Massive Hyphema After Combined Cataract Surgery And Istent Inject Implant. About 2 Cases

To show the therapeutic management of massive hyphema in the immediate postoperative period after combined cataract surgery and iStent Inject implant.

CLINICA REMENTERIA, MADRID.

We present two cases of two patients who underwent combined cataract surgery with iStent inject, who presented with massive hyphema as an early complication at 24 hours after surgery.
The first, an 81-year-old woman, with primary open-angle glaucoma, undergoing anticoagulant treatment .

The second, a 71-year-old woman, with pseudoexfoliative glaucoma , with oral treatment due to Mellitus Diabetes.

both patients showed an anterior chamber hyphema at 24 hours associated with intra ocular pressure higher than 38 mm  Hg; in the second case, there was organised bleeding in half of the anterior chamber too.
Topical and oral treatment management was not effective, so the anterior chamber was flushed in the operating theatre with removal of the fibrous coagulum.

In the second case, the toric IOL was repositioned on its axis, displaced by almost 90º due to the tractional effect of the retroiridian clot.
24hours later they did not have high IOP, and topical treatment was prescribed for control until the week follow-up of and month check-up, respectively.
Subsequently, the pressure was controlled in a similar way to that of the contralateral eye.

Despite the exceptional presence of massive bleeding after trabecular surgery with the
iStent inject, immediate surgical treatment is necessary because of the organisation of the bleed
and results in resolution of the event.

Subsequent visual recovery is rapid and medium-term control does not seem to be related to the occurrence of the event.