Perioperative & Surgical Risk Considerations

Suprachoroidal Hemorrhage

Suprachoroidal hemorrhage (SCH) is sudden, severe bleeding into the space between the sclera and choroid, occurring during or after glaucoma surgery. It is rare but serious, arising from rupture of choroidal vessels, most often triggered by sudden hypotony: the same pressure drop that can follow overfiltration after trabeculectomy. Left unmanaged, it can cause severe and permanent vision loss. Intraoperative and early postoperative IOP control matters for this reason as much as it does for the surgery's long-term drainage outcome.

Managing Anticoagulated Patients

Consider a patient on chronic warfarin for a mechanical heart valve who needs trabeculectomy. Stopping the anticoagulant abruptly risks a thromboembolic event; continuing it raises the bleeding risk of bleb-forming surgery. Neither option is safe to choose alone. The correct approach is to coordinate perioperative anticoagulation management with the prescribing physician, typically the cardiologist, rather than have the ophthalmologist decide unilaterally. The same principle applies to any glaucoma surgery in a patient anticoagulated for a high-risk indication, not just trabeculectomy.