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

Abstract

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.

Clinical Outcome After Nd: Yag Laser Iridotomy In Patients With Primary Angle Closure Glaucoma: A Hospital Based Study

“…Although Nd: YAG laser has easy iris penetration with lower chances of iridotomy occlusion but in dark irides it is associated with high risk of failure and complications, including iris hemorrhage which may lead to abandoning of the procedure. 4 The modified technique of laser iridotomy using Argon and Nd: YAG laser has benefits of both lasers and avoids complications. In dark Asian irides, it is probably the best technique to be used.…”