Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan.
Medicine (Baltimore). 2022 Jul 8;101(27):e29278. doi: 10.1097/MD.0000000000029278.
Hyphema, that is, massive anterior chamber hemorrhage, is one of the major complications after a recent minimally invasive glaucoma surgery. Hyphema along with high intraocular pressure increases the risk of corneal bloodstaining.
A 71-year-old female was receiving 0.1% fluorometholone drops in both eyes for severe dry eye. She was also receiving antiplatelet agents for platelet aggregation hyperactivity and prednisolone for interstitial pneumonia internally. Her right eye was suffering from increased intraocular pressure.
We diagnosed her right eye as steroid-induced glaucoma.
We performed microhook trabeculotomy.
At postoperative day 10, she had total anterior chamber hemorrhage and high intraocular pressure, and subsequently developed corneal blood staining at postoperative day 15, for which we performed anterior chamber cleaning. After that, we did not perform additional anterior chamber cleaning, and during the 1-year follow-up, a gradual improvement was noted in the entire cornea with reddish-brown opacity, from the periphery to the center. However, almost the entire pupil was still covered with opacity, and her visual acuity was at the light perception at the final visit.
Corneal bloodstaining takes a considerable time to resolve and causes severe vision loss. Special attention should be given to persistent corneal blood staining when hyphema and high intraocular pressure are observed after minimally invasive glaucoma surgeries.
前房积血，即大量前房出血，是最近微创青光眼手术后的主要并发症之一。前房积血加上高眼压会增加角膜血染的风险。
一位 71 岁女性因严重干眼症双眼滴用 0.1%氟米龙滴眼液，同时因血小板聚集过度口服抗血小板药物，因间质性肺炎口服泼尼松龙。右眼眼压升高。
右眼诊断为激素性青光眼。
行微钩小梁切开术。
术后第 10 天，患者发生前房全部积血和高眼压，随后在术后第 15 天发生角膜血染，行前房冲洗。此后，我们未再行前房冲洗，在 1 年的随访中，整个角膜的红棕色混浊逐渐改善，从周边向中央。然而，几乎整个瞳孔仍被混浊覆盖，最终就诊时视力仅光感。
角膜血染需要相当长的时间才能消退，并导致严重的视力丧失。在微创青光眼手术后观察到前房积血和高眼压时，应特别注意持续的角膜血染。
