Spontaneous iris bleeding during cataract surgery in a patient with thrombocytopenia

A 91-year old man with a history of senile cataract and chronic lymphocytic leukemia (CLL), with a platelet count of 75,000/μL, presented for phacoemulsification and intraocular lens implantation in the left eye. A paracentesis made at the beginning of the procedure caused a small but not unusual amount of anterior chamber decompression. Spontaneous bleeding subsequently occurred from multiple sights on the iris surface. The bleeding was stopped by injecting hyaluronic acid into the anterior chamber to increase intraocular pressure. The remainder of the procedure was performed without complication, and resulting visual acuity improved from 20/70 preoperatively to 20/20(-2) with refraction 1 week postoperatively. In previously reported cases of intraocular bleeding during cataract surgery in thrombocytopenic patients, platelet counts were all ≤55,000/μL.