Special Focus, Retina, Original Article

Modified posterior drainage of post‑operative suprachoroidal hemorrhage

Subhendu Kumar Boral, Deepak Agarwal

Purpose: To study the anatomical and functional outcomes of trans‑conjunctival 23G or 25G Video Available on:
cannula‑guided modified posterior passive drainage of post‑operative suprachoroidal hemorrhage (SCH). www.ijo.in
Methods: A retrospective study was done on 15 eyes in the last nine years. Vitrectomy with perfluorocarbon
liquid injection to push SCH from inside along with 23G or 25G cannula‑guided passive drainage of Access this article online
SCH was performed by making multiple sutureless posterior sclerotomies at 10–15 mm behind the Website:
www.ijo.in
limbus. Postoperatively, best corrected visual acuity (BCVA), intraocular pressure (IOP), and posterior
DOI:
segment findings were compared from pre‑operative findings. Results: Mean age at presentation was 10.4103/ijo.IJO_3533_20
64.93 ± 7.62 years. Complete resolution of SCH with attached retina was achieved in 60% (9/15) of PMID:
cases. Mean pre‑operative BCVA of Log MAR 2.82 ± 0.21 improved to mean post‑operative BCVA Log *****
MAR 1.04 ± 0.53 (P < 0.001). Mean pre‑operative IOP of 27.87 ± 8.67 mmHg improved significantly to Quick Response Code:
post‑operative IOP of 10.2 ± 5.16 mmHg (P < 0.001). Silicone oil removal was possible in 11/15 (73.33%) cases.
Conclusion: Posterior passive drainage of post‑operative SCH by multiple sclerotomies using 23G or 25G
cannulas can salvage these eyes with both anatomical and functional recovery.

Key words: Cannula‑guided, passive drainage, posterior sclerotomies, suprachoroidal hemorrhage

Suprachoroidal Hemorrhage (SCH) is a rare vision‑threatening into the suprachoroidal space to facilitate further outflow.[11‑14]
condition defined as a rapid accumulation of blood in the Rossi T et al.[14] described SCH drainage through 23 Gauge (G)
suprachoroidal space.[1] The potential, virtual space between cannula placed 3.5 mm from limbus using anterior chamber
sclera and choroid, the suprachoroidal space, contains maintainer. The use of 20G trocar/cannula system introduced
approximately 10 µL of fluid.[2] The literature revealed the 7 mm posterior to limbus has been advocated by Rezende FA
etiology of SCH to be spontaneous onset, trauma, or as a et al.[13] However, recently, Rizzo et al.[15] described two‑stage
complication of ocular surgery.[3‑5] The incidence of SCH management in nine cases of massive SCH. Few experimental
after ocular surgery varies, ranging between 0.04% and 1%, treatment studies in animals and case reports in humans
for different procedures.[3,5,6] Delayed SCH is defined as a showed the potential of recombinant tissue plasminogen
suprachoroidal hemorrhage that develops in the post‑operative activator (r‑tPA) in SCH.[16‑18]
period but is not typically associated with the expulsion of
intraocular contents.[1] Factors that predispose to SCH include Methods
advanced age, glaucoma, high myopia, systemic cardiovascular The purpose was to study the anatomical and functional
disease, aphakia, and history of vitreous loss.[7‑9] Small loculated outcomes of transconjunctival 23G or 25G cannula‑guided
collections of blood within the suprachoroidal spaces may modified posterior passive drainage of post‑operative SCH as
resolve spontaneously with conservative treatment. Surgical single‑stage management.
drainage is advised for uncontrolled raised intraocular pressure
with maximum possible medications, flat anterior chamber, The present study is an institutional, retrospective,
Retinal Detachment (RD), appositional or kissing SCH, retinal interventional case series including 15 eyes of 15 consecutive
or vitreous incarceration, and prolonged SCH. patients. The study was conducted from May 2011 to
September 2019 at a tertiary eye care hospital. A sutureless
The use of perfluorocarbon liquid (PFCL) in vitreous technique using a 23G or 25G trocar/cannula system (Alcon,
surgery was popularized by Dr. Stanley Chang.[10] In the past, Fort Worth, TX) was used for drainage of post‑operative SCH.
surgical external drainage required radial 2–3 mm sclerotomies
combined with vitrectomy and use of PFCL and silicone oil
with the occasional introduction of a cyclodialysis spatula This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License,
which allows others to remix, tweak, and build upon the work non‑commercially,
as long as appropriate credit is given and the new creations are licensed under
Department of Vitreoretina, Disha Eye Hospitals Pvt Ltd, Kolkata,
the identical terms.
West Bengal, India
Correspondence to: Dr. Subhendu Kumar Boral, Disha Eye Hospitals For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
Pvt Ltd, 88 (63A) Ghosh Para Road, Barrackpore, Kolkata ‑ 700 120,
West Bengal, India. E‑mail: drsubhendu@yahoo.co.uk Cite this article as: Boral SK, Agarwal D. Modified posterior drainage
Received: 25-Nov-2020 Revision: 11-May-2021 of post‑operative suprachoroidal hemorrhage. Indian J Ophthalmol
2021;69:3584-90.
Accepted: 11-May-2021 Published: 26-Nov-2021

