Suprachoroidal Haemorrhage Mimicking Capsular Block Syndrome and Fluid Misdirection Syndrome during Cataract Surgery

Suprachoroidal haemorrhage (SCH) is a rare but serious complication of intraocular surgery that may be misdiagnosed intraoperatively as capsular block syndrome (CBS) or fluid misdirection syndrome (FMS), especially in the absence of a clear fundal view. We report the case of a 70-year-old male undergoing phacoemulsification for a dense cataract, who developed sudden anterior chamber shallowing and iris prolapse following repeat hydrodissection. The initial impression favoured CBS or FMS. However, SCH became apparent only after the case was converted to extracapsular cataract extraction for nucleus removal, at which point the absence of red reflex and vitreous prolapse were noted. The incisions were promptly sutured after a limited anterior vitrectomy. The eye ball was left aphakic and slightly hypertonic. The patient was placed in a reverse Trendelenburg position. Postoperative B-scan confirmed the diagnosis of appositional SCH, and the patient was conservatively managed. Regression of SCH with improvement in vision was noted at 3 weeks follow-up. This case underscores the diagnostic challenge and emphasises the importance of timely recognition and appropriate management of SCH.