Predictors of Visual Outcomes in Surgically Managed Hemorrhagic Choroidal Detachment

Purpose: To identify predictors of visual acuity (VA) after surgical management of hemorrhagic choroidal detachment (HCD) and assess whether surgical timing or drainage technique affects anatomic outcomes and postoperative rhegmatogenous retinal detachment (RRD). Methods: Retrospective cohort of surgically managed HCD eyes. Timing was categorized as 0–6, 7–14, or ≥15 days from diagnosis. Primary outcome was postoperative month-6 (POM6) best available VA (logMAR) analyzed with multivariable linear regression. Secondary outcomes included HCD resolution and postoperative RRD. Results: Sixty-seven eyes were included (mean age 74.8 ± 12.1 years; 44.8% female). Median time to surgery was 8-days (IQR, 3–14). Mean VA improved from 2.57 ± 0.34 logMAR (Snellen 20/8000) to 2.07 ± 0.79 logMAR (Snellen 20/2400) at POM6 (p<0.001). Using 7–14 days as reference, 0–6-day surgery independently predicted worse POM6 VA (p=0.008), whereas ≥15 days surgery did not. Worse baseline VA, appositional choroidal detachments, and trauma were also independently associated with poorer POM6 VA (p<0.05). Time to HCD resolution did not differ by timing or drainage technique; however, all five repeat drainages occurred in the 0–6-day group. Postoperative RRD occurred in 20 eyes (29.9%) and was independently associated with traumatic etiology. Conclusion: Early surgery was associated with worse 6-month visual outcomes compared with surgery at 7–14 days. Neither drainage technique nor surgical timing influenced anatomic resolution or postoperative RRD risk. These findings support delayed intervention until clot liquefaction when appropriate and identify trauma-associated HCD as a higher-risk subgroup.