Abstract
BackgroundSuprachoroidal 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 presentationA 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.ConclusionSpontaneous 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.
Highlights
Suprachoroidal haemorrhage is a rare complication of either medical anticoagulation treatment or intraocular surgical procedures
Case presentation We present a case of acute angle closure due to spontaneous suprachoroidal haemorrhage secondary to loss of anti-coagulation control
The consequence was inadvertent warfarin overdose, causing loss of anticoagulation control, which led to the spontaneous suprachoroidal haemorrhage in the right eye
Summary
Suprachoroidal haemorrhage is a rare complication of intraocular surgery or trauma. Even more rarely it may be spontaneous. Risk factors include older age, patients on systemic anticoagulation, systemic hypertension, atherosclerosis, age-related macular degeneration and chronic kidney disease When they occur, Suprachoroidal haemorrhages often have devastating visual outcome despite conservative and/or surgical intervention [1–3]. A 67-year-old man, who recently returned from a holiday abroad, presented with a one-day history of worsening right visual acuity and 4 day history of increasing He had a past medical history of essential tremor managed with Propranolol, Atrial Fibrillation on anticoagulation with Warfarin 4 mg daily – target International Normalised Ratio (INR) 2.5. Our patient was known to have normal tension glaucoma (NTG) managed with Latanoprost He had Selective Laser Trabeculoplasty (SLT) to the right eye 12 months before to improve his intraocular pressure control. He was restarted on IOP lowering topical treatment (G Brinzolamide/Timolol BD)
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