Spontaneous suprachoroidal hemorrhage: Case report and review of the literature

Abstract

We present the clinical course, management, and final outcome of spontaneous suprachoroidal hemorrhage (SSCH) in an age-related macular degeneration (AMD) patient-a 64-year-old male receiving antiplatelet therapy who developed SSCH during the Valsalva maneuver. In addition to our case study, we discuss the results of a systemic review of the literature and reference lists of retrieved studies published from January 2001 to December 2013. Among a total of 31 patients (32 eyes), acute secondary glaucoma was a complication in 87.5% of the cases, and over half of the cases (20 eyes, 62.5%) received surgery. Twenty cases (64.5%) were characterized by systemic hypertension (HTN), followed by cardiovascular or cerebral vascular disease in 17 cases (54.8%). The Valsalva maneuver was performed in five cases (16.1%) prior to the episode. Twenty-three cases (74.2%) had abnormal hemostasis, including use of anticoagulants or thrombolytic agents (18 cases), chronic renal failure (CRF, 5 cases), and blood dyscrasia (3 cases). AMD was the most common (17 eyes of 16 patients, 53.1%) ocular disease. Visual acuity was classified as hand motion (HM) or worse in 20 eyes (of 28 eyes, 71.4%) at initial presentation and in 24 eyes (of 30 eyes, 80%) upon final examination. Anticoagulated patients with AMD should be informed of the risk of intraocular hemorrhage. Medical therapy usually fails in the treatment of glaucoma. Surgical intervention provides an option for the purpose of pain relief. Even so, the final visual prognosis is usually poor.

Keywords: choroidal; glaucoma; hemorrhage; sclerotomy; suprachoroidal.

Fig. 1

Fundus photography of the right eye showing numerous small-sized and confluent drusen (upper left), which were stained at the late stage without leakage using fluorescein angiography (upper right). These pictures were obtained 2 years prior to the episode. Slit-lamp examination shows forward displacement of the iris and lens with total iridocorneal touch (lower left). B-Scan ultrasonography of the right eye reveals a dome-shaped choroidal detachment (arrow) with hypo-echogenous content (asterisk) in addition to a dense vitreous hemorrhage (H) (lower right).

Fig. 2

The common factors related to systemic associations in the 31 cases with SSCH. CAD = carotid arterial disease; CRF = chronic renal failure; CVA = cerebrovascular accident; DM = diabetes mellitus; HTN = systemic hypertension; SSCH = spontaneous suprachoroidal hemorrhage.

Fig. 3

The use of anticoagulants, antiplatelets, and thrombolytic agents in the cases of SSCH in the literature. The use of medication was associated with hemostasis in 18 cases. SSCH = spontaneous suprachoroidal hemorrhage; TPA = tissue plasminogen activator.

Fig. 4

The possible risk factors for ocular associations [not including retinal detachment (1 case) and corneal inflammation (1 case)]. dAMD = age-related macular degeneration; PDR = proliferative diabetic retinopathy.