Managing a sudden choroidal hemorrhage during this Boston K-Pro surgery requires immediate control of intraocular pressure and rapid stabilization before attempting any drainage. At the first sign of suprachoroidal expansion, loss of the red reflex, a dark hue, rapid shallowing of the chamber, rising pressure, the infusion should be stopped and the eye closed promptly with watertight sutures to tamponade further bleeding. External ocular pressure can help limit expansion while maintaining patient blood pressure control and avoiding Valsalva. Once the eye is stabilized, controlled drainage can be planned. A trans-scleral approach is typically used, creating small posterior sclerotomies in quadrants of maximal elevation. After initial passive decompression, tissue plasminogen activator (tPA) can be injected trans-sclerally into the suprachoroidal space to promote clot liquefaction, allowing more complete evacuation over the next few minutes. Careful, incremental aspiration through the drainage sites minimizes traction on the retina. Once the suprachoroidal space is adequately decompressed, the K-Pro procedure can be cautiously resumed with close attention to pressure stability. Have you every seen this complication? How did you manage it?
