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Background
Amsler-Verrey sign describes the characteristic anterior chamber (AC) bleeding that is noted in patients with Fuchs heterochromic uveitis (FHU). AC bleeding in patients with Fuchs uveitis has been known to occur either be spontaneous or associated with trivial trauma, gonioscopy, applanation tonometry and pharmacological mydriasis. The use of a Honan balloon during cataract surgery has also been known to cause the AC haemorrhage. To the best of our knowledge, this is the first documented case of intraoperative AC bleeding occurring during cataract surgery in a patient with FHU. We describe the clinical features ( surgical video attached ) and management strategies to deal with this very rare complication during cataract surgery.
Video 1 media-1 bcr.11.2009.2456.v1 10.1136/bcr.11.2009.2456v1
Case presentation
A 53-year-old Caucasian woman with past history of anterior uveitis and cataract was referred for cataract surgery in the right eye (RE). Her past medical history was unremarkable. Ocular history was significant for recurrent FHU in the RE. On examination best-corrected visual acuities were hand movements in the RE and 6/6 in the left eye (LE). Examination of the left eye was unremarkable. Slit lamp biomicroscopy of the right eye showed characteristic stellate keratic precipitates scattered throughout the corneal endothelium, heterochromia irides and a dense, white cataract. The AC appeared quiet and the intraocular pressures were within normal limits. B-scan ultrasonography showed a normal posterior segment in the RE. Under perioperative steroid cover (oral steroids 40 mg per day started a week prior to surgery and tapered postoperatively over a period of 4 weeks) cataract surgery was performed under topical (proxymethacaine 0.5% Minims; Chauvin...