New Ultrasound-Guided Technique Safely Drains Postoperative Eye Bleeding, Case Report
A recent case report shows that using a clot-dissolving drug, recombinant tissue plasminogen activator (rtPA), under ultrasound guidance allows surgeons to safely and rapidly drain severe postoperative eye bleeding. This breakthrough technique bypasses weeks of waiting, enabling immediate treatment to protect patient vision.
These findings of the case report are published in the Journal of Current Glaucoma Practice by Saurabh Verma and colleagues from the Department of Ophthalmology at the Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi.
Managing a post-surgical suprachoroidal hemorrhage is highly critical because delayed drainage can result in permanent blindness, particularly in advanced glaucoma patients whose optic nerves cannot tolerate elevated intraocular pressure (IOP). This case is of paramount clinical importance because it successfully overcomes the traditional ten-to-fourteen-day delay required for natural clot liquefaction, thereby preventing irreversible retina-to-retina adhesions from appositional or kissing choroidals.
A middle-aged male with bilateral progressive visual decline underwent an uneventful trabeculectomy on his right eye, which was complicated on postoperative day one by an SCH diagnosed through USG showing appositional clotted choroidal mounds, elevated IOP of 38 mm Hg, and vision reduced to light perception. To treat this, the medical team executed a two-stage intervention comprising targeted suprachoroidal injections of 100 micrograms of rtPA, followed five hours later by trocar-cannula drainage under positive pressure, resulting in stable IOP of 10 to 12 mm Hg and complete anatomical resolution of choroidal detachment at the six-month follow-up.
The injection of rtPA directly into the suprachoroidal space initiates enzymatic fibrinolysis of clotted blood, transforming solid hematomas into a drainable liquid state within a few hours. This liquefaction process is non-invasively monitored via serial USG, which reveals a reduction in spike amplitude within the suprachoroidal space, while positive infusion pressure from the anterior chamber maintainer facilitates complete extrusion of the liquefied blood.
The approach is highly valuable for managing postoperative ocular emergencies, particularly in eyes with kissing choroidals or medically uncontrolled IOP where delayed intervention increases the risk of retinal detachment and irreversible optic nerve damage. By establishing a safe protocol for rapid, ultrasound-confirmed clot lysis, this technique provides clinicians with a powerful tool to achieve early anatomical success and preserve vision, especially in vulnerable, monocular glaucoma patients.
Reference
Verma S, Azad SV, Udenia H, Balaji A, Dada T. Recombinant Tissue Plasminogen Activator-assisted Early Drainage of Suprachoroidal Hemorrhage. J Curr Glaucoma Pract 2026;20(2):95–97.
