{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:32:12Z","timestamp":1785429132181,"version":"3.56.0"},"reference-count":43,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Suprachoroidal hemorrhage (SCH) is a rare and sight-threatening complication of various intraocular surgeries, including cataract surgery. Although the rate of SCH complicating cataract surgery has decreased in the era of phacoemulsification, most likely due to smaller self-sealing incisions and modern equipment, it remains a challenging complication to manage. The aim of this review is to summarize the current evidence of the pathophysiology and management of SCH complicating phaco surgery. A literature review was performed using the PubMed database searching for diagnosis, therapy, and management of SCH during phacoemulsification. The evidence available on the optimal management of this condition is low, and there is no consensus so far. An early diagnosis is thought to be essential to avoid progression to the devastating stage of expulsion of intraocular contents (expulsive hemorrhage). Sudden intraoperative anterior chamber shallowing, red reflex loss, and a significant increase in intraocular pressure are highly suspicious for this severe complication. A fundus examination and ocular ultrasound are crucial to confirm the diagnosis and, if it is confirmed, stabilize the globe immediately. The initial therapeutic approach includes aggressive topical and systemic medication focused on controlling ocular inflammation and intraocular pressure, whereas the timing and the indications of surgical intervention remain controversial.<\/jats:p>","DOI":"10.3390\/medicina59030583","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T03:50:45Z","timestamp":1678938645000},"page":"583","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Management of Suprachoroidal Hemorrhage during Phacoemulsification: A Comprehensive Review"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5880-1594","authenticated-orcid":false,"given":"Ana","family":"Flores M\u00e1rquez","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Hospital Costa del Sol, 29603 Marbella, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1288-3715","authenticated-orcid":false,"given":"Facundo","family":"Urbinati","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hospital Regional Universitario de M\u00e1laga, 29010 Malaga, Spain"},{"name":"Faculty of Medicine, Universidad de M\u00e1laga, 29016 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7464-2493","authenticated-orcid":false,"given":"Carlos","family":"Rocha-de-Lossada","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hospital Regional Universitario de M\u00e1laga, 29010 Malaga, Spain"},{"name":"Qvision, Ophthalmology Department, VITHAS Almer\u00eda Hospital, 04120 Almer\u00eda, Spain"},{"name":"Ophthalmology Department, VITHAS M\u00e1laga Hospital, 29016 Malaga, Spain"},{"name":"Departamento de Cirug\u00eda, Universidad de Sevilla, \u00c1rea de Oftalmolog\u00eda, Doctor Fedriani, 41004 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3751-4817","authenticated-orcid":false,"given":"Juan \u00c1ngel","family":"Moreno Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hospital Costa del Sol, 29603 Marbella, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihnea","family":"Munteanu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Victor Babes University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariantonia","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universidad de M\u00e1laga, 29016 Malaga, Spain"},{"name":"Manchester Royal Eye Hospital, Manchester M13 9WL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4626-3741","authenticated-orcid":false,"given":"Joaqu\u00edn","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Qvision, Ophthalmology Department, VITHAS Almer\u00eda Hospital, 04120 Almer\u00eda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"6539917","DOI":"10.1155\/2022\/6539917","article-title":"Risk Factors and Treatments of Suprachoroidal Hemorrhage","volume":"2022","author":"Jiang","year":"2022","journal-title":"BioMed. Res. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/S0886-3350(98)80133-8","article-title":"Risk of acute suprachoroidal hemorrhage with phacoemulsification","volume":"24","author":"Eriksson","year":"1998","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/S0886-3350(99)00351-X","article-title":"Acute suprachoroidal hemorrhage during phacoemulsification","volume":"26","author":"Nambiar","year":"2000","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/S0886-3350(01)01230-5","article-title":"Expulsive hemorrhage before phacoemulsification","volume":"28","author":"Iaccarino","year":"2002","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/S0039-6257(99)00037-5","article-title":"Suprachoroidal hemorrhage","volume":"43","author":"Chu","year":"1999","journal-title":"Surv. