Role of trabeculectomy in the management of hypertensive traumatic total hyphaema

To assess the visual outcome and complications after trabeculectomy in patients of hypertensive traumatic total hyphaema. Case series. Department of Ophthalmology, Dow University of Health Sciences, Karachi, from June 2004 to May 2008. Patients with total hyphaema admitted in eye ward were included. Socio-demographic data was recorded. Complete ophthalmic examination and B-scan ultrasonography were undertaken. Trabeculectomy was performed. Visual outcome, intraocular pressure reduction and complications were recorded. Descriptive statistics were calculated. Twenty two patients underwent trabeculectomy with mean age was 23.18 +/- 12.67 years. Male to female ratio was 3.26:1. Toy gun pellet injury was present in 6 [27.3%] cases. The average intraocular pressure before surgery was 40.86 mm of Hg. All the patients had a visual acuity of light perception with an accurate projection. Evidence of corneal blood staining was observed in 16 [72.7%] patients. Mean intraocular pressure at last follow-up was 15.1 +/- 2.11 mm of Hg with a minimum of 12 mm and maximum of 20 mm of Hg in 19 [86.3%] patients [complete success]. Three patients were on additional anti-glaucoma medications. Filtering bleb was functional in only 4 [18.2%] patients. Visual acuity was 6/18 or better in 18 [81.8%] patients at last follow-up. Trabeculectomy was a satisfactory procedure for traumatic hyphaema for restoring good vision, if undertaken earlier. This procedure is not associated with significant complications and is very useful in reducing raised intraocular pressure

Reversible no light perception in patients with hyphema

One hundred cases of hyphema were studied from 1989-91. Seventy-six% of patients were under 20 years of age. Trauma was the prevalent cause of hyphema [94%]. 42% of the patients had intraocular pressure above 21 mm Hg. Along with hyphema, we observed vitreous hemorrhage [32%], corneal laceration [20%], macular edema [16%], traumatic lens opacity [12%], conjunctival laceration [8%], retinal detachment [RD] [5%], optic atrophy [5%] and scleral laceration [2%]. 62% of patients had a visual acuity between light [LP] and hand motion [HM] and 8% were no light perception [NLP] and had +4 reverse Marcus-Gunn [MG]. Two NLP patients whose intraocular pressure [IOP] could not be controlled with medical treatment underwent anterior chamber washout procedure. As a result of this, they gained visual acuity [VA] of 4/10-6/10 and their reverse MG was resolved. No significant complications such as vitreous hemorrhage or lens opacity were observed. Since hyphema alone can cause NLP and reverse MG, we suppose that all NLP patients with hyphema whose IOP are not under control with full medical treatment can be a candidate for the above mentioned surgical procedure

La iridectomía, una alternativa en el tratamiento del hipema total / Iridectomy, an alternative in the treatment of total hyphema

Iridectomy as a therapeutic alternative for total hyphema. Complete resorption of blood in eyes with posttraumatic total hyphema and high intraocular pressure not amenable to medical therapy was accomplished by means of peripheral iridectomy. No postoperative complications were noted in any of the six patients studied and intraocular pressure remained normal without medications for at least one year after the surgical procedure. Pupillary block and obstruction of the drainage pathway by the clot could account for the secondary glaucoma in these patients

Vitreófago: um instrumento útil no tratamento do hifema traumático / Vitreousphago: an useful instrument in treatment for traumatic hyphema

O Hifema Traumático é uma condiçäo bastante comum e cujas maiores complicaçöes estäo relacionadas ao aumento da pressäo intra-ocular dele resultante (ceratochema e atrofia óptica). A recidiva da hemorragia é uma situaçäo freqüente e aumenta a chance de termos glaucoma. A conduta para esses casos é ainda assunto controvertido. Drogas antiglaucomatosas säo utilizadas para o controle da PIO, e o tratamento cirúrgico se impöe quando este objetivo näo é alcançado. Vários métodos cirúrgicos têm sido adotados como a paracentese clássica, a remoçäo com pinça, a remoçäo através de infusäo e aspiraçäo. Acreditamos que a utilizaçäo do vitreófago nesses casos apresenta inúmeras vantagens em relaçäo aos métodos anteriores: preserva a câmara anterior formada durante o ato operatório; permite a retirada, com segurança, de coágulos densos e possibilita o tratamento de hemorragias recidivantes. Os autores apresentam a técnica operatória por eles empregada para o tratamento o hifema traumático

Hyphema in angle-closure glaucoma

A 66-year-old mildly hypertensive woman developed spontaneous hyphema during an acute attack of primary angle-closure glaucoma in her right eye. This manifestation is extremely rare in cases of acute angle-closure. This patient did not have any findings to suggest neovascular glaucoma. The intraocular pressure was brought under control by trabeculectomy when initial laser iridotomy failed to do so. The normalization of intraocular pressure and deepening of the anterior chamber did not cause recurrence of hyphema