What is the role of vitrectomy instrumentation in the treatment of hyphema?

Updated: Jan 18, 2019
  • Author: David L Nash, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Answer

Currently, the preferred technique is evacuation of the hyphema with vitrectomy instrumentation. The initial clear corneal incision is made with a diamond blade. To avoid both the iris and the lens, the blade is oriented and pushed into the anterior chamber in such a manner that it is parallel to the plane of the iris. A 20-gauge Ocutome or similar guillotine instrument, attached to an infusion line of balanced salt solution plus (BSS-Plus), is gently placed into the anterior chamber. The bottle of BSS-Plus should be 30-40 cm above the eye to maintain normal intraocular pressure. With the Ocutome cutting port half open and the infusion line in place, irrigating and aspirating free blood from the formed clot are possible. The suction mode is initially set at 4, and the cutting speed is set at 150 for the procedure. An anterior chamber maintainer can help stabilize fluctuations in intraocular pressure during clot evacuation. [67]

Extreme care is required to avoid any contact with the iris, the lens, or the corneal endothelium. Directing the guillotine port anteriorly and always keeping the port in view generally avoids intraoperative uveal tissue injury. This operative procedure is used to remove the central portion of the clot. Removing the entire clot in the periphery of the anterior chamber is not necessary.

If a secondary hemorrhage occurs during the operative procedure, the authors recommend tamponade of the bleeding by elevation of the infusion bottle to approximately 70 cm above the eye for several minutes. If the bleeding continues, filling the anterior chamber with an air bubble after evacuating the clot is helpful. If bleeding persists, bimanual bipolar diathermy is extremely helpful when the bleeding site is visible. [68] At the end of the surgical procedure, filling the anterior chamber with an air bubble is helpful. This also helps to control any secondary bleeding. The corneal incision is closed with two 10-0 nylon sutures. The response in lowering intraocular pressure with the Ocutome instrumentation has been quite successful. Each eye operated on with this technique has shown an initial decrease in intraocular pressure associated with the surgery.


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