Abstract： A 61-year-old male visited the hospital with the main complaint of black shadow in the left eye accompanied by vision loss for 2 weeks.The patient underwent trabeculectomy in the left eye 4 years ago,penetrating keratoplasty in the right eye 2 years ago and cataract surgery in the right eye 1 year ago.Due to granular corneal dystrophy in the left eye,the patient underwent deep lamellar keratoplasty in our hospital 6 months ago.The operation was successful,and the follow-up visits were regularly arranged.Some corneal sutures were removed 3 months after the operation.Four months after deep lamellar keratoplasty,phacoemulsification and IOL implantation were performed on the left eye.Two months thereafter,the corneal sutures of the left eye were removed again.Two weeks later,the patient complained of black shadow in the left eye accompanied by loss of vision.Physical examination of the left eye showed the uncorrected visual acuity was CF/10 cm,the intraocular pressure was 5 mmHg,the corneal graft was transparent and well-positioned,the anterior chamber was clear,the pupil was round with normal light reflex,the IOL was transparent,and the choroid was extensively detached without retinal hole or hemorrhage.The choroidal detachment was obvious in B-scan.After 5 days of local mydriatics and local and systemic anti-inflammatory treatments,the choroidal detachment did not show significant improvement.Then we decided to perform vitrectomy and choroidal reattachment surgery on her left eye.During the operation,a large amount of yellowish fluid in the suprachoroidal space was released.The choroid was reattached without retinal hole,and the vitreous cavity was filled with gas.Vision of the left eye improved gradually postoperatively.After further inquiry of the patient,we noticed that the patient felt obvious pain and nervous with forced breath-holding during the second procedure of suture removal.Summary of discussions:the Valsalva maneuver during the corneal suture removal could be the cause of choroidal detachment in this case;it is necessary to know the detailed condition of the patient,communicate well before the operation;enhance humanistic care,administer thorough anesthesia,and closely monitor the patient's condition intraoperatively;provide effective patient education,and ensure early postoperative follow-up to promptly identify any potential complications.