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    The hyphema that keeps on giving

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


    Point to wrap up surgery

    Tamponade of the eye was tried for a full 5 minutes. The bleeding recommenced. The tube was flushed to ensure there was no clot downstream in the patient’s Baerveldt implant.

    “I did just a little more clean-up and then I decided to call it a day,” Dr. Giaconi said. “I didn’t think his cornea could handle all this surgery.”

    Viscoelastic material was injected at the end of the case to help tamponade bleeding, but the AC was not filled with viscoelastic to avoid high pressures that would cause the patient headache.

    Although vision was improved and the patient’s pressure was reasonable, in the IOP in high 20 mm Hg, over the subsequent few days, the patient’s eye looked similar to its preoperative appearance within a week.

    Retinal oncology took him back to the OR, removed the clot, and resected the superior iris to remove the tumor.

    “In hindsight, I’d maybe place my incisions in different locations, pull on the clot further away from the tumor location to loosen it, and have been even more patient with the vitrectomy process,” Dr. Giaconi concluded. “The gentleman does have a medical condition and was on drugs that cause bleeding. I don’t know if things would have turned out differently,”

    JoAnn A. Giaconi, MD

    e. [email protected]

    This article was adapted from a presentation that Dr. Giaconi delivered at the 2016 Glaucoma Subspecialty Day, held prior to the 2016 American Academy of Ophthalmology meeting. Dr. Giaconi has no related financial disclosures.

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