Department of Ophthalmology, Jules-Gonin Eye Hospital, FAA, University of Lausanne, Lausanne, Switzerland.
Klin Monbl Augenheilkd. 2022 Apr;239(4):559-564. doi: 10.1055/a-1785-4912. Epub 2022 Apr 26.
We report a rare case of spontaneous suprachoroidal hemorrhage and present a systematic review of the literature using PubMed/Medline databases. Patients that developed a spontaneous suprachoroidal hemorrhage with a history of previous intraocular surgery were excluded. An 82-year-old male patient with no known ocular pathologies or surgical history was referred with acute ocular pain and decreased vision in the right eye (BCVA: 0.6 with hyperopic correction) following a Valsalva maneuver. General history included chronic heart failure and coronary artery disease, treated with anticoagulant and antihypertensive drugs. Dilated fundus examination revealed a posterior red-brown choroidal mass, with a thickness of 1.5 mm on B-scan ultrasonography. The lesion was not visible on fluorescein or indocyanine green angiography and was located under the choroid on B-scan optical coherence tomography. The diagnosis of a spontaneous suprachoroidal hemorrhage was evoked, and the patient was observed. Five months later, BCVA was 1.0 uncorrected, with a normal-appearing fundus. In a literature review, eight cases of spontaneous suprachoroidal hemorrhage following an episode of increased intrathoracic pressure were identified, including our patient. M/F ratio was 1 : 1, with a median age of 66.5 years. All cases presented systemic pathologies. All cases presented with a unilateral suprachoroidal hemorrhage. Only 2/8 patients had ocular comorbidities. Complications requiring treatment were noted in 4/8 cases, including 2 cases that resulted in the loss of the vision following an acute angle-closure glaucoma. Spontaneous resolution of the hemorrhage was observed in the other 4 patients. In 6/8 cases, vision recovered over a mean period of 10 weeks. In conclusion, spontaneous suprachoroidal hemorrhage following a Valsalva maneuver in eyes with no history of ocular surgery or trauma is rare, and has been associated with advanced age, cardiovascular disease and asthma. In severe cases (2/8) the eye was lost, while most cases (6/8) recovered, presenting a good visual outcome.
我们报告了一例罕见的自发性脉络膜上腔出血病例，并使用 PubMed/Medline 数据库进行了系统综述。排除了有先前眼内手术史的患者。一名 82 岁男性患者，无已知眼部疾病或手术史，在 Valsalva 动作后因右眼急性眼痛和视力下降（矫正远视后视力为 0.6）就诊。一般病史包括慢性心力衰竭和冠状动脉疾病，用抗凝和抗高血压药物治疗。散瞳眼底检查显示后棕红色脉络膜肿块，B 超检查厚度为 1.5mm。荧光素或吲哚青绿血管造影未见病变，B 扫描光相干断层扫描显示病变位于脉络膜下。考虑自发性脉络膜上腔出血的诊断，并对患者进行观察。5 个月后，未矫正视力为 1.0，眼底正常。在文献综述中，共发现 8 例因胸腔内压力增加而导致自发性脉络膜上腔出血的病例，包括我们的患者。男女比例为 1:1，中位年龄为 66.5 岁。所有病例均有系统性疾病。所有病例均表现为单侧脉络膜上腔出血。仅有 2/8 例患者有眼部合并症。8 例中有 4 例出现需要治疗的并发症，包括 2 例急性闭角型青光眼导致视力丧失。4 例患者的出血自发性消退。6/8 例患者视力在平均 10 周内恢复。总之，在无眼部手术或外伤史的眼睛中，Valsalva 动作后自发性脉络膜上腔出血罕见，与年龄较大、心血管疾病和哮喘有关。在严重的情况下（2/8），眼睛丧失，而大多数情况下（6/8）恢复，视力预后良好。
