In this video from Dr. Osher's Video Journal of Cataract and Refractive Surgery, Drs. Amar Agarwal and Soosan Jacob share two cases of explosive hemorrhage and their pearls for prompt recognition and management of the situation.

The first case demonstrates a traumatic dislocated IOL and occult globe rupture. As the surgeon retrieves the lens, vitreous prolapses and a greying of reflex is seen. The surgeon neglects the signs and the choroid surges forward. Despite all efforts, the open globe leads to an IOP drop, surprachoroidal bleed, and extrusion of intraocular contents.

In a second case, femtosecond laser-assisted keratoplasty is planned to manage pseudophakic bullous keratopathy secondary to an AC IOL. Ominous movement of the choroid is seen once more. The surgeon immediately applies digital pressure on the open globe to maintain intraocular pressure and avoid expulsion. The AC IOL is left in situ temporarily to act as a tamponade. Sclerotomies are made to drain the suprachoroidal hemorrhage, and with just a few cardinal sutures, the surgeon preserves the anatomy of the eye.