Suprachoroidal Hemorrhage During Pars Plana Vitrectomy Associated with Valsalva Maneuver

Woong Lim Han; Woo Ko Byung; Song Yumi; Ro Lee Byung

doi:10.3341/jkos.2008.49.6.1022

Journal List > J Korean Ophthalmol Soc > v.49(6) > 1008006

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Han, Byung, Yumi, and Byung: Suprachoroidal Hemorrhage During Pars Plana Vitrectomy Associated with Valsalva Maneuver

Original Article

J Korean Ophthalmol Soc 2008;49(6):1022-1027.

Published online: 8 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.6.1022

Suprachoroidal Hemorrhage During Pars Plana Vitrectomy Associated with Valsalva Maneuver

Woong Lim Han, M.D., Woo Ko Byung, M.D., Song Yumi, M.D., Ro Lee Byung, M.D.

Department of Ophthalmology, College of Medicine, Hanyang University, Seoul, Korea

Address reprint requests to Byung Ro Lee, M.D. Department of Ophthalmology, College of Medicine, Hanyang University Hospital #Haengdang 1-dong, Seongdong-gu, Seoul 133-792, Korea Tel: 82-2-2290-8570, Fax: 82-2-2291-8517, E-mil: Brlee@hanyang.ac.kr

22 May 2008 Accepted 23 April 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a suprachoroidal hemorrhage by Valsalva maneuver during vitrectomy under general anesthesia.

Case summary

A healthy 26-year-old man had vitrectomy under general anesthesia due to rhegmatogenous retinal detachment in his right eye. During scleral indentation and endolaser photocoagulation, he took a sudden and severe bucking reflex because the effect of general anesthesia was insufficient. After the bucking reflex, suprachoroidal hemorrhage occurred in his right eye. Immediate IOP elevation and hyperfluorocarbon tamponade was performed to remove the suprachoroidal hemorrhage and reattach the retina and choroid. The patient’s corrected visual acuity was 20/50 and slender crescent‐ shaped choroidal rupture remained around the temporal area of the macula, unlike traumatic choroidal rupture. Following fluorescein angiography, staining was evident at the choroidal rupture site; no fluorescein leakage was evident.

Conclusions

We report a case of acute suprachoroidal hemorrhage which we investigated by fundus examination and fluorescein angiography.

Keywords: Suprachoroidal hemorrhage, Valsalva maneuver, Vitrectomy

References

1. Taylor DM. Expulsive hemorrhage. Am J Ophthalmol. 1974; 78:961–6.

2. Payne JW, Kameen AJ, Jensen AD. . Expulsive hemorrhage: its incidence in cataract surgery and a report of four bilateral cases. Trans Am Ophthalmol. 1985; 83:181–204.

3. Davison JA. Acute suprachoroidal hemorrhage in extracapsular cataract surgery. J Cataract Refract Surg. 1986; 12:606–22.

4. Welch JC, Spaeth GL, Benson WE. Massive suprachoroidal hemorrhage. Follow up and outcome of 30 cases. Ophthalmology. 1988; 95:1202–6.

5. Speaker MG, Guerriero PN, Met JA. . A case control study of risk factors for intraoperative suprachoroidal expulsive hemorrhage. Ophthalmology. 1991; 98:202–9.

6. Reynolds MG, Haimovici R, Flynn HW Jr. . Suprachoroidal hemorrhage. Clinical features and results of secondary surgical management. Ophthalmology. 1993; 100:460–5.

7. Davison JA. Acute intraoperative suprachoroidal hemorrhage in capsular bag phacoemulsification. J Cataract Refract Surg. 1993; 19:534–47.

8. Purcell JJ Jr, Krachmer JH. . Expulsive hemorrhage in penetrating keratoplasty. Ophthalmology. 1982; 89:41–3.

9. Ingraham HJ, Donnenfeld ED, Perry HD. Massive suprachoroidal hemorrhage in penetrating keratoplasty. Am J Ophthalomol. 1989; 108:670–5.

10. Gressel MG, Parrish RK II, Heuer DK. Delayed nonexpulsive suprachoroidal hemorrhage. Arch Ophthalmol. 1984; 102:1757–60.

11. Cantor LB, Katz LJ, Spaeth GL. Complications of surgery in glaucoma. Suprachoroidal expulsive hemorrhage in glaucoma patients undergoing intraocular surgery. Ophthalmology. 1985; 92:1266–70.

12. Ruderman JM, Harbin TS Jr, Cambell DG.Postoperative suprachoroidal hemorrhage following filtration procedures. Arch Ophthalmol. 1986; 104:201–5.

