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JAMA Ophthalmology Clinical Challenge |

Recurrent Vitreous Hemorrhage Despite Pars Plana Vitrectomy, Laser, and Injections QUIZ

Anthony Chung, BS1; Eric K. Chin, MD1; David R. P. Almeida, MD, MBA, PhD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City
JAMA Ophthalmol. 2016;134(2):231-232. doi:10.1001/jamaophthalmol.2015.2136.
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A man in his 60s had sudden-onset blurry vision in the right eye secondary to vitreous hemorrhage and dry cough. Careful examination revealed a dislocated haptic of the single-piece intraocular lens inferonasally with a small radial tear in the anterior capsule in the right eye. What would you do next?

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A, Slitlamp photograph of the right eye revealing an iris transillumination defect (arrowhead) in the area of the displaced intraocular lens haptic. B, Anterior segment ultrasound biomicroscopy confirming a displaced inferonasal haptic with iris touch (arrowhead).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Sulcus Intraocular Lens Haptic Amputation

Video of amputation of the displaced inferonasal haptic while the patient was under monitored anesthesia care. Viscoelastic was injected into the anterior chamber, and a single iris retractor was used to temporarily pull the iris away from inferonasal haptic. Horizontal microscissors and forceps were used to cut and explant the displaced haptic. The viscoelastic was removed from the anterior chamber with bimanual irrigation and aspiration, and the paracentesis wounds were hydrated.

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