma, presented with active ocular bleeding and expulsion of intraocular tissues. Almost the entire cornea was absent, except for several small and irregular areas in its periphery. Histopathologic evaluation of the eviscerated contents was performed. RESULTS: Clinicopathologic evaluation revealed acute inflammation of the corneal remains as well as intraocular inflammation. Inflammatory necrosis of choroidal vessels was evident. CONCLUSION: The findings point to the assumption that choroidal bleeding, secondary to vascular inflammatory necrosis, was the initial event in this case of spontaneous expulsive suprachoroidal hemorrhage. Presumedly, the intraocular pressure level was very high owing to continuous bleeding, which could result in a very large, rather than localized, tearing of the peripherally inflamed cornea.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/14. Massive choroidal hemorrhage associated with low molecular weight heparin therapy.An 84-year-old woman with unstable angina pectoris was treated with subcutaneous enoxaparine (Clexane) for several days before presenting with severe pain and decreased vision in her left eye. The intraocular pressure was 70 mmHg, and fundus examination showed a pigmented choroidal lesion and associated choroidal and retinal detachment. ultrasonography was consistent with choroidal hemorrhage, and she was diagnosed as having acute glaucoma secondary to massive subchoroidal hemorrhage. Medical control of the intraocular pressure resulted in a significant clinical improvement. Intraocular hemorrhage and angle-closure glaucoma are rare and previously unreported complications in patients treated with low molecular weight heparin. It is important to be aware of this ocular complication as these drugs are so often used.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/14. 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.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
6/14. 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.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/14. Expulsive choroidal effusion: case report of a rare complication of intraocular surgery.A case of expulsive choroidal effusion occurring during extracapsular cataract extraction in a 75 year old woman is presented. The episode occurred at the time of insertion of the pseudophake into the ciliary sulcus. The woman had pre-existent filtering bleb and was hypertensive, factors which may have contributed to the episode. Although this is dramatic occurrence, it needs to be distinguished from expulsive choroidal hemorrhage which carries a much worse porgnosis. In this instant, management was expectant and patient attained 6/12 with over-refraction. It is recommended that patients who may be at risk for expulsive choroidal effusion should have in the bag pseudophake fixation rather than sulcus fixation to obviate pressure on the circular vascular arcade.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/14. Complications following ex-press glaucoma shunt implantation.PURPOSE: To report post-operative course and complications in patients who underwent Ex-Press glaucoma shunt placement. DESIGN: Small case series. methods: Four patients were referred for management following Ex-Press shunt implantation. patients underwent complete ophthalmologic evaluation and were appropriately managed. RESULTS: Of the four patients, two had inadequate control of intraocular pressure related to bleb failure caused by subconjunctival scar tissue formation. One patient experienced suprachoroidal hemorrhage 5 days after shunt placement followed a year later with conjunctival erosion and shunt rim exposure. endophthalmitis from conjunctival erosion over the Ex-Press shunt rim was observed in one patient. CONCLUSION: patients with subconjunctival implantation of the Ex-Press shunt should be monitored closely for possible conjunctival erosion that can lead to endophthalmitis and failure from fibrosis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/14. Delayed-onset expulsive choroidal hemorrhage attributed to an acute elevation in systemic blood pressure following traumatic globe rupture.The authors describe a 78-year-old woman who suffered a traumatic partial dehiscence of a penetrating keratoplasty on the day prior to presentation. While awaiting surgical repair, the patient experienced an expulsive choroidal hemorrhage necessitating a primary evisceration of the eye. This case is unique because the hemorrhage can be largely attributed to the acute dramatic rise in systemic blood pressure that immediately preceded it. Management considerations for patients with open-globe injuries who have poorly controlled systemic hypertension should include close monitoring of vital signs in a controlled setting, anxiolysis, aggressive intervention for hypertensive lability, and hastening of surgical repair regardless of nothing by mouth status.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
10/14. Delayed nonexpulsive suprachoroidal hemorrhage after trabeculectomy.Five cases of delayed nonexpulsive suprachoroidal hemorrhage after trabeculectomy in aphakic eyes are reported. Four cases were done under general anesthesia and in three there was straining and bucking at extubation. The most common presentation was sudden severe ocular pain one day postoperatively, associated with marked decrease in vision and low intraocular pressure. The prognosis was related to the extent of the hemorrhage; where suprachoroidal hemorrhage was extensive, surgical drainage appeared to help. Our last two patients, both with massive postoperative nonexpulsive suprachoroidal hemorrhage, underwent surgical drainage of suprachoroidal blood and recovered preoperative visual acuity.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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