Eight-ball hyphema after laser iridotomy in a patient with undiagnosed hypocellular myelodysplastic syndrome

Abstract

Introduction

We report a rare case of unexpected gross hyphema in the right eye (OD) and eight-ball hyphema in the left eye (OS) from a bilateral laser iridotomy in an acute primary angle-closure patient. We also demonstrated the effectiveness of the inferior full-thickness trabeculectomy with daily intracameral air injection as an alternative treatment in eight-ball hyphema.

Case report

An 81-year-old Thai female presented with gross hyphema grade II OD and eight-ball hyphema with blood-stained cornea OS after laser iridotomy. The patient was scheduled for surgery and the preoperative blood test showed bicytopenia. We performed anterior chamber washout OD and an inferior full-thickness trabeculectomy with daily intracameral air injection OS. The hyphema completely resolved on the following day OD and 3 days after surgery OS. The inferior bleb OS did not raise with digital pressure and became nonfunctional in 7 days. No recurrent hyphema was found in both eyes (OU) during 6 months of follow-up. This patient was ultimately diagnosed with hypocellular myelodysplastic syndrome (MDS).

Conclusion

Gross hyphema after laser iridotomy can be seen in patients with hypocellular MDS. The inferior full-thickness trabeculectomy is an alternative surgical procedure for an eight-ball hyphema.

Keywords:

• gross hyphema
• full-thickness trabeculectomy
• primary angle-closure
• goniosynechialysis

Acknowledgments

We thank David Dimasi, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript. The authors declare that no funding was obtained for this study.

Disclosure

The authors report no conflicts of interest in this work.