Introduction:

Vitreoretinal sutureless surgery has evolved in recent years into a safer, more effective group of procedures. It is, therefore, an unexpected sight to have a vitreous hemorrhage at the end of an otherwise uneventful vitrectomy. A possible cause of such a finding is an external hemorrhage that occurs immediatly after the removal of the trocars, that finds its way inside the vitreous cavity through the sclerotomy.

Methods:

The authors present two video cases of vitreous hemorrhages that occured just after the removal of the 23G trocars. In both cases, the bleeding initiated from scleral and conjunctival vessels adjacent to the scleral tunnel, and progressed into the posterior segment that was already filled with air. In the first case, when the superficial hemorrhage was noticed, diathermia was applied and had apparently stopped the bleeding. The result, however, was a gush of blood into the anterior chamber and, after irrigation-aspiration, also filled the vitreous cavity completely, prompting a complete cleansing of the posterior segment as well. The second case was similar at first, but this time the authors based on the previous experience and noticing a darkening of the red reflex, decided to immediatly open the conjunctiva and re-insert the trocars. Although blood found its way to the vitreous cavity, this time the anterior chamber remained clear. This allowed a clear visualizati on of the course of the blood, finding its way from the scleral tunnel inner entrance along the peripheral retina, into a pool over the macula. In this case, this complication was quickly managed.

Conclusions:

The authors believe that hemorrhages originating close to the scleral 23G entry-sites may result in unexpected complications. To prevent this complication we suggest that, when extensive external bleeding occurs after trocar removal, air pressure should be increased immediatly while keeping all other ports occluded tightly, the conjunctiva should be opened and the scleral wound should be sutured safely. Performing isolated diathermia or compressing/massaging the conjunctiva, without a sufficient positive pressure differential from the vitreous cavity, may have the unintended effect of forcing the blood to drain interiorly. We believe that ignoring these events and not checking the posterior segment for complications may result in a possible need for reintervention.

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