A rare case of acute angle closure due to spontaneous suprachoroidal haemorrhage secondary to loss of anti-coagulation control: a case report

Abstract

Background: Suprachoroidal haemorrhage is a rare complication of either medical anticoagulation treatment or intraocular surgical procedures. Suprachoroidal haemorrhages often have devastating visual outcome despite conservative and/or surgical intervention.

Case presentation: A patient with known Open Angle Glaucoma and Atrial Fibrillation on warfarin presents symptoms and signs suggestive acute angle closure. Examination reveals the underlying cause is a large, macula involving, spontaneous suprachoroidal haemorrhage secondary to loss of anti-coagulation control. Following aggressive medical treatment and surgical intervention, including drainage combined cataract extraction with intraocular lens implant, pars-plana vitrectomy, and external drainage of suprachoroidal haematoma, we managed to preserve the patient's eye and some of its function.

Conclusion: Spontaneous suprachoroidal haemorrhages are rare complications of loss of anticoagulation control. Our case shows that aggressive treatment in selected cases can offer a relatively good outcome.

Keywords: Acute angle closure; Anticoagulation; Suprachoroidal haemorrhage.

Fig. 1

Right eye anterior segment optical coherence tomography (OCT) showing a closed iridocorneal angle

Fig. 2

Slit lamp photo of the right eye

Fig. 3

Left eye Anterior Segment OCT showing an open iridocorneal angle

Fig. 4

Ultrasound B-Scan of the right eye showing extensive suprachoroidal haemorrhage involving the center of the macula

Fig. 5

Right eye post operative anterior segment appearance showing a wide open iridocorneal angle

Fig. 6

Multicolor photo of the right eye fundus showing a flat retina post operatively