Hyphema in the immediate postoperative period usually originates from the incision or the iris. The risk of hyphema is greater in patients with pseudoexfoliation syndrome, anterior segment neovascularization, Fuchs heterochromic uveitis, or vascular tufts at the pupillary margin. Combined minimally invasive glaucoma surgeries may cause hyphema postoperatively.
Hyphema is commonly mild and resolves spontaneously. When it is prolonged, the major complications are elevated IOP and corneal blood staining. IOP should be monitored closely and initially treated medically, although it may be difficult to control if the blood is mixed with the OVD used during the procedure. Resolution may take longer if the blood has mixed with vitreous. Surgical evacuation is occasionally necessary.
Hyphema occurring months to years after surgery is usually the result of incision vascularization or erosion of vascular tissue in the iris or ciliary body by an IOL haptic or optic edge. Laser photocoagulation of the bleeding vessel, often performed through a goniolens, may stop the bleeding or prevent rebleeding. To reduce the risk of continued or recurrent bleeding, antiplatelet or anticoagulation therapy may be withheld, if medically possible, until the hyphema resolves. Occasionally, an IOL that comes in contact with the iris or angle structures and causes recurrent intraocular hemorrhage (uveitis-glaucoma-hyphema syndrome, discussed later in this chapter) must be repositioned or exchanged.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.