Abstract
Purpose :
To understand the course and optimize management of patients with hyphema and vitreous hemorrhage caused by intraocular lens (IOL) subluxation.
Methods :
Retrospective chart review of patients presenting with vision loss from hyphema and vitreous hemorrhage associated with IOL subluxation.
Results :
Five patients presented with transient episodes of vision loss from IOL subluxation, and evidence of red blood cells in the anterior chamber. All were male and minimum 70 years of age (Mean 80 ± S.D. 10) and previous cataract surgery more than 10 years earlier. Often the bleeding episodes in the anterior chamber cleared spontaneously. Evidence of IOL subluxation was demonstrated by iris transillumination defects and loss of iris pigment epithelium from contact by the IOL. All patients were initially managed by cycloplegia to reduce iris movement. Three patients (60%) were on anti-coagulant or anti-platelet therapy. Patients were followed for an average of 4 years. Eventually 4 (80%) patients developed a dense non-clearing vitreous hemorrhage that required pars plana vitrectomy (PPV). Hemolytic glaucoma developed in 2 patients. IOL exchange was necessary in 4 patients. In one patient, recurrent episodes of vitreous hemorrhage cleared without vitrectomy, and eventually remained clear after stopping warfarin.
Conclusions :
Hyphema and vitreous hemorrhage may be late complications of cataract surgery in elderly patients who are placed on blood-thinning medication. When non-clearing vitreous hemorrhage develops, vitrectomy with IOL sulcus repositioning or exchange can be beneficial.
This is a 2020 ARVO Annual Meeting abstract.