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    Entry wound complications: Unexpected entry site hemorrhage proved difficult to manage

    Using valved cannulas during phacovitrectomy is highly recommended when an unexpected site hemorrhage becomes difficult to manage, according to David Fonseca Martins, MD.

    Dr. Martins of Lisbon, Portugal, described the case of a 25-year-old male patient with a personal history of intravenous drug use and uveitis. The patient underwent a combined 23-gauge phacovitrectomy to remove a secondary cataract and clear the vitreous. There were numerous inflammatory membranes in the posterior pole and optic disc that were carefully removed.

    The case was presenting during a session on retina complications at Retina Subspecialty Day prior to the 2015 American Academy of Ophthalmology annual meeting in New Orleans.

    “We decided to peel the epiretinal membrane and the internal limiting membrane using a mixture of Trypan blue and Brilliant Blue,” Dr. Martins said. “At the end, we did a fluid-air exchange to tamponade the eye.”

    Dr. Martins noticed some conjunctival hemorrhage just above the scleral entry site after removal of the first surgical trocar, and applied external diathermia. Although that appeared successful, there was a “gushing of blood into the anterior chamber coming from behind the iris. In a few seconds, the entire anterior chamber was filled with blood,” he said.

    To see Dr. Martins perform this procedure, click here to skip to the last page. 

    What was the cause?

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