© 2021 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow

Table 1: Demographics and clinical features of the patients with suprachoroidal hemorrhage, treated by the described technique
Cases Age Sex RE/ Time Preop Primary Preop Anterior Lens Pre‑operative USG Gauze No. of Post‑operative Silicone Post op Postop
(years) LE interval BCVA Surgery IOP chamber status of drainage Fundus oil BCVA IOP
(in (Log (mm sugary sclerotomies removal (Log (mm
December 2021

days) MAR) Hg) MAR) Hg)

I 67 M RE 15 2.9 Phaco 32 Corneal edema, Aphakia SCH ( 2 quadrants) with 23G 3 Retina on + Done 0.78 17
retained lens vitreous hemorrhage Resolved SCH
matters
II 57 F RE 32 2.9 Phaco 24 Iris incarceration Aphakia SCH (2 quadrants) with 23G 2 Retina on + Done 1 9
with retained vitreous hemorrhage Resolved SCH
lens matters
III 75 F RE 6 2.9 Phaco 30 Corneal edema Aphakia Dropped nucleus with 23G 2 Retina on + Done 0.78 11
SCH (1 quadrant) Resolved SCH
IV 62 F LE 16 2.9 Phaco 27 Hyphema Aphakia SCH with kissing 23G 4 Retina on + Done 1.4 5
choroidals with vitreous Residual SCH
hemorrhage with retinal
detachment
V 78 F LE 10 2.9 Phaco 25 Hyphema with Aphakia SCH (3 quadrants) with 23G 2 Retina on + Not done 2 4
Iris & Retinal vitreous hemorrhage with Residual SCH
incarceration retinal detachment
VI 63 F LE 9 2.9 Phaco 33 Hyphema Aphakia SCH (2 quadrants) with 23G 4 Retina on + Done with 0.3 19
vitreous hemorrhage Resolved SCH Glued IOL
VII 72 M RE 22 2.9 Phaco 36 Hyphema ACIOL Hemorrhagic kissing 23G 2 Retina on + Not done 1.3 6
choroidals Residual SCH
VIII 76 M LE 8 2.9 Vitrectomy 24 Corneal edema PCIOL SCH (1 quadrant) with 25G 3 Retina on + Done 0.3 17
for RD PFCL filled vitreous cavity Resolved SCH
+ RD
IX 62 M LE 30 2.9 Phaco 36 Shallow AC PCIOL SCH with kissing 25G 3 Retina on + Done 1.4 6
choroidals with vitreous Residual SCH
hemorrhage with retinal
detachment
X 54 F LE 18 2.9 Phaco 42 Hyphema, Aphakia SCH with kissing 25G 4 Retina on + Not done 2 3
Shallow choroidals with vitreous Residual SCH
AC, Retinal hemorrhage with retinal
Boral and Agarwal: Posterior drainage of suprachoroidal hemorrhage

incarceration detachment
XI 68 F RE 10 2.9 Vitrectomy 24 Shallow AC PCIOL SCH (2 quadrants) + 25G 2 Retina on + Done 0.6 12
for RD partially detached retina Resolved SCH
XII 59 F LE 18 2.9 Phaco 30 PCIOL PCIOL Vitreous hemorrhage 25G 4 Retina on + Not done 1.3 6
+ SCH with kissing Residual SCH
choroidals + Total RD
XIII 56 F RE 22 2.3 Vitrectomy 6 PCIOL PCIOL Total RD with Late SCH (2 25G 2 Retina on + Done 0.78 11
for RD (Late quadrants) Resolved SCH
expulsive)
3585

