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. 2021 Aug 5;6(3):210-213.
doi: 10.1177/24741264211028418. eCollection 2022 May-Jun.

Management of Suprachoroidal Hemorrhage in a Patient With Boston Type I Keratoprosthesis

Sushant Wagley  1 , Dieter D Brandner  2 , Joshua H Hou  1 , Sandra R Montezuma  1
Affiliations

Management of Suprachoroidal Hemorrhage in a Patient With Boston Type I Keratoprosthesis

Sushant Wagley et al. J Vitreoretin Dis. .

Abstract

Purpose: Suprachoroidal hemorrhage (SCH) is a rare but vision-threatening complication in patients with keratoprosthesis devices (KPro), particularly in the setting of concurrent glaucoma tube shunts. Although there are many approaches to draining an SCH, surgery can be especially challenging in these patients because a crowded anterior chamber, and frequent anterior extension of the SCH.

Methods: A case report is discussed.

Results: We describe a novel approach to surgical drainage of SCH in a 64-year-old monocular patient with a Type I Boston KPro, an Ahmed valve, and aphakia.

Conclusion: Successful repair of appositional SCH in the context of KPro can be safely and effectively achieved by injecting viscoelastic through the backplate holes of the KPro, thereby providing internal tamponade within the vitreous compartment while liquefied hemorrhage is drained by sclerotomy.

Keywords: keratoprosthesis; suprachoroidal hemorrhage; viscoelastic.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Sequential B-scan ultrasonograms of the right eye show retinal apposition during the postoperative course. Echogenic swirling suggestive of hemorrhage liquefaction was appreciated on postoperative day 11. Probe orientations are as follows: initial = L9; day 5 = L12; day 8 = T9; day 11 = L9.
Figure 2.
Figure 2.
(Left) Schematic of the suprachoroidal hemorrhage shows initial retinal apposition. (Middle) A radial sclerotomy incision 6 mm from the limbus was used to expel liquefied hemorrhage, and a 30-gauge needle was inserted through one of the inferotemporal keratoprosthesis device's backplate holes into the posterior segment to inject viscoelastic. This fluid facilitated reformation of the vitreous cavity and provided tamponade. After drainage, the retina was restored to its appropriate position in the posterior segment, following the scleral curvature with no retinal tears or detachments. (Right) Minor residual anterior choroidal hemorrhages remained after the procedure. SCH indicates suprachoroidal hemorrhage.
Figure 3.
Figure 3.
(Top) Optos fundus photograph and (bottom) macular optical coherence tomography through the fovea at 6 months post suprachoroidal hemorrhage drainage.
See this image and copyright information in PMC

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