Managing Delayed Suprachoroidal Hemorrhage After Insertion of XEN45 Glaucoma Device

Abstract

A 78-year-old man with angle closure glaucoma and on treatment with oral anticoagulants, underwent phacoemulsification. An early acute suprachoroidal hemorrhage (SCH) occurred and the surgical wound was rapidly sutured without complete soft lens matter removal, nor insertion of intraocular lens. The SCH was managed conservatively and it resolved in 5 weeks; the intraocular pressure was 35 mm Hg despite maximal medical treatment. Secondary soft lens matter removal followed by intraocular lens implantation combined with XEN45 was then performed. After 7 days the patient developed a potentially "kissing" choroidal touch due to significant delayed SCH. This was treated with surgical drainage. Significant suprachoroidal bleeding can occur after minimally invasive glaucoma procedures. Patients on anticoagulant therapy may require careful monitoring while planning glaucoma surgery.