Can facial arteriovenous malformation predispose to bilateral intraoperative suprachoroidal hemorrhage?

Suprachoroidal hemorrhage is one of the most dreaded intraoperative complications that can lead to loss of vision, and is usually associated with certain ocular and systemic risk factors and is rarely reported with phacoemulsification. We present a case of bilateral recurrent intraoperative suprachoroidal hemorrhage during phacoemulsification and secondary intraocular lens implantation in a patient with no known risk factors. Our patient had a history of surgery for a lower facial arteriovenous malformation and no external ocular vascular anomalies. However, postoperatively after the resolution of the complication, enhanced-depth imaging optical coherence tomography showed bilateral marked thickening of the choroid, suggestive of subclinical choroidal hemangioma in both eyes. This abnormally thickened choroid was the possible risk factor causing recurrent suprachoroidal hemorrhage in our case. We suggest performing choroidal thickness measurements in patients with facial vascular malformations or when suprachoroidal hemorrhage occurs in the absence of known risk factors.