Supplementary Material for: Expulsive Choroidal Hemorrhage (ECH) during Femtosecond Laser-Assisted Cataract Surgery (FLACS) in a Patient with Acute Angle-Closure Glaucoma: A case report

We present a case that underscores the occurrence of Expulsive Choroidal Hemorrhage (ECH) during the procedure of Femtosecond Laser-Assisted Cataract Surgery (FLACS), emphasizing the imperative for surgeons to engage in a meticulous evaluation of the ECH risk associated with FLACS.
Case Presentation: A 73-year-old female patient, afflicted with cataract and Acute Angle-Closure Glaucoma, underwent FLACS. After an initial attempt at docking met with failure, the second endeavor proved successful. In the wake of the femtosecond laser surgery, a minor hemorrhage was discerned at the nasal anterior chamber angle. During the phacoemulsification (PHACO) , further hemorrhaging manifested at the nasal anterior chamber, accompanied by a subincisional iris that prolapsed from the main incision. A rupture of the posterior capsule ensued, precipitating the outflow of blood and vitreous from the vitreous cavity, thereby thwarting the planned implantation of the intraocular lens. Consequently, the patient underwent vitrectomy and external drainage of the sclera. Remarkably, her postoperative course unfolded without incident, culminating in an uneventful final result.
Conclusions: This case suggests that performing FLACS during cataract surgery in patients with acute angle-closure glaucoma may lead to ECH . It is advisable to consider FLACS after sufficiently and adequately reducing intraocular pressure and eliminating intraocular inflammation only. Surgeons should more carefully assess the risks and benefits of using FLACS in similar cases and develop a management plan for potential ECH.