Controversies in the pathophysiology and management of hyphema

Bansal, Svati; Gunasekeran, Dinesh Visva; Ang, Bryan Chin Hou; Lee, Jia Ying; Khandelwal, Rekha; Sullivan, Paul; Agrawal, Rupesh

doi:10.1016/j.survophthal.2015.11.005

Cited by 46 publications

(62 citation statements)

References 73 publications

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“…Obstruction of the trabecular meshwork by erythrocytes, fibrin, debris, and platelets increases the IOP (1). A disruption of the wound healing process could prevent clot formation and allow blood to fill up the trabecular meshwork.…”

Section: Discussionmentioning

confidence: 99%

“…The accumulation of blood in the anterior chamber is called hyphema. This accumulation can occur due to trauma or intraocular surgery, or it can occur spontaneously (as in rubeosis iridis, juvenile xanthogranuloma, retinoblastoma, metastatic tumors, iris melanoma, myotonic dystrophy, keratouveitis, leukemia, hemophilia, thrombocytopenia, and Von Willebrand disease) (1). Hyphema may cause intraocular pressure (IOP) increases, inflammation, peripheral anterior synechia, optic atrophy, corneal staining, secondary bleeding and accommodative disorder (2).…”

Section: Introductionmentioning

confidence: 99%

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The effect of intracameral bevacizumab on current hyphema

Polat¹,

Özkan²,

Akbaş³

et al. 2019

Ann Med Res

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The aim of this study was to investigate the effect of intracameral bevacizumab on the current hyphema. Material and Methods: The animals were assigned to the following 4 groups; Group 1: One 2.5 mg bevacizumab injection to the anterior chamber; Group 2: One 1.25 mg bevacizumab injection to the anterior chamber; Group 3: One 1cc balanced salt solution injection to the anterior chamber; and Group 4: Untreated hyphema group. Non-heparinized blood that obtained from the rabbit ear was used to fill the anterior chamber to create total hyphema. Intraocular pressures (IOP), hyphema resorption time, clot formation, peripheral synechia formation, and corneal staining were recorded. Results: IOP results were 26±1.2, 30±2.1, 24±2.9, and 22±0.0 mm Hg for groups 1, 2, 3, and 4, respectively, and were significantly higher in group 2 than in the other groups (p= 0.001). Resorption times of hyphema were 13±2.2, 13±3.2, 9±1.7, and 9±1.6 days for groups 1, 2, 3, and 4, respectively, and were significantly longer for the groups receiving bevacizumab than for the others (p=0.018). The clot formation scores were 0.16±0.41, 0.14±0.38, 0.86±0.38, and 1.0±0.0 for groups 1, 2, 3, and 4, respectively, and were significantly lower for the groups receiving bevacizumab than in the other groups (p= 0.002). The peripheral synechia formation scores were 0.0±0.0, 0.0±0.0, 0.43±0.53, and 0.50±0.54 for groups 1, 2, 3, and 4, respectively, and were not significantly different (p= 0.213). The corneal staining scores were 0.85±0.35, 0.86±0.38, 0.14±0.38, and 0.14±0.38 for groups 1, 2, 3, and 4, respectively, and were significantly higher for the groups receiving bevacizumab (p= 0.035). Conclusion: Intracameral bevacizumab may increase complications that related current hyphema.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effect of intracameral bevacizumab on current hyphema

Polat¹,

Özkan²,

Akbaş³

et al. 2019

Ann Med Res

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“… 8 Surgical management is required only if medical management fails or as a rule, when true eight-ball hyphema occurs. 8 At presentation, our patient was indicated to surgical intervention OU based on empirical criteria proposed by Read and Goldberg. 8 , 17 …”

