•Hemorrhage in the anterior chamber (hyphema) after AC paracentesis during anterior segment or cataract surgeries.
•It is due to the presence of fine, fragile vessels in the anterior chamber angle.
•Present in Fuch’s Heterochromic Uveitis (FHU).
•Gonioscopy in FHU shows: Small twig-like vessels in the angle that likely give rise to Amsler-Verrey sign.
•The fine vessels at the angle of the anterior chamber are fragile and prone to rupture after trivial trauma.
•The actual nature of these vessels is unknown and may be abnormal vasculature or new vessels.
HOW DO WE MANAGE IT?
•The hyphema due to the Amsler sign is typically mild.
•It may stop spontaneously.
•If it continues: form the AC with viscoelastic or raise the IOP.
•The hyphema typically does not worsen the visual outcomes.
•Most cases of FHU might have mild perioperative hemorrhage after cataract surgery.
Other features of FHU:
•Fine stellate keratic precipitates that are present over the endothelium diffusely and not restricting itself to the Arlt’s triangle.
•Heterochromia iridis (usually hypochromic).
•Absent posterior synechiae.
•Mild AC cells and flare.
•Iris nodules (Koeppe).
•Diffuse Iris atrophy giving a smooth, featureless appearance.
•Opacities in the vitreous.
Art by @mahuness