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T. A. Larson, S. J. Bakri, L. Sculley, A. O. Edwards; Ultrasound Biomicroscopic Analysis of Haptic Position in Recurrent Hyphema and Vitreous Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2008;49(13):615.
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© ARVO (1962-2015); The Authors (2016-present)
To describe haptic-ciliary body touch on ultrasound biomicroscopy (UBM) in cases of recurrent hyphema or vitreous hemorrhage in pseudophakic patients for which no cause is found.
Retrospective chart review of five cases of pseudophakic patients with recurrent hyphema or vitreous hemorrhage who underwent UBM analysis. UBM (Humphrey Instruments) was performed with a 50 MHz transducer by the same ultrasonographer. Following topical ocular anesthesia, a scleral cup was filled with sterile saline and placed between the eyelids. The UBM transducer was then introduced, providing a 2-D image of a 5 mm x 5 mm region of the anterior segment of the eye.
Five pseudophakic patients presented with decreased vision secondary to recurrent hyphema and or vitreous hemorrhage. All cases had prior intraocular lens (IOL) placement: 1 sulcus IOL, 3 posterior chamber IOLs, and 1 anterior chamber IOL placement. Two cases had documented glaucoma with one having had prior tube shunt placement. Time from IOL implantation ranged from 7 months to 18 years with no documented time in one case. Two cases demonstrated a Krukenberg spindle on anterior segment exam. Hyphema alone was present in two cases, hyphema and vitreous hemorrhage was present in one case, and vitreous hemorrhage alone was present in two cases. No preceding trauma or retinal pathology was found to account for the recurrent hyphema or vitreous hemorrhage; however, two cases had diabetic retinopathy and one had history of retinal detachment repair. UBM was performed and revealed haptic ciliary body touch in all cases with the superior footplate of the anterior chamber IOL embedded in the ciliary body. IOL exchange was recommended for all cases.
UBM is a useful tool to evaluate haptic position in pseudophakic patients with recurrent hyphema and or vitreous in which no other source of bleeding is found. In the five cases presented here, UBM revealed haptic-ciliary body touch as a source of recurrent bleeding. Definitive therapy would then require IOL exchange or repositioning of the IOL haptics.
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