Abrupty Developed Suprachoroidal Hemorrhage During The Peritoneal Dialysis

Hui Jae Lee

Purpose: To report a case of abruptly developed suprachoroidal hemorrhage during the peritoneal dialysis in patient with PDR

Case Summary: A 53-year-old women visited our clinic with blurred vision due to vitreous hemorrhage with proliferative diabetic retinopathy. She had a medical history of the diabetes, hypertension, chronic renal failure and took a scheduled peritoneal dialysis. We performed a vitrectomy without any complications. 2 hours later, retina was stable and IOP was 11 mmHg. 4 hours later, while she took a peritoneal dialysis, she felt abruptly developed eye ball pain. When we examined her eye, intraocular pressure was 30 mmHg and she had a suprachoroidal hemorrhage in entire peripheral retina and posterior pole. Until postoperative 12 hours, suprachoroidal hemorrhage were more aggravated and 'kissing retina' was imminent, so we decided to inject silicone oil. When we did air-fluid exchange, there were no enough space to fill silicone oil because suprachoroidal hemorrhage were more aggravated. So we made a sclerotomies to remove suprachoroidal hemorrhage, then we were able to find space to inject silicone oil. Postoperative 2 months later, she took a removal of silicone oil and her visual acuity was improved to 20/40 but one month later, she died of pontine hemorrhage.

Conclusion: It should be noted that suprachoroidal hemorrhage can occur from increasing abdominal pressure during the peritoneal dialysis in virectomized patients because chronic renal failure patients with diabetes and hypertension have a structural vulnerability and weakness of vascular system from the arterial sclerosis in regard to increasing blood pressure.