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    The hyphema that keeps on giving

    Challenging glaucoma patient leads to a range of methods to stop bleeding

    By Vanessa Caceres; Reviewed by JoAnn A. Ciaconi, MD

    Large hyphemas in patients with glaucoma and persistent bleeding can be challenging to treat. JoAnn A. Giaconi, MD, discussed a challenging case of a recurrent hyphema.

    A male patient had metastatic renal carcinoma with a metastasis to the superior iris/angle that had received plaque brachytherapy five years earlier. The patient subsequently developed neovascular glaucoma four years after the plaque therapy, necessitating a Baerveldt tube shunt, with persistent neovascularization of the iris, and a small layered hyphema of a couple of millimeters in height.

    The patient also was taking a multikinase inhibitor (sunitinib malate) for his cancer and bleeding is a known side effect. Over the next year of follow-up, his vision dropped to bare hand motion level because of the enlargement of the hyphema, which grew to fill the entire anterior chamber.

    Dr. Giaconi, associate clinical professor of ophthalmology, David Geffen School of Medicine UCLA, Stein Eye Institute, Los Angeles, and retinal colleagues took the patient to the operating room. The surgeons performed an anterior chamber (AC) washout, along with intracameral cautery of the regressed tumor. However, the patient’s AC quickly refilled with blood postoperatively. 


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