Massive Hyphaema Following Laser Iridotomy in a Patient on Dual Antiplatelet Therapy (Aspirin plus Ticagrelor): Case report and literature review

Authors

Virgilio Galvis, Department of Ophthalmology, Universidad Autónoma de Bucaramanga, Bucaramanga and Department of Ophthalmology, Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
Alejandro Tello, Department of Ophthalmology, Universidad Autónoma de Bucaramanga, Bucaramanga and Department of Ophthalmology, Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
Néstor I. Carreño, Department of Ophthalmology, Universidad Autónoma de Bucaramanga, Bucaramanga and Department of Ophthalmology, Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
Walter A. Sánchez, Department of Ophthalmology, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia
Gabriel A. Frederick, Department of Ophthalmology, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia
Nicolás A. Blanco, Department of Ophthalmology, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia

Abstract

Massive hyphaema presentation after a laser iridotomy is very rare. We report a 63-year-old man with ischaemic heart disease on dual antiplatelet therapy (aspirin plus ticagrelor) who was diagnosed as a primary angle-closure suspect and was to undergo a neodymium-doped yttrium aluminium garnet laser iridotomy at Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia in 2016. While performing the iridotomy in the left eye, active bleeding occurred that finally filled approximately 75% of the anterior chamber. Intraocular pressure (IOP) increased to 62 mmHg. Mannitol and a topical dorzolamide/timolol were used to control the increase in IOP. The hyphaema slowly resolved over the following week without sequelae. This case revealed that massive hyphaema can complicate laser iridotomy in patients on dual antiplatelet therapy, although this is rare. Therefore, if patients are taking aspirin and ticagrelor, it would be advisable to stop the second medication if possible. In addition, sequential application of photocoagulation and photodisruption lasers might diminish the risk of significant bleeding.

Publication Date

5-30-2019

First Page

e63

Last Page

67

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Recommended Citation

Galvis, Virgilio; Tello, Alejandro; Carreño, Néstor I.; Sánchez, Walter A.; Frederick, Gabriel A.; and Blanco, Nicolás A. (2019) "Massive Hyphaema Following Laser Iridotomy in a Patient on Dual Antiplatelet Therapy (Aspirin plus Ticagrelor): Case report and literature review," Sultan Qaboos University Medical Journal: Vol. 19: e63-67.
DOI: https://doi.org/10.18295/squmj.2019.19.01.012