Contd...
3586 Indian Journal of Ophthalmology Volume 69 Issue 12

Written consent was obtained from the patients before study

Post op Postop
participation. Patients consented to the publication of their

(mm
IOP

Hg)
15

12
clinical findings and images. Institutional Ethical Committee
approval was obtained. Present study strictly adhered to the

BCVA

MAR)
(Log
tenets of the declaration of Helsinki. A complete ophthalmic

0.6

1
evaluation was done after detailed history taking. Best
corrected visual acuity (BCVA) and intraocular pressure (IOP)
were recorded. B‑scan ultrasonography (USG) was done to
Post‑operative Silicone

removal
determine the site of maximum elevation of SCH and to assess

Done

Done
any associated co‑morbidity like vitreous hemorrhage, kissing
oil

choroidal, and RD. Inclusion criteria: Patients presenting with

Resolved SCH

Resolved SCH
Retina on + severe vision loss due to post‑operative SCH. Drainage of SCH

Retina on +
was contemplated only when USG showed SCH liquefaction.
drainage Fundus

PC IOL=Posterior Chamber IOL, AC IOL=Anterior Chamber IOL, ECCE=Extra Capsular Cataract Extraction, SCH=Supra Choroidal Hemorrhage, RD=Retinal Detachment
Surgical technique: Peribulbar block followed by aseptic
dressing and draping was done in all cases. Here we
used a modified approach of posterior passive drainage
sugary sclerotomies

of post‑operative SCH cases by multiple sutureless

No. of

sclerotomies. In cases with massive SCH (involving three

2

quadrants or kissing choroidal), an anterior chamber

maintainer was used instead of infusion cannula at the
beginning of surgery. In all other cases, three pars plana
Gauze

25G

25G
of

vitrectomy ports (23G or 25G) were made at the beginning

of the procedure. A 23G or 25G trocar‑cannula complex was
introduced obliquely into suprachoroidal space at an angle
of 5–10° tangential to the scleral plane in between 10 and
Aphakia Temporal half SCH (2

Aphakia Temporal half SCH (2

Pre‑operative USG

15 mm posterior to the limbus. The quadrants of maximum

suprachoroidal elevation, as determined and localized by
quadrants) + RD

pre‑operative USG, were selected for SCH drainage. Trocar

quadrants)

was then removed keeping cannula in situ, which acted as

a conduit for blood drainage from suprachoroidal space.
This was followed by vitrectomy and injection of PFCL to
fill at least half of the vitreous cavity to exert a uniform
push over SCH from inside. High IOP (40–60 mmHg)
status
Lens

was maintained for a very brief period during the blood

drainage procedure. Multiple 23G or 25G sclerotomies were
made with slight readjustment of the cannula tip direction
matters in AC
retained lens
Aphakia with

for complete external drainage of suprachoroidal blood.

Additional procedures as required in individual cases were
IOP chamber
Preop Anterior

Aphakia

performed, such as retinectomy for retinal incarcerations at

the limbal wound. Chandelier’s illuminator was used for
better visibility. When the tip of the cannula was visible
(mm
Hg)

in suprachoroidal space due to paucity of residual blood,

32

17

completion of blood drainage could be assumed. After

adequate drainage of SCH, all the cannulas were removed
Vitrectomy

and gentle massage over the outer scleral flaps overlying

LE interval BCVA Surgery
Age Sex RE/ Time Preop Primary

for RD
ECCE

the sclerotomies [Video Clip 1] was performed. At the end of

the surgery, PFCL was removed and silicone oil was injected
for endotamponade. Finally, all pars plana cannulas were
days) MAR)
(Log

2.9

2.3

removed and sites of sclerotomies were checked for any

leakage [Figs. 1 and 2].
Postoperatively, we prescribed topical steroids, antibiotics,
(in

10

and cycloplegics. Anti‑glaucoma medications were given

for cases with high IOP. At each follow‑up visit, detailed
LE

LE

ophthalmic examination, ultra wide‑field fundus photograph

by Optos 200Tx (Optos, Dunfermline, UK), and USG,
M
Table 1: Contd...

