During routine phacoemulsification, a 62-year-old woman suddenly complains of severe pain. The eye becomes tense and hard, the anterior chamber shallows, the pupil dilates, and dark red-black material is seen behind the iris. What has occurred and what is the immediate management?

• A Posterior capsule rupture; inject viscoelastic and continue phacoemulsification
• B Vitreous presentation; perform anterior vitrectomy through the same incision
• C Expulsive suprachoroidal haemorrhage; immediately close all incisions and abandon surgery ✓
• D Iris prolapse; reposit the iris and lower the infusion bottle height

Explanation

Sudden severe pain with a rock-hard globe, shallow anterior chamber, and dark choroidal elevation indicates an expulsive suprachoroidal haemorrhage from rupture of a posterior ciliary artery. The only correct response is immediate closure of all incisions to prevent extrusion of intraocular contents, sometimes aided by posterior sclerotomy. Continuing surgery or performing vitrectomy would permit catastrophic loss of ocular contents.

Reference: Khurana, Comprehensive Ophthalmology, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.