J Korean Ophthalmol Soc.  2017 May;58(5):611-615. 10.3341/jkos.2017.58.5.611.

A Case of Acute Angle-closure Glaucoma Secondary to Spontaneous Suprachoroidal Hemorrhage

• Yoon DH
• Kim HK
• Shin JP
• Kim IT
• Kim DW

• KMID: 2378635
• DOI: http://doi.org/10.3341/jkos.2017.58.5.611

Abstract

PURPOSE
To report a case of acute angle-closure glaucoma secondary to spontaneous suprachoroidal hemorrhage in a hemodialysis patient.
CASE SUMMARY
A 71-year-old man visited our clinic after 3 days of vision loss and ocular pain in the right eye. He had been treated with hemodialysis using heparin due to diabetic nephropathy. Visual acuity (VA) was hand motion in the right eye and 0.2 in the left eye. The intraocular pressure (IOP) was 58 mmHg in the right eye and 15 mmHg in the left eye. Gonioscopic examination revealed a closed angle in the right eye. Fundus examination of the right eye showed a massive hemorrhagic retinal detachment and ultrasound sonography revealed a dome-shaped retinal detachment with suprachoroidal hemorrhage in the right eye. The patient was treated with topical aqueous suppressants and cycloplegics. After two weeks of medical treatment, VA in the right eye was still hand motion and IOP was 8 mmHg. Gonioscopic examination showed a wide-open angle in the right eye. During the two-month observation period, VA in the right eye did not recover, however there was no sign of IOP elevation or symptoms of ocular pain.
CONCLUSIONS
Spontaneous suprachoroidal hemorrhage can occur in patients who receive hemodialysis with heparin. This spontaneous suprachoroidal hemorrhage can be subsequently accompanied by acute angle-closure glaucoma. Spontaneous decrease of suprachoroidal hemorrhage, loss of angle-closure, and decline of IOP can be expected by treating with topical aqueous suppressants and cycloplegics.

Keyword

Acute angle-closure glaucoma; Hemodialysis; Suprachoroidal hemorrhage

MeSH Terms

Aged
Diabetic Nephropathies
Glaucoma, Angle-Closure*
Hand
Hemorrhage*
Heparin
Humans
Intraocular Pressure
Mydriatics
Renal Dialysis
Retinal Detachment
Ultrasonography
Visual Acuity
Heparin
Mydriatics

Figure

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  Figure 1 Anterior segment photograph after acute angle-closure attack. Slit lamp photograph shows a shallow anterior chamber in the right eye.

• 

  Figure 2 Changes of massive hemorrhagic retinal detachment in the right eye. (A) Fundus photography shows massive hemorrhagic retinal detachment in the right eye before treatment. (B) Ultrasound sonography of the right eye reveals a dome-shaped choroidal detachment with hypo-echogenous content in addition to hemorrhagic retinal detachment before treatment. (C, D) Fundus photography and ultrasound sonography show vitreous hemorrhage in the right eye two weeks after instillation of topical aqueous suppressants and cycloplegics.

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