whenever necessary, were performed for evaluation of

(years)

anatomical and functional improvement. Patients were

59

66

followed up for a minimum of 6 months. Anatomical

and functional results were determined as the resolution
Cases

of suprachoroidal blood, change in BCVA, and IOP on

XIV

XV

each follow‑up visit. Anatomical success was defined as

December 2021 Boral and Agarwal: Posterior drainage of suprachoroidal hemorrhage 3587

anatomical stabilization, which was defined as complete Results

resolution of SCH along with attached retina. Functional
success was considered for those who gained BCVA LogMAR Fifteen eyes of 15 consecutive patients were included in
the present study. The demographics profile and clinical
1 (6/60 in Snellen’s chart) or more.
outcomes of the patients with post‑operative SCH treated
Statistical analysis by the described technique are highlighted in Table 1. There
The student’s paired t‑test was used to evaluate change in were 10 females and 5 males. Right eye was involved in
BCVA and IOP before and after surgery. Statistical analysis was 6 cases and left eye in 9 cases. The mean age at presentation
performed using SPSS software version 20. A P value of < 0.05 was 64.93 ± 7.62 years (54–78 years). Primary surgery that
led to SCH was phacoemulsification in 10 cases, vitrectomy
was considered statistically significant.
in 4 cases, and extracapsular cataract extraction (ECCE)
in 1 case. 9/15 eyes were aphakic on presentation, 5 had
posterior chamber intraocular lens (IOL), while one eye had
anterior chamber IOL. At presentation, anterior segment
findings were hyphema (n = 5), corneal edema (n = 3),
shallow anterior chamber (n = 3), iris incarceration (n = 2),
retained lens matters (n = 3), and retinal incarceration (n = 2).
Posterior segment abnormalities on USG B‑Scan showed
SCH involving two or fewer quadrants (n = 9), massive SCH
involving three quadrants, or kissing choroidal (n = 6), vitreous
hemorrhage (n = 8), rhegmatogenous RD (n = 9), and retained
PFCL bubble (n = 1). Five out of six massive suprachoroidal
hemorrhages were associated with RD. In all cases. PVR
changes were not beyond Grade C as noted intra‑operatively
on the table. 23G vitrectomy system was used in 7 cases and
25G in 8 cases. Anterior chamber maintainer was used at
the initiation of surgery in six eyes, while in the rest of the
Figure 1: Schematic of injecting perfluorocarbon liquid (PFCL) inside cases three‑port pars plana vitrectomy system (23G or 25G)
the vitreous cavity and external passive blood drainage by posteriorly was used since the beginning of surgery. The mean number
placed cannulas of cannulas used for the drainage was 2.8 ± 0.86. None of

a b c

d e f

g h i
Figure 2: Steps of suprachoroidal hemorrhage (SCH) drainage - (a and b) Oblique posterior introduction of 23G and 25G trocar-cannula complex,
respectively, in the presence of anterior chamber maintainer and (c) with infusion cannula; (d) perfluorocarbon liquid (PFCL) injection; (e) External
blood drainage; (f) Visible cannula tip after drainage; (g) PFCL removal; (h) Silicone oil injection; (i) Cannula removal
3588 Indian Journal of Ophthalmology Volume 69 Issue 12

