Acute intraoperative suprachoroidal hemorrhage or effusion (AISH) was studied in a prospective manner over the past three years. In a general cataract surgery population of 2,523 patient eyes, 15 (0.6%) experienced an AISH. Results of a specific surgical management technique are presented. Surgical control of the AISH consisted of immediate closure of the incision and application of pressure directly to the eye. This tamponades the effusion or hemorrhage, which allows coagulation and completion of the case. There was no attempt to drain the suprachoroidal space. All cases were completed the same day, usually within an hour. The postoperative visual acuities were quite good--20/40 or better in 93% of cases. Factors contributing to AISH were 4+ brunescent nuclear sclerosis, the large incision used with nucleus expression extracapsular cataract extraction, and the combination of anticoagulation and systemic vascular disease.