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"338","DOI":"10.5301\/ejo.5000707","article-title":"Choroidal Effusion and Suprachoroidal Hemorrhage during Phacoemulsification: Intraoperative Management to Prevent Expulsive Hemorrhage","volume":"26","author":"Savastano","year":"2015","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.21037\/atm-2020-rcs-16","article-title":"Recent developments in cataract surgery","volume":"8","author":"Grzybowski","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/S0886-3350(02)01605-X","article-title":"Acute suprachoroidal hemorrhage during clear corneal phacoemulsification using topical and intracameral anesthesia","volume":"29","author":"Basti","year":"2003","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_9","first-page":"136","article-title":"Expulsive Hemorrhage: A case report and literature review","volume":"86","year":"2012","journal-title":"Rev. Mex. Oft."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/S0886-3350(13)80104-6","article-title":"Study of acute intraoperative suprachoroidal hemorrhage","volume":"18","author":"Arnold","year":"1992","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/S0161-6420(91)32316-9","article-title":"A case-control study of risk factors for intraoperative suprachoroidal expulsive hemorrhage","volume":"98","author":"Speaker","year":"1991","journal-title":"Ophthalmology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/S0886-3350(86)80075-X","article-title":"Acute intraoperative suprachoroidal hemorrhage in extracapsular cataract surgery","volume":"12","author":"Davidson","year":"1986","journal-title":"J Cataract Refract. Surg"},{"key":"ref_13","first-page":"66","article-title":"Management of Suprachoroidal Hemorrhage during Cataract Surgery: A Case Report","volume":"7","author":"Koksaldi","year":"2022","journal-title":"Beyoglu Eye J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1038\/eye.1998.210","article-title":"Acute intraoperative suprachoroidal haemorrhage in ocular surgery","volume":"12","author":"Beatty","year":"1998","journal-title":"Eye"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1038\/eye.1993.131","article-title":"Expulsive haemorrhage during phacoemulsification","volume":"7","author":"Elliott","year":"1993","journal-title":"Eye"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1136\/bjo.2003.026138","article-title":"Suprachoroidal haemorrhage complicating cataract surgery in the UK: Epidemiology, clinical features, management, and outcomes","volume":"88","author":"Ling","year":"2004","journal-title":"Br. J. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ajoc.2016.08.010","article-title":"Suprachoroidal hemorrhage during femtosecond laser assisted cataract surgery","volume":"4","author":"Bozkurt","year":"2016","journal-title":"Am. J. Ophthalmol. Case Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e8697","DOI":"10.1097\/MD.0000000000008697","article-title":"Delayed suprachoroidal hemorrhage after cataract surgery: A case report and brief review of literature","volume":"97","author":"Song","year":"2018","journal-title":"Medicine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1136\/bjo.2003.026179","article-title":"Suprachoroidal haemorrhage complicating cataract surgery in the UK: A case control study of risk factors","volume":"88","author":"Ling","year":"2004","journal-title":"Br. J. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/S0886-3350(13)80618-9","article-title":"Acute intraoperative suprachoroidal hemorrhage in capsular bag phacoemulsification","volume":"19","author":"Davison","year":"1993","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1097\/j.jcrs.0000000000000921","article-title":"Clinical features, management, and outcomes of expulsive choroidal hemorrhage during cataract surgery: 13-year experience of a tertiary eye center","volume":"48","author":"Shekhar","year":"2022","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_22","first-page":"1186","article-title":"Rare Presentation of Bilateral Carotid Cavernous Fistula as Supra-choroidal Hemorrhage during Cataract Surgery","volume":"6","author":"Zainol","year":"2021","journal-title":"Retin. Cases Brief Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e6204","DOI":"10.1002\/ccr3.6204","article-title":"Suprachoroidal hemorrhage during phacoemulsification surgery associated with recent COVID-19: A report of two cases","volume":"10","author":"Jamali","year":"2022","journal-title":"Clin. Case Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1016\/j.jcrs.2004.10.073","article-title":"Suprachoroidal hemorrhage during cataract surgery in a vitrectomized eye","volume":"31","author":"Wong","year":"2005","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1159\/000525213","article-title":"Anterior Chamber Shallowing from the Early Stage of Surgery and Supra-choroidal Effusion during Clear Corneal Small-Incision Cataract Surgery: A Case Report","volume":"13","author":"Okubo","year":"2022","journal-title":"Case Rep. