What factors should be considered when deciding the best timing for choroidal drainage in a monocular patient with a suprachoroidal hemorrhage and a concurrent retinal detachment?

Reason for the suprachoroidal hemorrhage, size, duration, nature of the retinal detachment, and other coexisting conditions are some factors to consider. A therapeutic level of coumadin, use of antiplatelet medications are fine; clearly a greatly elevated INR is a contraindication. Some surgeons might briefly discontinue all of this class of drug; that decision would have to take into account the patient's risks for CVA or MI. Duration: waiting at least a week greatly increases the chances of a successful drain without inducing more bleeding, but more time is better. A small choroidal may not need drainage. A recurrent detachment with a choroidal hemorrhage an an existing scleral buckle is very different than a choroidal hemorrhage after co...

Another useful adjunct while waiting for drainage is the usage of relatively high-dose oral prednisone. You could consider doing a taper of 60 mg, 40 mg, 20 mg for five days each. As always, ensure there are no contraindications with regard to history of stomach ulcers, mental status change, uncontrolled diabetes, etc. Try to do in conjunction with primary care being aware.

I agree, trying to wait at least a week or even possibly closer to two is preferable when possible.

Lastly, be aware that in the immediate postoperative/post-drainage period it is not uncommon to see some degree of exudative subretinal fluid. This will often resolve on its own and should not prompt further immediate surgery to try and attempt detachment repair.

In these cases, the most important and sometimes most difficult thing is determining whether the retinal detachment is exudative or rhegmatogenous. This will affect the decision-making process regarding when to operate. If it's rhegmatogenous, you may need to operate sooner than would be optimal for choroidal drainage.

Assuming the retinal detachment is exudative, I would optimize the intraocular pressure, ensuring it's not too high, and wait until the clot has had a chance to dissolve before attempting drainage, as this will give you the best possible outcome. Ideally, I typically wait one to two weeks before draining the choroidal hemorrhage.

If you operate too early, you may find that the choroidal hemorrhage doesn't drain well because t...