13. Givens K, Shields MB. Suprachoroidal hemorrhage after glaucoma filtering surgery. Am J Ophthalmol. 1987; 103:689–94.

14. Ariano ML, Ball SF. Delayed nonexpulsive suprachoroidal hemorrhage after trabeculectomy. Ophthalmic Surg. 1987; 18:661–6.

15. Wolter JR. Expulsive hemorrhage during retinal detachment surgery. A case of survival of the eye after Voerhoff sclerotomy. Am J Ophthalmol. 1961; 51:264–6.

16. Hawkins WR, Schepens CL. Choroidal detachment and retinal surgery. Am J Ophthalmol. 1966; 62:813–9.

17. Tabandeh H, Sullivan PM, Smahliuk P. . Suprachoroidal hemorrhage during pars plana vitrectomy. Risk factors and outcomes. Ophthalmology. 1999; 106:236–42.

18. Lakhanpal V, Schocket SS, Elman MJ. . Intraoperative massive suprachoroidal hemorrhage during pars plana vitrectomy. Ophthalmology. 1990; 97:1114–9.

19. Piper JG, Han DP, Abrams GW. . Perioperative choroidal hemorrhage at pars plana vitrectomy— a case control study. Ophthalmology. 1993; 100:699–704.

20. Sharma T, Virdi DS, Parikh S. . A case control of suprachoroidal hemorrhage during pars plana vitrectomy. Ophthalmic Surg Lasers. 1997; 28:640–4.

21. Scott IU, Flynn HW Jr, Schiffman J. . Visual acuity outcomes among patients with appositional suprachoroidal hemorrhage. Ophthalmology. 1997; 104:2039–46.

22. Wirostko W, Han DP, Mieler WF. . Suprachoroidal hemorrhage: outcome of surgical management according to hemorrhage severity. Ophthalmology. 1998; 105:2271–5.

23. Wolter JR, Garfinkel RA. Ciliochoroidal effusion as precursor of suprachoroidal hemorrhage: a pathologic study. Ophthalmic Surg. 1988; 19:344–9.

24. Beyer CF, Peyman GA, Hill JM. Expulsive choroidal hemorrhage in rabbits: a histopathologic study. Arch Ophthalmol. 1989; 107:1648–53.

25. Manschot WA. The pathology of expulsive hemorrhage. Am J Ophthalmol. 1955; 40:15–24.

26. Brown MP, Chignell AH. Accidental drainage of subretinal fluid. Br J Ophthalmol. 1982; 66:625–6.

27. Zauberman H. Expulsive choroidal hemorrhage: an experimental study. Br J Ophthalmol. 1982; 66:43–5.

28. The Fluorouracil Filtering Study Group: Risk factors for suprachoroidal hemorrhage after filtering surgery. Am J Ophthalmol. 1992; 113:501–7.

29. Hoffman P, Pollack A, Oliver M. Limited choroidal hemorrhage associated with intracapsular cataract extraction. Arch Ophthalmol. 1984; 102:1761–5.

30. Lakhanpal V, Schocket SS, Elman MJ. . A new modified vitreoretinal surgical approach in the management of massive suprachoroidal hemorrhage. Ophthalmology. 1989; 96:793–800.

31. Abrams GW, Thomas MA, Williams GA. . Management of postoperative suprachoroidal hemorrhage with continuous‐ infusion air pump. Arch Ophthalmol. 1986; 104:1455–8.

32. Tabandeh HT. Flynn HW Jr. Suprachoroidal hemorrhage during pars plana vitrectomy. Curr Opin Ophthalmol. 2001; 12:179–185.

33. Lanigan LP, Clark CV, Hill DW. Intraocular pressure responses to systemic automonic stimulation. Eye. 1989; 3:477–83.

34. van Meurs JC, van den Bosch WA. Suprachoroidal hemorrhage following a Valsalva maneuver. Arch Ophthalmol. 1993; 111:1025–6.

Figure 1.

Fundus photograph at the initial examination reveals simple rhegmatogenous retinal detachment in the superior quadrant.

Figure 2.

After the bucking reflex, dark brown convex elevation representing suprachoroidal hemorrhage appeared during the surgery.

Figure 3.

At postoperative 1 month, fundus photography showed slender choroidal rupture lines from the superior to inferior vascular arcade at the temporal area of the macula.

Figure 4.

Fluorescein angiographs at postoperative 3 months shows fluorescein staining at the site of choroidal rupture. It seems to be traumatic choroidal rupture.

Figure 5.

Indocyanine angiograph at postoperative 7 months shows features suggesting traumatic choroidal rupture.

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