Suprachoroidal Hemorrhage Outcome of Surgical Management According to Hemorrhage Severity William J. Wirostko, MD, Dennis P. Han, MD, William F. Mieler, MD, Jose S. Pulido, MD, Thomas B. Connor, Jr., MD, Evelyn Kuhn, PhD Objective: To report the visual and anatomic outcome after surgical drainage of suprachoroidal hemorrhage according to hemorrhage severity. Design: A retrospective chart review. Participants: Forty-eight consecutive eyes undergoing surgical drainage of a suprachoroidal hemorrhage at The Medical College of Wisconsin were examined. Intervention: Demographic and clinical data were abstracted from patients’ medical records. Eyes were classified into four categories of increasing hemorrhage complexity: (1) nonappositional choroidal hemorrhage without vitreous or retinal incarceration in the wound (12 eyes); (2) centrally appositional choroidal hemorrhage without vitreous or retinal incarceration in the wound (17 eyes); (3) choroidal hemorrhage with associated vitreous incarceration in the wound (11 eyes); and (4) choroidal hemorrhage with associated retinal incarceration in the wound (8 eyes). Main Outcome Measures: Visual acuity, rate of persistent hypotony, and incidence of irreparable retinal detachment after surgical drainage for four classes of suprachoroidal hemorrhage were defined. Results: Overall, 11 (23%) of 48 eyes had no light perception (NLP) vision develop, 9 (19%) of 48 eyes had persistent postsurgical hypotony (intraocular pressure  6), and 21 (64%) of 33 eyes with retinal detachment enjoyed successful retinal reattachment surgery. A definite trend toward an increased rate of NLP vision (P  0.02), persistent hypotony (P  0.05), and irreparable retinal detachment (P = 0.11) was observed with increasing suprachoroidal hemorrhage complexity. Eyes with retinal incarceration, compared to eyes without retinal incar- ceration, had an increased rate of NLP vision (63% vs. 15%; P  0.01), persistent postsurgical hypotony (50% vs. 13%; P  0.05), and irreparable retinal detachment (50% vs. 20%; P = 0.07). Conclusions: Eyes requiring surgical drainage of a suprachoroidal hemorrhage have a guarded prognosis, with a poorer outcome associated with increasing hemorrhage complexity. A classification system incorporating choroidal apposition, and vitreous and retinal incarceration in the wound, provides a format for reporting and assessing the efficacy of management strategies in this condition. Ophthalmology 1998;105:2271–2275 A suprachoroidal hemorrhage (SH) is a rare but potentially catastrophic ocular event. It occurs most frequently after ocular surgery or trauma and is capable of moving retinal surfaces into apposition and expelling intraocular contents out of the eye. 1 Factors reported to predispose one to SH include advanced age, glaucoma, increased axial length, systemic cardiovascular disease, nonphakic status, and a history of vitreous loss. 2,3 Visual rehabilitation after SH often is limited, and many patients suffer severe vision loss. 4,5 Surgical drainage of the SH has been advocated for patients with retinal detachment (RD), central choroidal apposition (CCA), retinal or vitreous incarceration in the wound, a persistent flat anterior chamber, extreme pain, uncontrolled elevated intraocular pressure, or the inability to reposit the intraocular contents. 4 –10 Several clinical fea- tures that portend a poor visual outcome include a 360° SH, 5 the presence of RD at presentation, 5 and vitreous incarcer- ation in the wound. 11 Information regarding the visual prognosis after surgical drainage of SH is limited. Few large studies have been performed, and the collection of data is hampered by both its rare occurrence and the absence of adequate classifica- tion. In one of the largest series, Reynolds et al 5 reported their experience with 41 eyes. Thirty-four percent obtained a final visual acuity of 20/200 or better. In 1988, Welch et Originally received: February 20, 1998. Revision accepted: June 24, 1998. Manuscript no. 98084. From The Eye Institute, Medical College of Wisconsin, Milwaukee, Wis- consin. Presented in part as a poster at the Association for Research in Vision and Ophthalmology annual meeting, Fort Lauderdale, Florida, May 1997; and at the American Academy of Ophthalmology annual meeting, San Fran- cisco, California, October 1997. Supported in part by a Heed Ophthalmic Foundation Fellowship (WJW) and an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York. No conflicting commercial interests exist. Address correspondence to Dennis P. Han, MD, The Eye Institute, 925 N. 87th St., Milwaukee, WI 53226. 2271