Author: Muhammad Raza Cheema (United Kingdom)
Co-authors: Ahmed Saad
Purpose
There is no defined, universally accepted technique of draining Supra-choroidal haemorrhage (SCH). This procedure is not performed routinely, thereby surgeons may experience anxiety and be hesitant with their surgical approaches to this problem. The purpose of this video is to illustrate a simple, novel and safe technique to drain SCH present in one or more than 1 quadrants, occurring after cataract surgery. We propose this technique to be safe in the hands of experienced vitreo-retinal fellows and retina specialists who have recently begun to practice, as this technique is relatively straightforward.
Setting/Venue
The procedure was performed at tertiary centre with the modern-day ophthalmic unit at James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, United Kingdom.
Methods
Background of the case in results section. 10-days post-event, SCH drainage was performed using this novel technique as follows: Corneal paracentesis was performed using MVR blade to introduce anterior chamber infusion. Pressure is maintained between 50 – 60 mmHg to provide active force, from anterior to posterior, to help drain SCH. A conjunctival peritomy is performed, to expose bare sclera and a meticulous, full thickness sclerotomy is then performed using MVR blade, 6 mm from the limbus in the detached quadrant. Drainage of SCH is initiated with gentle pressure on the lip of the sclerotomy. An extrusion Cannula is then used to perform active aspiration of supra-choroidal blood from the ostium of the sclerotomy. This is performed while maintaining gentle pressure to help extrude blood. Active aspiration at the ostium is able to completely drain the Supra-Choroidal bleed. The steps are repeated in each quadrant of choroidal haemorrhage. After assessing capsular bag integrity, IOL was re-centred. 8/0-vicryl suture is used to close the sclerotomy and conjunctival peritomy. A further internal examination can be performed, if required
Results
72-year old lady, with background of Age-related macular degeneration, undergoing cataract surgery was noticed to have Anterior chamber shallowing and loss of “red reflex” while inserting intra-ocular lens (IOL) into the posterior chamber bag. Prompt closure of the corneal wound performed to minimise loss of intra-ocular contents. Post-operative examination revealed a dislocated IOL and SCH eclipsing 80% of the visual axis. Ultrasonography revealed SCH in supero-temporal and infero-nasal quadrants >5mm in height. After SCH drainaige, patient has made an excellent recovery with no post-operative complications. 1- week post-operative fundus examination revealed no SCH and retinal detachment. IOL remained well-centred. Patient’s intra-ocular pressure was 22mmHg and despite Age-related Macular degeneration, patient’s vision was 6/24 at 4 weeks post-operative review. The procedure yielded a successful result, with minimally invasive surgical drainage of SCH.
Conlusions
SCH is a rare but potentially devastating complication of any intra-ocular surgery, especially cataract and glaucoma-drainage surgeries. A timely and safe drainage of large SCHs can result in a significantly better visual outcome result for the patient. Our technique utilises extrusion cannula as an active aspirator of choroidal blood without necessitating the need for Pars plana choroidal haemorrhage drainage, which, can lead to further retinal tears and retinal detachment in SCH cases. We advocate using an Anterior chamber infusion along with extrusion cannula active aspiration to achieve best results with minimally invasive surgery. The advantage of this technique is, it is a relatively straightforward technique that can restore ambulatory vision in patients.
Financial Disclosure
No financial interests
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