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ABSTRACT
A surgical approach that involves paracentesis and gentle anterior chamber washout and minimal surgical trauma is presented for dealing with traumatic hyphema. This technique taught by Dr. Paul Chandler produces excellent results and is safe, simple, and without need for elaborate instrumentation.
In this paper we would like to renew awareness of a technique that in our hands has been extremely useful in the surgical management of patients suffering from extensive anterior chamber hemorrhage from trauma. All treatment regimens are directed toward preventing and treating the major complications of hyphema: recurrent bleeding, secondary glaucoma with possible optic atrophy, blood staining of the cornea, and peripheral anterior synechiae formation. If medical treatment fails, a variety of surgical techniques have been recommended in the literature,112 some of which involve extensive incisions or elaborate instrumentation. It is the purpose of this paper to review 13 cases and to discuss a surgical approach that is brief, simple, safe, devoid of elaborate instrumentation, and involves minimal surgical trauma to the eye. This technique was taught to us and used before us by Dr. Paul A. Chandler and has been in use in our practice for more than 30 years.13,14
TECHNIQUE
The operation is done using standard preparation and draping techniques and can be done with either local or general anesthesia. If local anesthesia is chosen, we do a Hd block in the usual manner, and akinesia and anesthesia of the globe are obtained by injecting each of the four quadrants with lcc of a 50/50 mixture of 2% lidocaine without epinephrine and .75% bupivicaine with 1 to 400,000 epinephrine combined with Hyaluronidase. The injection is through skin with a non-disposable needle in each quadrant (10:30, 1:30, 4:30, and 7:30 o'clock positions). A retrobulbar injection is avoided. In very cooperative patients, topical anesthesia, such as proparacaine and cocaine 10%, one drop every 10 minutes x 2 can be used and will often suffice.
Using a Wheeler knife or similar blade, a beveled paracentesis incision is made into clear cornea, parallel to the iris, usually in the inferotemporal quadrant, with enlargement of the incision to twice the width of the knife blade. The total incision should be approximately 3 mm wide, equal in width on the inside of the...