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JAMA Ophthalmology Clinical Challenge
February 2016

Recurrent Vitreous Hemorrhage Despite Pars Plana Vitrectomy, Laser, and Injections

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City
JAMA Ophthalmol. 2016;134(2):231-232. doi:10.1001/jamaophthalmol.2015.2136

A man in his 60s had sudden onset of blurry vision in the right eye secondary to vitreous hemorrhage (VH) preceded by persistent dry cough. He had undergone uncomplicated cataract surgery with intraocular lens (IOL) implantation in both eyes approximately 10 years earlier. His medical history indicated no diabetes mellitus or hypertension. His best-corrected visual acuity (VA) at presentation was hand motions at 3 ft OD and 20/20 OS. Slitlamp examination of his right eye was significant for moderate spillover hemorrhage in the anterior chamber and dense VH posteriorly. B-scan ultrasonography of the right eye revealed moderately diffuse VH with a possible retinal tear inferotemporally at the anterior equator. His vision improved with close observation to 20/40 OD. The results of fundus examination and fluorescein angiography were normal for retinal tears or peripheral neovascularization at follow-up when sufficient VH had cleared for complete dilated fundus examination. One month later, the patient had spontaneous recurrent VH. His VA was 20/80 OD, and thus pars plana vitrectomy with panretinal photocoagulation laser and intravitreal ranibizumab was performed on the right eye because of the possibility of an occult branch retinal vein occlusion. The patient received additional intravitreal injections but had recurrent cough-induced VH. Careful examination revealed a dislocated haptic of the single-piece IOL inferonasally with a small radial tear in the anterior capsule in the right eye. Iris transillumination defects and the results of anterior segment ultrasound biomicroscopy were confirmatory (Figure).

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