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    The hyphema that keeps on giving

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


    Eight-ball hyphema

    When Dr. Giaconi saw the patient postoperatively, the patient’s intraocular pressure (IOP) was over 50 mm Hg. “That wasn’t surprising considering the eight-ball hyphema,” Dr. Giaconi said.

    An eight-ball hyphema is misnamed, as it is not a liquid hyphema, but rather a clot. “When I got to the OR, the one thing I didn’t want to do was pull on the clot,” said Dr. Giaconi, as that had initiated rebleeding with the first AC washout.

    After viscodissection of the clot from the cornea, a vitrectomy of the clot was initiated in the central AC with an anterior vitrector. The eight-ball hyphema had the consistency of a gummy bear or congealed cheese, Dr. Giaconi described.

    The clot would not come to the mouth of the vitrector to be cleared, so Dr. Giaconi adjusted settings, i.e., bottle height and dropped the cut rate greatly to facilitate progress. Although textbooks advise removing an eight-ball with a vitrector, using cut-irrigation/aspiration, that did not work in this case.

    “I actually needed to aspirate a little bit of the clot toward the tip before it would cut and engage,” Dr. Giaconi said.


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