Endocapsular Hematoma
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Endocapsular haematoma (ECH) is a rare complication of intraocular surgery characterized by the presence of blood between the posterior optical surface of the intraocular lens (IOL) and the anterior surface of the posterior capsule.
Disease Entity
Disease
Endocapsular haematoma (ECH) is an uncommon complication of intraocular surgery first described in 1989 by Thomas et al., which occurs when blood accumulates in the space between the IOL and the surrounding posterior capsule. It was first described in 1989 by Thomas et al. as the collection of blood "in the bag" posterior to the intraocular lens forming a fluid level on the second postoperative day following a combined trabeculectomy and extracapsular cataract extraction with posterior chamber intraocular lens implantation.
Etiology
ECH in pseudophakic eyes is most often attributed to as a late post-cataract surgery complication, even more so if phacoemulsification is combined with a trabeculectomy or non-penetrating glaucoma surgery. ECH has also been reported as a rare form of ocular bleed following thrombolysis with streptokinase. Other cases have been reported to be related to uveitis-glaucoma-hyphema and trauma.
Risk Factors
A variety of factors may increase the risk of both IOL friction and bleeding.
- Pre-existing neovascularization of iris and/or capsule
- Diabetic retinopathy
- Zonular weakening
- Vascular disease
Pathophysiology
Although early reports referred to the condition as endocapsular hyphema, more recent literature suggests this is an inaccurate description due to the location, the insufficient quantity of blood cells and the failure of the blood to be reabsorbed. Authors initially suspected the the blood leaked through the posterior capsule from an anterior vitreous hemorrhage. However, most investigators now believe that the blood most likely originates from the surgical incision site in acute postoperative cases.
