MANAGEMENT OF POSTOPERATIVE HYPHAEMA FOLLOWING DMEK WITH ANTERIOR CHAMBER WASHOUT AND PERIOPERATIVE BERIPLEX

To report a case of postoperative hyphaema following Descemet Membrane Endothelial Keratoplasty (DMEK) managed successfully with anterior chamber washout, Vitamin K and Beriplex (prothrombin complex concentrate) in a patient at high risk of recurrent bleeding.

Norfolk and Norwich University Hospital, United Kingdom

A 76-year-old female with Fuchs’ endothelial dystrophy and pseudophakic bullous keratopathy underwent DMEK in her right eye. On day 2 post-op, she developed raised intraocular pressure of 52mmHg which was treated with anterior chamber paracentesis and removal of SF6 with a subsequent intraocular pressure of 5mmHg. On the fifth postoperative day, she developed significant hyphaema, compromising vision and posing a risk to graft survival. Given she was on warfarin for atrial fibrillation, there was high-risk for further bleeding. An anterior chamber washout was performed, with 5mg Vitamin K administered perioperatively and Beriplex to reduce the likelihood of recurrent haemorrhage. Postoperative management included Dexamethasone eye drops, multiple intraocular pressure lowering drops and oral Acetazolamide. At the 2 month follow-up, her visual acuity improved to 6/12 (pinhole 6/9), intraocular pressure was stable off all therapy, and the graft remained clear with no evidence of recurrent hyphaema or rejection.

Postoperative hyphaema is a significant complication following DMEK, particularly in anticoagulated patients, due to the increased risk of graft failure. This case demonstrates that the use of Vitamin K and Beriplex prior to anterior chamber washout may mitigate bleeding risk, allowing for safe and effective management in high-risk patients, thereby preserving graft integrity and optimizing visual outcomes.