OSLI Retina

November 2019

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670 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina Practical Retina Incorporating current trials and technology into clinical practice Suprachoroidal Hemorrhage: Risk Factors and Diagnostic and Treatment Options by Dimosthenis Mantopoulos, MD, PhD; and Howard F. Fine, MD, MHSc In this issue's Practical Retina column, Dimosthenis Mantopoulos, MD, PhD, and Howard F. Fine, MD, MHSc, from the Geisel School of Medicine at Dart- mouth and the Rutgers Robert Wood Johnson Medical School, respectively, discuss the risk factors and diagnostic and treatment options for managing suprachoroidal hemorrhage. We are all aware that there is great discussion and wide variability in thinking among our colleagues re- garding approach- es to diagnose and manage supracho- roidal hemorrhage. Common discus- sion includes de- finitive differen- tiation of tumors, congenital retinal pigment epithelial hypertrophy, and suprachoroidal hemorrhage. Acute in- tra- and perioperative management of this condition is frequently debated. Additionally, discussion frequently takes place regarding early versus de- layed drainage. Drs. Mantopoulos and Fine tackle this topic in a concise and logical manner. They will provide a thorough review of the literature and provide opinions based on their clini- cal experience and strength of the evi- dence in the literature. I am certain that their insights will be very valuable for optimizing out- comes in patients with this unfortu- nate condition. Suprachoroidal hemorrhage (SCH) is a clinical entity that was first reported in the literature more than 1 century ago. 1 Nevertheless, its diagnosis is frequently stress-provoking, both for the patient experiencing deep and boring pain in the eye as well as for the doctor, who is sometimes uneasy about the exact etiology and clinical course of the condition. The prevalence of certain risk factors, such as the use of anticoagulants and aging of the population, are rapidly increasing, 2 and for that exact reason the modern ophthalmologist should be prepared to promptly identify and efficiently manage this condition. The proposed pathophysiology in the de- velopment of SCH implicates a combination of mechanisms, including acute ocular hy- potony, uncontrolled systemic cardiovascu- lar risk factors, fragile choroidal vasculature, elevated episcleral, and/or choroidal vascular pressure, as well as some degree of choroidal effusion. 3 The incidence of spontaneous SCH is rare but exact fig- ures are unknown, whereas the risk of perioperative SCH var- ies significantly depending on the type of the ophthalmologic procedure. This risk is higher for patients undergoing glauco- ma surgery (range: 0.15% to 6.1%) and vitreoretinal surgery (range: 0.17% to 1.9%) and lower in those having penetrating keratoplasty (range: 0.087% to 1.08%) or cataract surgery (range: 0.03% to 0.81%). 4 RISK FACTORS Certain characteristics from the patient's medical and ocu- lar history increase the relative risk for SCH. The systemic risks include use of anticoagulant or anti-platelet medications, advanced age, uncontrolled hypertension, atherosclerosis, dia- doi: 10.3928/23258160-20191031-01 Dimosthenis Mantopoulos Howard F. Fine Seenu M. Hariprasad Practical Retina Co-Editor

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