Dabigatran-etexilate

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Haemorrhagic choroidal detachment and suprachoroidal haemorrhage: case report A 76-year-old man developed haemorrhagic choroidal detachment and suprachoroidal haemorrhage during treatment with dabigatran-etexilate for atrial fibrillation. The man, who had primary open-angle glaucoma, was referred to the IRCCS Foundation and Hospital San Matteo, Pavia, Italy, due to uncontrolled intraocular pressure and disease progression. He had undergone cataract extraction in both eyes and 7 years back a trabeculectomy was performed on the left eye. He had been receiving treatment with timolol/dorzolamide fixed combination twice daily and bimatoprost once daily. He had a history of hypertension, ischaemic cerebrovascular accident, and atrial fibrillation, for which he had been receiving therapy with 110mg of dabigatran-etexilate twice daily as an oral anticoagulant agent. He underwent a PreserFlo Microshunt implantation in the left eye, to achieve the target intraocular pressure and halt the progression of the disease. One week after the surgery, his intraocular pressure was detected 6 to 8 mmHg, and conjunctival bleb was diffuse. There was no sign of choroidal effusion presence. His best-corrected visual acuity varied between 20/40 and 20/32. He was complaining of severe ocular pain and sudden loss of vision in the operated eye 12 days after the surgery. He denied any strain or valsalva manoeuvre and his blood pressure found normal. A slit-lamp examination was performed, which revealed corneal oedema and a flat anterior chamber. His best-corrected visual acuity was light perception, and intraocular pressure was 50 mmHg. The preserFlo microshunt was visible into the anterior chamber, deflected upward, and it was almost touching the corneal endothelium. Behind the intraocular lens, a dark mass was barely visible. Ultrasound examination was performed, which showed suprachoroidal haemorrhage, with almost the same as haemorrhagic choroidal detachment. The man started treatment with betamethasone, timolol/dorzolamide, and atropine eye drops. He underwent prompt surgical drainage of the suprachoroidal haemorrhage through 2 inferior sclerotomies, due to the persisting of ocular pain and high intraocular pressure in the next few hours. His PreserFlo Microshunt was removed. Moreover, His novel oral anticoagulant therapy was discontinued. On postoperative day 1, intraocular pressure decreased along with pain relief, and partial improvement of the haemorrhagic choroidal detachment. On postoperative day 3, his intraocular pressure increased, and ocular pain exacerbated. An ultrasound examination was performed, which showed an extension of the suprachoroidal haemorrhage. His haemorrhagic choroidal detachment was drained again through the previously performed sclerotomies, which was associated with parsplana vitrectomy and silicone-oil tamponade. Four weeks after the surgery, his intraocular pressure was 18 mmHg with dorzolamide/ timolol eyedrops. The haemorrhagic choroidal detachment resolved, and best-corrected visual acuity was hand m

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