2954: Quiz: Help solve this mystery bleeding
Why did this intraoperative hemorrhage occur during an otherwise routine cataract surgery? In this video, our guest surgeon encounters unexpected bleeding from the iris or angle structures, and the exact etiology remains a mystery. When analyzing a sudden bleed like this, we have to consider several possibilities. Could it be a localized micro-hyphema caused by subtle, microscopic mechanical trauma from an instrument? Was there any evidence of rubeosis iridis or neovascularization of the iris? Is there an underlying, undetected vascular anomaly, or perhaps early signs of UGH syndrome predisposition? Another culprit could be a sudden fluctuation in anterior chamber pressure, causing a decompression effect on fragile iris vessels, or even an unexpected spike in episcleral venous pressure.
We need your expertise to help solve this clinical mystery. Please analyze the surgical technique, fluidics, and anatomy carefully, and leave a comment below with your diagnosis or theories. Let’s crowd-source the answer to help our global ophthalmic community!
Fuchs uveitis?
Undiagnosed platelet disorder; r/o hematologic malignancy or new onset ITP. In addition to the intraocular heme, an unusual pattern of conj oozing is apparent temporally at 2:16. Unprovoked conj bleeding also peeks out nasally for a split second at 0:14. Structures that barely get touched are bleeding, consistent with a systemic clotting problem.