(1)
St. Johns, FL, USA
(2)
Helen Keller Foundation for Research and Education, International Society of Ocular Trauma, Birmingham, AL, USA
(3)
Consultant and Vitreoretinal Surgeon, Milos Eye Hospital, Belgrade, Serbia
(4)
Consultant and Vitreoretinal Surgeon, Zagórskiego Eye Hospital, Cracow, Poland
47.1 General Considerations
47.1.1 The Rationale for Surgical Removal
There are several reasons why the presence of blood in the AC should be taken seriously, especially if the hemorrhage is exacerbated by systemic conditions such as sickle cell disease. The risk of secondary complications is roughly proportional to the amount of blood present. The negative consequences of the hemorrhage, listed below, increase in case of a rebleeding:
Risk of glaucoma.
The bleeding can also be the consequence of (neovascular) glaucoma.
Risk of corneal blood staining (see Sect. 29.1.5).
Reduced vision for the patient.
Lack of ability to visualize the retina for the ophthalmologist – this is especially a concern if the hyphema has been caused by trauma: up to half of these eyes have serious pathology in the posterior segment.
The medical treatment (see below) is aimed at preventing secondary complications and rebleeding. If they are ineffective, surgery is indicated, especially if the IOP cannot be controlled.
47.1.2 Medical Treatment
Antiglaucoma therapy (β-blockers, carbonic anhydrase inhibitors, oral acetazolamide etc.).
Antifibrinolytic agents (aminocaproic acid, tranexamic acid).
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