title: Choroidal effusion and suprachoroidal hemorrhage during phacoemulsification: intraoperative management to prevent expulsive hemorrhage.
abstract: OBJECTIVE
  To describe the intraoperative management of choroidal effusion (CE) or suprachoroidal hemorrhage (SCH) during cataract surgery with the phacoemulsification technique.
  
  
  METHODS
  The study is a retrospective interventional study through which we describe the intraoperative management adopted in 6 cases of CE or SCH during cataract surgery. The study involved 6,400 eyes (phacoemulsification) in 6 years observational time (incidence rate 0.094%). The surgical time at which these complications happened differed: nucleolus phacoemulsification in 2 eyes, cortex removal by bimanual irrigation-aspiration in 3 eyes, and intraocular lens implant for 1 eye. Once the complication was recognized, each patient was quickly moved to an extreme reverse Trendelenburg position and pharmacologically treated to manage high blood pressure, pain, and anxiety (150 mL of an 18% mannitol solution delivered in rapid infusion intravenously; 1-3 mg intravenous midazolam; 5 nifedipine sublingual drops).
  
  
  RESULTS
  In all the cases reported, the surgery was completed after resolution of the acute choroidal exudation or SCH. In the follow-up evaluation, the intraocular pressure was normal at each examination. The visual acuity of the patients was between 6/7.5 and 5/6 Snellen after 4 weeks. We observed a statistically significant reduction in endothelial cells in the 2 eyes in which the CE or SCH happened during the phacoemulsification compared with the other cases; this finding likely results from mechanical damage (p = 0.04 [95% confidence interval]).
  
  
  CONCLUSIONS
  Choroidal effusion or SCH can be intraoperatively managed to avoid expulsive hemorrhage and maintain the possibility of completing the surgery.
authors.affiliation: Azienda Ospedaliero-Universitaria Careggi, Florence - Italy.|Studio Medico Associato Savastano, Cassino (Frosinone) - Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Savastano
authors.affiliation: Azienda Ospedaliero-Universitaria Careggi, Florence - Italy.
authors.forename: Stanislao
authors.initials: S
authors.lastname: Rizzo
authors.affiliation: Studio Medico Associato Savastano, Cassino (Frosinone) - Italy.|Università Cattolica del Sacro Cuore, Policlinico Gemelli, Rome - Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Savastano
authors.affiliation: S. Maria della Pietà Hospital, Casoria (Naples) - Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Piccirillo
authors.affiliation: Spallanzani Hospital, Frosinone - Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Forte
authors.affiliation: Seconda Università degli Studi di Napoli (SUN), Naples - Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Sbordone
authors.affiliation: Moscati Hospital, Anesthesia Department, Aversa (Caserta) - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Diurno
authors.affiliation: Studio Medico Associato Savastano, Cassino (Frosinone) - Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Savastano
mesh_terms: D000368:Aged; D015862:Choroid Diseases / Q000209:etiology / Q000517:prevention & control; D002832:Choroid Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D018475:Head-Down Tilt; D006801:Humans; D007429:Intraocular Pressure; D007431:Intraoperative Complications / Q000517:prevention & control; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D012189:Retrospective Studies; D014792:Visual Acuity