Abstract
We have been using our in-house scoring system of hyphemas, i.e., Shimane University RLC postoperative hyphema scoring system (SU-RLC), which we designed to classify postoperative hyphema. SU-RLC classifies the severities of hyphemas based on three factors, i.e., red blood cells (RBCs) (R) 0–3, layer formation (L) 0–3, and clot (C) 0–1, by slit-lamp observation. To test the clinical usefulness of the SU-RLC for quantifying the postoperative hyphema severity, the SU-RLC scores were compared between eyes that underwent different minimally invasive glaucoma surgery (MIGS) procedures, i.e., Tanito microhook ab interno trabeculotomy and cataract extraction (TMH-CE) (n = 64 eyes of 64 subjects; mean age ± standard deviation, 72.4 ± 8.1 years) and iStent-CE (n = 21 eyes of 21 subjects; 76.1 ± 10.6 years). Compared to the iStent-CE, higher hyphema scores with the TMH-CE were found for the R scores on postoperative days 1, 2, and 3; for the L score on postoperative day 1; and for the C score on postoperative day 2. The sums of the R, L, and C scores (RLC) on postoperative day 1 were 3.2 ± 1.1 with the TMH-CE and 1.1 ± 1.3 with the iStent-CE; the scores reached almost 0 by 2 weeks in both groups. Significant differences in the RLC scores between the surgical groups were found on postoperative days 1, 2, and 3. Multivariate analyses showed that the TMH-CE rather than iStent-CE was associated with higher R, C, and RLC scores; anticoagulant/antiplatelet use was associated with higher R score; and myopia was associated with a higher C score. In the TMH-CE group, myopia was associated with a higher C score. In the iStent-CE group, anticoagulant/antiplatelet use was associated with higher R and RLC scores; and higher postoperative 1-day intraocular pressure was associated with a higher C score. The SU-RLC successfully detected the difference in hyphema severity between different MIGS procedures; thus, we concluded that our classification system may be feasible to evaluate hyphemas after glaucoma surgery.
Highlights
Postoperative hyphema is a common complication during glaucoma surgeries, including trabeculectomy, tube-shunt surgeries, and minimally invasive glaucoma surgeries (MIGS) [1,2]
intraocular pressure (IOP) and medications were significantly higher in the Tanito microhook (TMH)-CE group than in the iStentCE group, while other parameters including age, gender, glaucoma type, spherical equivalent refractive error (SERE), and anticoagulant/antiplatelet use were equivalent between the surgical groups
We found that the R, L, C, and/or RLC scores were higher in the TMH-CE group than in the iStent-CE group for up to three days postoperatively, while the scores became almost 0 by two weeks in both surgical groups
Summary
Postoperative hyphema is a common complication during glaucoma surgeries, including trabeculectomy, tube-shunt surgeries, and minimally invasive glaucoma surgeries (MIGS) [1,2]. The severity of postoperative hyphemas has been described using the classification for traumatic hyphemas [3] This classifies hyphemas into three grades including layer formation less than 1/3 of the anterior chamber (AC) as grade I, 1/3 to 1/2 of the AC as grade II, and greater than 1/2 of the AC including an eight-ball hemorrhage as grade III [3]. Other researchers have quantified postsurgical hyphemas by using a classification system based on the AC cells seen in eyes with uveitis [4,5] This classification quantifies the AC cells by the number of cells seen in the field of a 1-mm by 1-mm slit beam as 50 cells/field for respective grades of 0, 0.5+, 1+, 2+, 3+, and 4+ [6]. Other than the presence of the layer formation and floating RBCs in the AC, blood clots frequently seen postoperatively cannot be described using those previously described classifications
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