Suprachoroidal hemorrhage: A classification of severity and its association with visual and anatomic outcome

Purpose. To report the visual and anatomic outcomes of eyes after surgical treatment for a suprachoroidal hemorrhage according to hemorrhage severity. Methods. A retrospective review of all patients receiving surgical intervention at our tertiary referral center for a choroidal hemorrhage since 1987 was performed. Eyes were classified according to severity of hemorrhage and were evaluated for final visual acuity, post-surgical hypotony(IOP<6), and retinal attachment. Results. Forty-eight eyes were classified into four categories of hemorrhage severity: non-appositional choroidal hemorrhage without vitreous or retinal incarceration in the wound(!2 eyes), appositional choroidal hemorrhage without vitreous or retinal incarceration in the wound(17 eyes), choroidal hemorrhage with associated vitreous incarceration in the wound( 11 eyes), and choroidal hemorrhage with associated retinal incarceration in the wound(8 eyes). The percentage of eyes maintaining ambulatory vision(>5/200) in each category, respectively, was 42%(5/12), 4I%(7/17), 36%(4/ll),and !2%(l/8). Overall, 35%(17/48) of eyes maintained ambulatory vision. The prevalence of post-surgical hypotony in each category was 8%{1/12), 12%(2/17), 18%(2/11), and 50%(4/8). Overall, post-surgical hypotony developed in 19%(9/48) of eyes. Of eyes that presented with a retinal tear or detachment, the rate of retinal reattachment in each subgroup respectively was 78%(7/9), 62%(5/8), 62%(5/8), and 50%(4/8). Overall, retinal reattachment was obtained in 64%(21β3) of eyes, 10%(2/21) of which remained hypotonous. Conclusion. Eyes requiring surgical drainage of a suprachoroidal hemorrhage have a guarded prognosis with a poorer outcome associated with increasing hemorrhage severity. Our classification system incorporating appositional status of the choroid and incarceration of vitreous or retina into the wound provides a format for reporting and assessing the efficacy of management strategies in this condition.