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JAMA Ophthalmology Clinical Challenge
March 2017

Diffuse Retinal Hemorrhages After Uncomplicated Glaucoma Drainage Implantation

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois Eye and Ear Infirmary
JAMA Ophthalmol. 2017;135(3):281-282. doi:10.1001/jamaophthalmol.2016.3823

A healthy adolescent Latino man with juvenile open-angle glaucoma underwent Ahmed valve placement in the left eye via uncomplicated surgery. Preoperative Snellen visual acuity was 20/40 and intraocular pressure (IOP) was 36 mm Hg; on postoperative day 1, IOP was 10 mm Hg and visual acuity fell to count fingers. Slitlamp examination of the left eye revealed an elevated bleb over the Ahmed plate with no leakage. The cornea was clear and compact, and there was a well-positioned tube overlying the iris superotemporally. The anterior chamber was deep with trace inflammation. Dilated fundus examination revealed disc edema, peripapillary hemorrhages, and diffuse intraretinal hemorrhages throughout the posterior pole and periphery (Figure 1). Spontaneous venous pulsations were not appreciated. Slitlamp examination of the right eye revealed a normal anterior and posterior segment, with no retinal vascular abnormality or hemorrhage.

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