Gonioaspiration for refractory glaucoma secondary to traumatic hyphema in patients with sickle cell trait

The authors describe a new surgical method for treating disproportionately high intraocular pressures secondary to small traumatic hyphemas in three patients with the sickle cell trait. A novel technique was performed in all three cases to clear the hyphema from the anterior chamber angle. A Lewicky anterior chamber maintainer cannula was placed at the superior limbus to maintain infusion into the anterior chamber. Under direct visualization using a Koeppe goniotomy lens, a 23-gauge single-port cannula was used to aspirate the hyphema from the anterior chamber angle until it was free of blood. There were no intraoperative complications. Measurements of intraocular pressure were normal 2 hours after the procedure and at every subsequent visit. There was an improvement in visual acuity to 6/9 or better in all three of the cases. Therefore, gonioaspiration is an effective treatment of persistently raised intraocular pressures in patients with sickle cell trait.