- 86 year old patient presented with headache and severe eye pain 9 days after complete blindness in one eye following ocular surgery - Exam found corneal edema, shallow anterior chamber, and no view of fundus in the affected eye - Ultrasound showed suprachoroidal hemorrhage, and the plan was for retina service to consult and revise the shunt and scleral graft with drainage of the hemorrhage.

1. Grand Rounds: October 3, 2007 86 yo CF 9 days s/p complete BVI OS c/o 2 days of HA, severe pain OS and in neck by Ali Bright Discussant: Dr. Brian Francis

6. B-Scan OS

8. A-Scan Representative

13. Arterial Supply to the Choroid

14. Venous Drainage from Choroid

16. Surgery Associated with SCH (Chu and Green meta-analysis, 1999) Surgery Type % expulsive SCH (# patients) % delayed SCH (#patients) CE/IOL Placement 0.05-0.2% (~100,000) 0.06-0.81% (~6000) Corneal 0.087-1.08% (945) Glaucoma 0.15% (1329) 1.6-6.1% (~10,000) Vitreoretinal 0.41-1.0% (3710)

19. SCH Signs

21. SEROUS CHOROIDAL DETACHMENT HEMORRHAGIC CHOROIDAL DETACHMENT Low IOP High IOP Transilluminates No transillumination Usually no pain Almost always painful despite analgesia Usually pre-equatorial may be more voluminous posterior to equator Resolution usually within 3 weeks Liquefies 6-26 days; resorbs ~4 weeks-several months Resolves without change in visual acuity Usually results in vision loss

33. Surgical Technique