Expulsive Choroidal Hemorrhage!

This video is a MUST SEE! An expulsive choroidal hemorrhage is a rare complication than any cataract surgeon must be able to recognize. This severe, sight-threatening complication can happen in just one second. While there are risk factors, it is difficult to predict which patients are more likely to have this terrible complication. I have never seen this complication in any of my surgeries in more than 20 years of doing ocular surgery. That does not mean it cannot happen in the future. And I encourage ALL of our CataractCoach.com viewers to study this video carefully so that in the rare chance that this complication happens to your patient, you will be able to handle the issues and help your patient.

We are grateful to for the anonymous submission from one of our CataractCoach fans and I encourage you to submit your video here so that we can all learn together.

Click below to learn from this incredible video of a choroidal hemorrhage:


    1. I’m not sure since the case was anonymously submitted. Typical the visual outcome is very limited.

  1. Have you experienced this complication?

    comments from FaceBook:

    Malik Naeem Awan
    Very dreadful scenario. It happened with one of my case.

    Joshua Udoetuk
    Yes, but only by referral
    limited peritomy with sclerotomy +/- PPV if warranted and safe enough

    Jay McDonald
    I had one. Actually showed the complication at ASCRS panel on complications. Unsettling unnerving and forever humbling.

    Stephanie Becker
    Omg ! It happened to me like 20 years ago when I was on a medical mission in Nigeria doing cataract surgery on a mature lens in a gentleman with preop IOP of 40+.

    Richard Schulze Jr
    thanks for sharing this case. This patient was lucky to have had only a limited choroidal hemorrhage which fortunately for him, was not truly expulsive. There is no way an AC IOL could have been placed with a full blown, expulsive choroidal hemorrhage

    Mohamed Sayed
    Yes, in a patient in whom I was performing ab interno trabeculotomy (combined with cataract surgery), the patient screamed of pain as I was passing the filament of the device into the Schlemm canal (? i could’ve been in the suprachoroidal space

    Mahbub Sobhan
    Yes 3 times. Horrible situations. Though never happened in my case, but had to manage others’.

    Alena Victoria
    Yes, but during a trab…

    Mahmoud Abdel Hafez
    Yes limited and aborted thank god and since that i always have a 8-0 over my machine every time i am in OR just in case
    In this case he was lucky and slow in closing the eye it might have been ended in a way more dramatic

    Sherif M. Ekram
    I actually haven’t had anyone before, but I have aborted one from about to happen. It was an open sky operation, penetrating keratoplasty and cataract for anterior staphyloma case, unstable eye already. Suddenly I found the intraocular content pulsating

    Rishi Swarup
    I’ve had a couple both during Keratoplasty

    Ruben Sanchez
    Yes, during a PK

    Lukan Mishev

    Larry Patterson
    we had one about 25 years ago operating in Guatemala. Large extra cap incision on a blind eye due to severe cataract. It was truly an expulsive hemorrhage. The intraocular contents out in seconds before anything could be done. No hope of fixing that.

    Hisham Ashraf Omar
    Yes .. had it once in a high myope patient with a giant retinal tear whom i planned for phaco vitrectomy… it happened while i was just finishing the cataract extraction.. it was very unfortunate … later i found out that the patient neglected to take his oral b blocker for hypertension.. so he probably developed tachycardia .. i drained the hge 2 weeks later and completed his vitrectomy but only regained a vision of 1/60

    Naveen Rao
    This is an amazing video. Thank you to the surgeon for being willing to share it so we can all learn.

    Ahmed Taha
    Great discussion

    Ahmed Al-Mohammadi
    reading comments gave me goosebumps!! It’s like watching a horror movie

    Ramesh Ayyala
    When you see suprachoroidal hem in the middle of a case, such as this one 1 close the wound ASAP like you pointed out 2 do a sclerotomy at the same time. This is only window that you have to drain some of the blood before it clots. Have to do it as one maintains high pressure in the eye. Even if you drain few cc s it will cut short the overall time of resolution with less pain

    John Belardo
    Yes, I caught early the red réflex was getting dark in the periphery and I immediately stopped doing the cataract surgery and inflated the eye . Post op the choriods slowly resolved and I finished her surgery several weeks later.

    Jodi Luchs
    Sadly I’ve been there

    William G. Myers
    I had one that occurred after the PC iol was in the bag. I had the nurse get 4 sutures cut in half and placed the needles across the wound but not removed nor tied until all needles were in place. Then I watched the IOL dial itself back into the AC. This was in ECCE days. Now with phaco incisions it would be 1-2 sutures.

    Rogério Horta
    Just once. Devastating situation for me and the patient.

    Jurij Kocmut
    yes about 35 yesrs ago

    Leonardo Torquetti
    I had it twice in PK patients, 17 years ago. Both patients had multiple previous eye surgeries. A nightmare….

  2. Thankfully I haven’t had this happen to me intraoperatively yet in 22+ years, but I’m dealing with an awful case of hemorrhagic choroidal effusions that appeared 3 days after a phaco case. The patient was on both plavix and xarelto when I thought it was only plavix Perhaps he had a small undetected choroidal hemorrhage intraoperatively, but he was not symptomatic on postop day 1. Had sudden onset of pain, decreased vision, and nasty 360 degrees of subconjunctival heme 3 days later. Exam revealed extensive hemorrhagic choroidals. The case is being managed with an excellent local vitreoretinal colleague but the Va remains poor some 7 weeks later. Bad juju.

    1. Great input. I tell patients that they must understand that the visual outcome is half from my surgery and half from their tissue and healing response.

  3. When you drain the suprachoroidal hame and visual prognosis? First time I’m seeing such a operative video. Thanks Dr.Devagan.

    1. the sooner it is drained, the better. some surgeons drain it at the same sitting while others prefer to wait a few days. I don’t have the final prognosis for this patient — the video was anonymously submitted.

  4. Its another reason to never convert a small 2.75mm or < phaco incision to a larger incision no matter what. With a small phaco incision you will never get an expulsive as the eye is pressurized to some degree

  5. Besides not performing this surgery, this there anything folks would have done differently to prevent this from happening in this scenario? Or is this simply a case of very bad luck? Thank you for sharing!

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