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Surgical evacuation of total traumatic hyphaema with acute rise in the intraocular pressure and no perception of light vision

Poster Details


First Author: A.Fahem UK

Co Author(s): G. Mariatos                    

Abstract Details

Purpose:

To highlight the considerable improvement in visual acuity after surgical evacuation of total traumatic hyphaema in 14 years old boy despite 18 hours of sustained high intraocular pressure not responding to medical treatment and no perception of light visual acuity

Setting:

14 years old boy attended the accident and emergency department in Rotherham General Hospital after being assaulted in his right eye with a metal knuckle that resulted in a blunt trauma and severe reduction in vision.

Methods:

A case presentation of 14 years old boy with right total traumatic hyphaema , NPL and acute rise in the intraocular pressure >45 mmHg for 18 hours that has failed to respond to IV acetazolamide and IV mannitol in addition to intensive topical treatment. Surgical evacuation of hypaema under GA has been performed, using anterior vitrectomy and simcoe cannula to remove a thick clotted and organised hypaema. More than 85% of the clot was removed. Viscoelastics then injected to exert a tamponade effect. The surgery has been video recorded.

Results:

Visual acuity was HM the next day then has gradually improved over the next 2 weeks reaching 0.52 Log Mar after 10 days. IOP was 8mmHg the next day and 12mmHg 10 days after. One re-bleeding episode occurred 3 days postoperatively and was managed conservatively with topical treatment and daily follow ups. B-scan was done before and after surgery and showed flat retina with no vitreous haemorrhage and a small trauamtic cataract has been noted as anterior chamber got clearer. Optic disc appeared healthy with cup disc ration of 0.3.

Conclusions:

No clear consensus exists with regarding to when to consider surgical evacuation of traumatic hyphaema. In this case, surgical evacuation (within 24 hours) of total traumatic hyphaema with high intraocular pressure and total vision loss has led to considerable improvement in vision. Therefore, surgical intervention within 24 hours of acute rise in IOP should be considered especially when satisfactory IOP control is difficult to be achieved with medical treatment.

Financial Disclosure:

None

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