the sclerotomies made to drain SCH‑needed sutures after drainage of SCH using transconjunctival, oblique posterior
removal of cannulas. The mean time interval from the onset sutureless sclerotomies by 23G or 25G trocar‑cannula complex.
and intervention was 15.6 ± 8.09 days. We have used Snellen’s B‑scan USG helps in not only the diagnosis of SCH but also
vision chart in our clinic. All BCVA was converted to logarithm in determining its extent and association with other morbid
of the minimum angle of resolution (log MAR) for statistical conditions like RD. Moreover, USG helps in determining the
analysis. As poor BCVA could not be quantified in Snellen’s site and timing of SCH drainage. Liquefaction of blood in the
chart, it was converted into LogMAR value according to Wei Y suprachoroidal space can be seen echo graphically and it usually
et al.[19], wherein light perception was assigned as 2.9 LogMAR, occurs between 7 and 14 days.[21] This had been suggested as
hand movement as 2.6 LogMAR, and counting finger as 2.3 the ideal time for a vitreoretinal intervention. In the present
LogMAR. Pre‑operative mean BCVA was 2.82 ± 0.21 log MAR. study, drainage of SCH was done only after ultrasonography
Post‑operative mean BCVA at 6 months was 1.04 ± 0.53 log showed liquefaction of suprachoroidal hemorrhage. The mean
MAR. This visual gain following SCH drainage was found to time interval between primary surgery and intervention in our
be statistically significant (P < 0.001). Postoperatively retina study was 15.71 ± 8.92 days, which was comparable to that
was attached in all 15 cases. Anatomical stabilization was observed by Lakhanpal V et al.[21] (mean of 14 days). However,
achieved in 9/15 cases [Fig. 3]. In case VI, glue‑assisted scleral in 4/15 patients (Case II, VII, IX, and XIII), our intervention was
fixation of IOL was performed along with silicone oil removal delayed due to the late referral of the patient.
after 3 months of vitrectomy. This patient had achieved a
final BCVA of 20/40 (Log MAR equivalent 0.3) [Fig. 4]. In Our approach is different from the previous approaches
6/15 patients, residual SCH of various amounts persisted and has multiple merits. First, the present sutureless
postoperatively [Fig. 5]. Silicone oil removal was possible technique is less traumatic than the radial sclerotomies.[11]
in 11/15 (73.33%) cases. In Case IV and Case IX, silicone oil Second, our drainage site is far more posterior, as posteriorly
was removed despite persistent residual suprachoroidal made sclerotomies maximizes drainage of SCH. Drainage
blood. Mean IOP preoperatively was 27.87 ± 8.67 mm Hg and sclerotomies were made 10–15 mm posterior to the limbus in a
improved postoperatively to 10.2 ± 5.16 mm Hg. This reduction quadrant of maximum elevation of SCH on USG. Rossi T et al.[14]
in IOP was found to be statistically significant (P < 0.001). In described the use of 23G cannula placed 3.5 mm posterior to
4/15 cases, silicone oil was not removed due to post‑operative limbus for drainage of SCH and Rezende FA et al.[13] drained
hypotony. at 7 mm from limbus using 20G cannula. However, drainage
of SCH posterior to the equator may not be possible by these
Discussion anteriorly placed cannulas. Thus, our approach is suitable to
Occurrence of SCH does not necessarily mean poor long‑term drain even posterior SCH. Third, we used multiple 23G/25G
visual outcome. [20] All of our primary cases are cataract
extraction (n = 11) and vitrectomy for RD repair (n = 4).
However, surprising we never faced SCH after Glaucoma
Filtration Surgery in our setting. The present study introduces
a surgical technique of cannula‑guided posterior passive

a c

a c
d

e
b d Figure 4: Shows (a) Pre-operative corneal edema, hyphema, and
Figure 3: Shows (a) Pre-operative corneal edema, retained aphakia in Case VI, (b) Pre-operative B-scan ultrasonography (USG)
lens matters, and aphakia in Case I, (b) Pre-operative B-scan showed suprachoroidal hemorrhage (SCH) in two quadrants, (c)
ultrasonography (USG) of the same patient showed suprachoroidal Stable intraocular lens (IOL) position after silicone oil removal (SOR)
hemorrhage (SCH) in two quadrants, (c) Post-operative USG after two and glued IOL implantation, (d) USG after SOR showed completely
weeks showed completely resolved SCH under silicone oil, (d) Retina resolved SCH and e) Retinal status without any residual suprachoroidal
status after silicone oil removal elevation after SOR
December 2021 Boral and Agarwal: Posterior drainage of suprachoroidal hemorrhage 3589

retinal incarceration while removing the cannulas, whether

the cannula was new or reused one.
BCVA improved significantly following SCH drainage in the
present study. Our result in this regard agrees with previous
studies where marked visual improvement has been noted
a
following SCH drainage.[11,14,21,22] Present study also highlights
a marked reduction in IOP after SCH drainage, which causes
alleviation of ocular discomfort and pain.