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1177\/112067210201200416","article-title":"Intraoperative capsular block syndrome masquerading as expulsive hemorrhage","volume":"12","author":"Yip","year":"2002","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s00417-017-3837-0","article-title":"Acute and chronic fluid misdirection syndrome: Pathophysiology and treatment","volume":"256","author":"Grzybowski","year":"2017","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_28","first-page":"309","article-title":"Acute retrobulbar hemorrhage: An ophthalmologic emergency for the emergency physician","volume":"21","author":"Pamukcu","year":"2015","journal-title":"Ulus Trayma Acil Cerrahi Derg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Globe Pertoration, Dai, Y., Sun, T., and Gong, G.F. (2021). Inadvertent globe perforation during retrobulbar anesthesia: A case report. World J. Clin. Cases, 9, 2001\u20132007.","DOI":"10.12998\/wjcc.v9.i8.2001"},{"key":"ref_30","first-page":"104","article-title":"Multimodal Imaging in a Case of Localized Suprachoroidal Hemorrhage","volume":"15","author":"Oli","year":"2020","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_31","first-page":"545","article-title":"Experimental and clinical observations on massive suprachoroidal haemorrhage","volume":"91","author":"Lankhanpal","year":"1993","journal-title":"Trans. Am. Ophthalmol. Soc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/ICB.0b013e3182437da2","article-title":"Delayed Suprachoroidal Hemorrhage after Cataract Surgery","volume":"6","author":"Ghorayeb","year":"2012","journal-title":"Retin. Cases Brief Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3395","DOI":"10.1007\/s00417-022-05689-4","article-title":"Does acute suprachoroidal haemorrhage during phacoemulsification cataract surgery need surgical treatment?","volume":"260","author":"Gupta","year":"2022","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e225","DOI":"10.1016\/j.jcjo.2019.02.015","article-title":"When do you go back to the OR? A case of delayed IOL repositioning after suprachoroidal hemorrhage","volume":"54","author":"Ma","year":"2019","journal-title":"Can. J. Ophthalmol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1038\/s41433-020-01170-w","article-title":"Outcomes of suprachoroidal haemorrhage drainage with and without vitrectomy: A 10-year study","volume":"35","author":"Qureshi","year":"2020","journal-title":"Eye"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"185","DOI":"10.2147\/IMCRJ.S92007","article-title":"Spontaneous resolution of massive expulsive suprachoroidal hemorrhage with good long-term visual outcome: A case report","volume":"ume 8","author":"Han","year":"2015","journal-title":"Int. Med. Case Rep. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1177\/112067210601600608","article-title":"Secondary Management and Outcome of Massive Suprachoroidal Hemorrhage","volume":"16","author":"Feretis","year":"2006","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1007\/s00417-013-2550-x","article-title":"Management of delayed suprachoriodal haemorrhage after intraocular surgery and trauma","volume":"252","author":"Jin","year":"2014","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"0028","DOI":"10.1007\/s004170050005","article-title":"Massive suprachoroidal hemorrhage: Secondary treatment and outcome","volume":"238","author":"Meier","year":"2000","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1080\/08820538.2021.1890790","article-title":"An Alternative Approach for External Drainage of Suprachoroidal Hemorrhage: Active Aspiration with Butterfly Needle","volume":"36","author":"Karaca","year":"2021","journal-title":"Semin. Ophthalmol."},{"key":"ref_41","first-page":"170","article-title":"Tissue plasminogen activator-assisted vitrectomy in theearly treatment of acute massive suprachoroidal hemorrhage complicating cataractsurgery","volume":"11","author":"Fei","year":"2018","journal-title":"Int. J. Ophthalmol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e241705","DOI":"10.1136\/bcr-2021-241705","article-title":"Suprachoroidal haemorrhage (SCH) drainage using suprachoroidal tissue plas-minogen activator (t-PA) after complicated cataract extraction (two-staged procedure): Early intervention could mean better vision","volume":"14","author":"Akram","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.12998\/wjcc.v6.i15.1059","article-title":"Sub-Tenon\u2019s urokinase injection-assisted vitrectomy in early treatment of suprachoroidal hemorrhage: Four cases report","volume":"6","author":"Chai","year":"2018","journal-title":"World J. Clin. Cases"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/3\/583\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:56:11Z","timestamp":1760122571000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/3\/583"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,15]]},"references-count":43,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["medicina59030583"],"URL":"https:\/\/doi.org\/10.3390\/medicina59030583","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,15]]}}}