Suprachoroidal Effusion or Hemorrhage
Suprachoroidal effusion with or without suprachoroidal hemorrhage usually occurs intraoperatively but may also occur later in cases with prolonged postoperative hypotony. Suprachoroidal effusion typically presents as a forward prolapse of ocular structures, including iris, lens diaphragm, and vitreous, generally accompanied by a change in the red reflex. Clinically, suprachoroidal effusion may be difficult to differentiate from suprachoroidal hemorrhage. Patient agitation and pain followed by an extremely firm globe suggest suprachoroidal hemorrhage. Suprachoroidal effusion and suprachoroidal hemorrhage have been associated with
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hypertension
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arteriosclerotic cardiovascular disease
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tachycardia
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obesity
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high myopia
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glaucoma
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advanced age
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nanophthalmos
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choroidal hemangioma associated with Sturge-Weber syndrome
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chronic ocular inflammation
Fortunately, both suprachoroidal effusion and suprachoroidal hemorrhage are much less likely with small-incision phacoemulsification than with larger-incision surgery because of the relatively closed system formed by the small, self-sealing incisions. The relatively tight fit of the phaco tip in the incision prevents prolonged hypotony and reduces intra-operative fluctuations in IOP.
Suprachoroidal effusion may be a precursor to suprachoroidal hemorrhage. Exudation of fluid from choroidal vasculature ultimately stretches veins or arteries that supply the choroid after coursing through the sclera. If suprachoroidal hemorrhage occurs in this situation, it is presumably a result of disruption of 1 or more of these taut blood vessels (see also BCSC Section 12, Retina and Vitreous).
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.