Posters

Managing delayed suprachoroidal haemorrhage after insertion of XEN45 glaucoma device

Poster Details

First Author: F.Stringa UK

Co Author(s):    V. Shankar                    

Abstract Details

Purpose:

We present a case of delayed suprachoroidal haemorrhage after secondary intraocular lens implant (IOL) combined with XEN45 insertion that required surgical intervention.

Setting:

Burnley General Teaching Hospital, East Lancashire Hospitals NHS Trust

Methods:

A 78 old male with angle closure glaucoma and on treatment with warfarin, underwent phacoemulsification in his left eye. An early acute suprachoroidal hemorrhage (SCH) occurred and the surgical wound was rapidly sutured without complete soft lens matter (SLM) removal, nor IOL insertion. The SCH was managed conservatively and it resolved in 5 weeks; the intraocular pressure (IOP) was 35 mmHg despite maximal medical treatment. Secondary SLM removal followed by IOL implantation combined with XEN45 was then planned

Results:

In light of the prior SCH, warfarin was stopped and the International Normalized Ratio (INR) target pre-operatively was less than 2.1. On the day of surgery he was started on tinzaparin 4,500 units.One week later IOL and XEN45 implantation, he presented with best corrected visual acuity (BCVA) of 6/60, IOP of 14 mmHg and significant choroidal bleeding with possible "kissing" choroidal touch. Transcleral drainage of the suprachoroidal bleeding was then carried out. The SCH settled completely over 8 weeks, with a IOP of 18 mmHg and BCVA of 6/12. Warfarin could be re-started safely two weeks after the drainage.

Conclusions:

Patients on anticoagulants should be managed carefully while planning intraocular glaucoma surgery, including minimally invasive glaucoma surgery. As well as post-operative monitoring of the eye itself, their INR should also be closely monitored. A multidisciplinary approach in conjunction with the haematology team could be beneficial to ensure their INR stays within the range to prevent potentially fatal consequences such as thromboemboli and minimising the chance of sight threatening complications such as SCH

Financial Disclosure:

None