Section: Discussionmentioning

confidence: 99%

“…There are various surgical methods for hyphema management such as limbal paracentesis needle drainage, anterior chamber washout using an irrigating Simcoe cannula, anterior chamber washout using an automated anterior vitrectomy, conventional limbal clot delivery method and trabeculectomy with anterior chamber washout and peripheral iridectomy. 8 For an eight-ball hyphema where surgical management is indicated, procedures other than those described above include injection of urokinase, injection of sodium hyaluronate, cryoextraction, iridectomy and evacuation by vitrectomy instrumentation. 9 – 13 However, surgical management of an eight-ball hyphema is more challenging than a non-eight-ball hyphema, as the anterior segment is totally obscured.…”

Section: Introductionmentioning

confidence: 99%

Eight-ball hyphema after laser iridotomy in a patient with undiagnosed hypocellular myelodysplastic syndrome

Arunmongkol¹,

Suwan²,

Supakontanasan³

et al. 2018

IMCRJ

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IntroductionWe report a rare case of unexpected gross hyphema in the right eye (OD) and eight-ball hyphema in the left eye (OS) from a bilateral laser iridotomy in an acute primary angle-closure patient. We also demonstrated the effectiveness of the inferior full-thickness trabeculectomy with daily intracameral air injection as an alternative treatment in eight-ball hyphema.Case reportAn 81-year-old Thai female presented with gross hyphema grade II OD and eight-ball hyphema with blood-stained cornea OS after laser iridotomy. The patient was scheduled for surgery and the preoperative blood test showed bicytopenia. We performed anterior chamber washout OD and an inferior full-thickness trabeculectomy with daily intracameral air injection OS. The hyphema completely resolved on the following day OD and 3 days after surgery OS. The inferior bleb OS did not raise with digital pressure and became nonfunctional in 7 days. No recurrent hyphema was found in both eyes (OU) during 6 months of follow-up. This patient was ultimately diagnosed with hypocellular myelodysplastic syndrome (MDS).ConclusionGross hyphema after laser iridotomy can be seen in patients with hypocellular MDS. The inferior full-thickness trabeculectomy is an alternative surgical procedure for an eight-ball hyphema.

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“…A careful ultrasound examination of the eye, by B-scan of the posterior segment and UBM, is mandatory in such cases for a better diagnostic and surgical plane [ 2 , 3 , 4 ]. A delayed surgery, controlling in the meantime spikes of IOP, can be better than an immediate one and less dangerous [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and Therapeutic Approach in a Case of Severe Post-Traumatic Hyphema with Subtotal Iridodialysis

Romanazzi¹,

Morano²,

Caccavale³

2017

Case Rep Ophthalmol

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Purpose: To report our diagnostic ultrasound-based approach and surgical strategy in a case of severe blunt trauma with complete hyphema, 270° iris disinsertion, and traumatic subluxated cataract. Case Report: A 70-year-old male was referred to our hospital for a blunt trauma in his right eye. A complete examination revealed visual acuity consisting in light perception, a complete hyphema, and an intraocular pressure of 45 mm Hg with moderate pain. Our diagnostic approached was ultrasound based with B-scan examination showing some vitreous hemorrhage and ultrasound biomicroscopy showing a large iris disinsertion of 270° with the iris entirely dislocated in the inferior sector of the anterior chamber. The patient was hospitalized and a systemic and topical treatment was started to lower intraocular pressure. Our surgery consisted in a single-step approach with removal of traumatic cataract with scleral fixation of an intraocular lens and iridoplasty. Conclusion: In our patient, the single-step surgery, supported by anterior and posterior ultrasound imaging, achieved a satisfactory anatomical and functional outcome.

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Controversies in the pathophysiology and management of hyphema

Cited by 46 publications

References 73 publications

The effect of intracameral bevacizumab on current hyphema

The effect of intracameral bevacizumab on current hyphema

Eight-ball hyphema after laser iridotomy in a patient with undiagnosed hypocellular myelodysplastic syndrome

Diagnostic and Therapeutic Approach in a Case of Severe Post-Traumatic Hyphema with Subtotal Iridodialysis

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