Intraoperative and postoperative suprachoroidal hemorrhage in pediatric patients undergoing penetrating keratoplasty or Ahmed valve implantation.

Purpose: This retrospective case series aims to characterize the ocular findings, clinical presentation, management, and outcomes of suprachoroidal hemorrhage (SCH) in pediatric patients undergoing penetrating keratoplasty (PK) or Ahmed glaucoma valve (AGV) implantation.

Methods: From 2012 to 2023, a total of 58 pediatric patients underwent PK, and 89 underwent AGV implantation at our institution. Among these, three perioperative SCH cases were identified. Medical records, anterior segment photographs, and ultrasonographic images of these patients were reviewed.

Results: All three patients had Peters anomaly, congenital glaucoma (CG), and aniridia in both eyes. In Case 1 with Peters anomaly, CG, and partial aniridia, SCH developed intraoperatively in an aphakic eye during the third PK. In Case 2 with Peters anomaly, CG, and total aniridia, SCH was observed one day after PK and lensectomy. In Case 3 with Peters anomaly, CG, and partial aniridia, SCH occurred two days after AGV implantation in a pseudophakic eye with prior PK and cataract surgery. SCH resolved with conservative management in all cases. However, Cases 1 and 2 ultimately lost light perception, while Case 3 achieved a best-corrected visual acuity of 0.06.

Conclusion: The risk of intraoperative and delayed SCH should be considered in eyes with Peters anomaly, CG, and aniridia during intraocular surgeries that involve significant intraocular pressure fluctuations.