Conclusion
b c In summary, useful vision can be restored in post‑operative
Figure 5: Shows a) Pre-operative ultra wide-field fundus picture of SCH if timely and adequate drainage is performed. Sutureless,
suprachoroidal hemorrhage (SCH) with total retinal detachment (RD) in minimally invasive passive drainage of SCH by posteriorly
Case IX, b) Pre-operative B-scan ultrasonography (USG) of the same placed multiple 23G or 25G cannulas as single‑stage
patient showed kissing SCH with total RD, c) Post-operative ultra wide- management can salvage these eyes and achieve both
field fundus picture of residual SCH with completely attached retina anatomical and functional recovery. Still, there are some
limitations present in our study. This is a single‑center study,
cannulas to maximize the drainage. Desai UR et al.[22] described and the described cannula‑guided drainage of suprachoroidal
the use of PFCL to facilitate drainage of SCH. The role of heavy blood is a slow process than radial sclerotomies. Moreover,
transparent fluid PFCL in the vitreoretinal procedure as an complete drainage of SCH may not be always possible due to
important intraoperative tool has already been well established incomplete clot lysis, even when there is liquefaction of SCH
because of its cohesive adherence to the retina due to its surface on ultrasonography.
tension. Moreover, its high specific gravity helps in complex Declaration of patient consent
scenarios such as in expulsive hemorrhage to exert a constant
The authors certify that they have obtained all appropriate
uniform tamponading force to push the suprachoroidal
patient consent forms. In the form, the patient(s) has/have
collected blood from inside to facilitate its drainage externally.
given his/her/their consent for his/her/their images and other
Similarly, we use PFCL to maximize the push on SCH from
clinical information to be reported in the journal. The patients
the inside. Further, keeping IOP high (40–60 mmHg) for a
understand that their names and initials will not be published
short time facilitates more complete passive external drainage
and due efforts will be made to conceal their identity, but
of SCH. Fourth, our approach is a single‑stage management.
anonymity cannot be guaranteed.
We avoided the two‑stage procedure as described by Rizzo S
et al.[15] because long‑term use of PFCL causes toxic changes Financial support and sponsorship
of retinal pigment epithelial cells and ganglion cells.[23,24] Self.
Study showing the nontoxic effect of PFCL is based on the
animal model.[25] Fifth, our approach was minimally invasive, Conflicts of interest
thereby limiting further trauma and inflammation avoiding There are no conflicts of interest.
360‑degree conjunctival peritomy to expose extra‑ocular
muscles as described by Rizzo S et al.[15] Sixth, we also avoided References
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Commentary: The challenges of Ultrasonography also helps to determine the location and
extent of the hemorrhage and to differentiate between serous
managing suprachoroidal hemorrhage and hemorrhagic choroidal detachment.
The goals of surgery are to drain adequate amount of blood
Suprachoroidal hemorrhage (SCH) is a rare but one of
the most feared complications of all intraocular surgeries. from suprachoroidal space to prevent or relieve appositional
SCH has been associated more commonly with glaucoma, choroidal detachment, to normalize IOP, and to relieve pressure
vitreoretinal, and penetrating keratoplasty procedures and on lens‑iris diaphragm to prevent its forward movement
less with modern techniques of cataract surgery. The risk and anterior chamber angle closure. There is no need for
factors include intraoperative hypotony, chronic glaucoma, complete drainage of SCH. Unless an underlying pathology
high myopia, aphakia, old age (arteriosclerosis), and systemic demands it, (i.e., breakthrough vitreous hemorrhage or retinal
hypertension. Patients on anticoagulation therapy can present incarceration) concurrent vitrectomy is not needed.
with spontaneous SCH. The spectrum ranges from localized,
Different methods have been described for surgical
self‑limiting SCH to expulsion of intraocular contents.[1]
drainage of SCH. Placement of infusion cannula, either in the
Limited SCH usually resolves spontaneously over 6–8 weeks. anterior chamber or through the pars plana, helps in better
Continuous monitoring of intraocular pressure (IOP) and intraoperative IOP control and satisfactory SCH drainage. The
appropriate management is critical in these eyes. 30% of eyes extent of the choroidal detachment and the ability to visualize
with massive SCH, if left untreated, had a final vision of no posterior segment details decides the location for the infusion
light perception.[2] cannula.
Early recognition during surgery and proactive restriction SCH can be drained by direct scleral cut down after limited
of further hypotony by closing wounds and raising IOP limit conjunctival peritomy or using trocar cannula system.
progression of the hemorrhage.[3]
One or more radial sclerotomies are made 8 to 9 mm
The most important factors for the decision of surgical posterior to the limbus in a quadrant/s with highest
intervention are the presence of appositional choroidal choroidal elevation. The detached choroid helps prevent
detachments, uncontrolled IOP with or without angle closure. an accidental full‑thickness penetration. Typically dark
The optimal timing for the drainage of SCH is controversial. red blood gushes out after full‑thickness scleral incision.
Though the window of 7 to 15 days is accepted by most Gentle pressure can be maintained on the sclera to achieve
surgeons, planning this after ultrasonographic confirmation maximum possible drainage. The sclerotomies can either
of liquefaction of SCH helps in more complete drainage.[4,5] be sutured or left open.