Intraoperative Suprachoroidal Hemorrhage After Penetrating Keratoplasty: Case Series and Review of Literature

Objective: To describe four cases of intraoperative suprachoroidal hemorrhage (SCH) during penetrating keratoplasty and to review the literature. Methods: Cases with intraoperative SCH during penetrating keratoplasty over 3-year period were reviewed. The parameters evaluated were ocular and systemic risk factors, intraoperative details, and postoperative outcomes. A review of literature of intraoperative SCH during penetrating keratoplasty was also conducted. Results: Of the 543 cases that underwent penetrating keratoplasty for optical indications during the study period, four cases developed intraoperative SCH, which is an incidence of 0.73%. Suprachoroidal hemorrhage occurred in the following cases: failed pediatric graft, donor eye in a case of contralateral autokeratoplasty, Marfan syndrome with aphakic bullous keratopathy who had undergone multiple ocular surgeries, and a case of healed keratitis with corneoiridic scar. The mean age, axial length, and intraocular pressure were 32.75±22.17 years (range, 4–57 years), 23.29±2.12 mm (range, 20.38–25.2 mm), and 16.25±3.86 mm Hg (range, 16–20 mm Hg), respectively. Postoperatively, two eyes had a best-corrected visual acuity (BCVA) of counting fingers. The third case had BCVA of light perception (LP), and fourth eye had no LP. Conclusion: The visual outcomes in cases of open-sky penetrating keratoplasty with SCH continue to be abysmally poor. The importance of thoroughly informing the patient about this complication cannot be underrated.