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Massive suprachoroidal hemorrhage during cataract surgery - Case report

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Abstract

A massive suprachoroidal hemorrhage is defined as a hemorrhage in the suprachoroidal space of sufficient volume either to cause extrusion of intraocular contents outside of the eye or to force the inner retinal surfaces into apposition ('kissing'). This is a very rare but one of the most serious complications of the intraocular surgeries. The authors describe a case of 84-year-old woman, who developed a massive suprachoroidal hemorrhage during cataract surgery. In our case, the main reason of expulsive hemorrhage development was a Valsalva effect, caused by unexpected cough during surgery. In a Valsalva maneuver, a sudden increase in venous pressure may lead to vessel-wall rupture, by an apparently excessive pressure gradient across the vessel wall. We present clinical and echographical study of this patient.

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... The continuous cough caused by asthma causes a sudden increase in venous pressure 13 and choriocapillaris microvasculature pressure. This Valsalva effect led to an imbalance between the hydrostatic and colloid osmotic pressures, 14 which favored fluid movement from the vascular to extravascular compartment in the choroidal layer, as stated in Starling's principle. 15 The excessive pressure gradient caused choroidal rupture, which was a similar mechanism to closed-globe injuries. ...
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... A PubMed search for key words of "cough," "coughing," "sneeze," "sneezing," "Valsalva," "choroid," "hemorrhage" lead to seven reports, six related to coughing/vomiting during or after ophthalmic surgical procedures. [8][9][10][11][12][13] There was only one single-case report of this occurrence in the non-surgical environment in a 65 year-old man after straining during bowel movement who developed a 4 mm thick suprachoroidal hemorrhage. 14 This patient had no previous ocular surgery or anticoagulation and experienced sudden ocular pain at the time. ...
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