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Patients may experience delayed-onset hyphema after trabeculotomy
Some patients experienced symptomatic delayed-onset hyphema more than 2 months after undergoing ab interno trabeculotomy, according to a study.
The researchers examined the triggers and symptoms of late-onset hyphema after implantation of the Trabectome (Neomedix).
“Although all Trabectome patients have an open blood-aqueous barrier … it is not clear why more patients do not experience late hyphemas. One possibility is that a healing response in most patients results in closure of the blood-aqueous barrier,” the study authors said. “Symptomatic patients should identify and avoid associated triggers because delayed-onset hyphema may be associated with intermittent intraocular pressure spikes that may require medical or surgical treatment.”
The retrospective study included 262 patients with open-angle glaucoma who underwent ab interno trabeculotomy.
Twelve patients (4.6%) experienced delayed-onset hyphema. Affected patients had an average age of 74.3 years. The median interval between surgery and onset of hyphema was 8.6 months.
Mean IOP of patients with delayed-onset hyphema was 25 mm Hg, significantly higher than mean IOP before diagnosis of hyphema and after its resolution (both 13 mm Hg, P = .01).
Symptoms typically began upon awakening; the most common triggering mechanism of onset was sleeping on the surgical side. Most hyphemas resolved in 1 or 2 weeks; one patient required trabeculectomy for a refractory IOP spike.
Systemic medications most commonly used at the time of hyphema onset were aspirin and antihypertensive medications such as beta-blockers and diuretics. Nine of the 12 patients had hypertension; data showed no other common diagnoses among the patients, the authors said.