OSLI Retina

July 2019

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454 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C A S E R E P O R T ■ Surgical Management of Suprachoroidal Hemorrhage in Younger Patients Edward H. Wood, MD; Omar Moinuddin, MD; Prethy Rao, MD, MPH; Kimberly A. Drenser, MD, PhD; Michael T. Trese, MD; Antonio Capone Jr., MD ABSTRACT: Suprachoroidal hemorrhage (SCH) is a rare but serious complication that may accompany nearly any ocular surgery. In contrast to SCH in adults, the incidence and management of SCH in the pediatric population is poorly defined. Herein, the authors describe their experience managing SCH in patients of a younger age group, character- ize this rare complication using multimodal imag- ing, and review the current literature on the sub- ject. In this retrospective case series, two patients developed intraoperative SCH during cataract ex- traction once rendered aphakic. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:454-458.] INTRODUCTION Suprachoroidal hemorrhage (SCH) is the accu- mulation of blood within the potential space be- tween the choroid and sclera. Most pathophysi- ological theories implicate hypotony precipitating sudden changes in the vascular gradient, decreased uveoscleral outflow, shearing of the choroidal vas- culature (especially the substantially traversing long posterior ciliary arteries), and eventually rup- ture into the suprachoroidal space. 1,2 SCH may occur intraoperatively (expulsive) or postoperatively as a delayed complication (DSCH) hours to months after surgery. Commonly recog- nized risk factors for SCH include older age, apha- kia, glaucoma, choroidal anomalies commonly associated with oculocutaneous or syndromic dis- orders, hypertension or cardiovascular disease, and intraoperative tachycardia. 3,4 Likewise, risk factors classically associated with DSCH include anticoagulation, axial myopia, and prior intraocu- lar surgery. 5,6 The occurrence of this complica- tion remains difficult to approximate, as smaller hemorrhages may often go unrecognized or under- reported in clinical records, and the incidence of SCH is likely variable based on the type of intraoc- ular surgery performed. 3 Based on the assessment of several studies, the reported incidence of SCH ranges from 0.06% to 1.8% in adults. 7-9,10,11,12-14 The estimated incidence of SCH in younger patients is reported at 0.36% and is similarly most commonly associated with glaucoma surgery. 15 Herein, we review cases of SCH occurring in either pediatric patients or eyes with a history of pediatric vitreoretinal disease at a single tertiary pediatric retina referral center (Associated Retinal Consultants, Royal Oak, MI), as well as present a discussion of pertinent risk factors and preferred management specific to SCH in younger patients. CASE REPORTS Case 1 A 20-year-old female with developmental delay and a history of retinopathy of prematurity (ROP) in both eyes (Stage 4A in the right eye [OD] status post laser and lens-sparing vitrectomy, and Stage 4B in the left eye [OS] status post three vitrectomies and lensectomy) underwent cataract surgery for a hyper-mature white cataract with superior zonular From Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan (EHW, PR, KAD, MTT, ACJ); Oakland University, William Beaumont School of Medicine, Rochester, Michigan (OM); and University of Michigan, W.K. Kellogg Eye Center, Ann Arbor, Michigan (OM). Originally submitted June 13, 2018. Revision received November 4, 2018. Accepted for publication January 3, 2019. The authors report no relevant financial disclosures. Address correspondence to Antonio Capone Jr., MD, Associated Retinal Consultants, William Beaumont Hospital, Neuroscience Center, 3555 W. 13 Mile Road, Suite LL-20, Royal Oak, MI 48073; email: acapone@arcpc.net. doi: 10.3928/23258160-20190703-08

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