Choroidal detachment and expulsive choroidal hemorrhage.

ECH occurring during open globe surgery is no longer synonymous with loss of the eye. If the eye is closed immediately (i.e., the hemorrhage does not become expulsive) and modern secondary reconstruction techniques are applied, the prognosis is good. Prophylaxis, however, is the ultimate goal, achieved by a conscious consideration of all risk factors and planning of the surgical intervention accordingly ECH nevertheless can occur, for which the surgeon must be mentally prepared and then act swiftly, based on a previously designed strategy. All ophthalmologists performing (especially open globe) surgery should remain alert. Although new techniques such as small, self-sealing incisions and phacoemulsification have lowered the ECH risk, it is still not zero. (3,44,71) Once the wound is closed and the bleeding has stopped, maneuvers such as drainage or even proceeding with the original surgery can be considered, but the risks of such a course must be carefully analyzed first. Comprehensive secondary reconstruction is best placed in the hands of specialists.