title: Diagnosis of hemophilia made after intraoperative bleeding during attempted penetrating keratoplasty in an elderly patient.
abstract: OBJECTIVE
  To report an unusual case where the diagnosis of hemophilia was made after attempted penetrating keratoplasty in an elderly patient.
  
  
  METHODS
  A 75 year old white male with a full-thickness corneal scar in the visual axis and a visually significant cataract OD was to undergo penetrating keratoplasty and cataract extraction with lens implantation for visual rehabilitation. There was no history of bleeding diathesis given.
  
  
  RESULTS
  During placement of the Flieringa ring, a progressively enlarging 360 degrees subconjunctival hemorrhage was observed. Given the unusual bleeding,the procedure was aborted and the patientwas referred to the hematology service for further evaluation. Laboratory studies revealed a diagnosis of atypical hemophilia of mild severity.
  
  
  CONCLUSIONS
  The initial diagnosis of hemophilia in any elderly patient is unusual. This case is even more unusual asthe diagnosis of a bleeding disorder was first considered after excessive subconjunctival hemorrhage developed during attempted penetrating keratoplasty.
authors.affiliation: Department of Ophthalmology, University of Florida College of Medicine, Gainesville 32610-0284, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Choi
authors.forename: M H
authors.initials: MH
authors.lastname: Goldstein
authors.forename: W T
authors.initials: WT
authors.lastname: Driebe
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002387:Cataract Extraction; D003229:Conjunctival Diseases / Q000175:diagnosis*; D005130:Eye Hemorrhage / Q000175:diagnosis*; D006467:Hemophilia A / Q000175:diagnosis*; D006801:Humans; D015948:Keratoplasty, Penetrating; D019654:Lens Implantation, Intraocular; D008297:Male