PURPOSE: To report the management of recurrent, spontaneous hyphema associated with florid iris vascular tufts in a patient presenting for cataract surgery. METHODS: Interventional case report and review of the literature; presentation of clinical findings, iris angiography, and the argon laser regimen used to minimize potential corneal complications with increased total treatment energy. RESULTS: An 80-year-old man with a 20-year history of bilateral, recurrent, spontaneous hyphema associated with extensive iris vascular tufts presented with visually significant cataracts. Serial argon laser photocoagulation treatment of the prominent, circumferential iris vascular tufts of the left eye arrested further episodes of spontaneous hyphema and facilitated uneventful cataract surgery. Argon laser parameters were titrated to therapeutic effect during the initial treatment sessions, and sectoral photocoagulation of the circumferential vascular tufts was performed during a 5-month period to accommodate increased laser power and energy. The total energy required to complete treatment of the extensive lesions was substantially more than that in similar previous reports; however, no adverse corneal complications were associated with the laser therapy. CONCLUSIONS: This case appears to represent the first description of chronic, bilateral, recurrent spontaneous hyphema associated with iris vascular tufts. Argon laser treatment of symptomatic iris vascular tufts promotes resolution of recurrent, spontaneous hyphema and may serve to mitigate the risk of hemorrhage from these lesions during subsequent intraocular surgery. Conservative management of increased total treatment energy may minimize the potential risk of corneal decompensation with argon laser therapy.
PURPOSE: To report the management of recurrent, spontaneous hyphema associated with florid iris vascular tufts in a patient presenting for cataract surgery. METHODS: Interventional case report and review of the literature; presentation of clinical findings, iris angiography, and the argon laser regimen used to minimize potential corneal complications with increased total treatment energy. RESULTS: An 80-year-old man with a 20-year history of bilateral, recurrent, spontaneous hyphema associated with extensive iris vascular tufts presented with visually significant cataracts. Serial argon laser photocoagulation treatment of the prominent, circumferential iris vascular tufts of the left eye arrested further episodes of spontaneous hyphema and facilitated uneventful cataract surgery. Argon laser parameters were titrated to therapeutic effect during the initial treatment sessions, and sectoral photocoagulation of the circumferential vascular tufts was performed during a 5-month period to accommodate increased laser power and energy. The total energy required to complete treatment of the extensive lesions was substantially more than that in similar previous reports; however, no adverse corneal complications were associated with the laser therapy. CONCLUSIONS: This case appears to represent the first description of chronic, bilateral, recurrent spontaneous hyphema associated with iris vascular tufts. Argon laser treatment of symptomatic iris vascular tufts promotes resolution of recurrent, spontaneous hyphema and may serve to mitigate the risk of hemorrhage from these lesions during subsequent intraocular surgery. Conservative management of increased total treatment energy may minimize the potential risk of corneal decompensation with argon laser therapy.