title: Evaluation of recurrent hyphema after trabeculectomy with ultrabiomicroscopy 50-80 MHz: a case report.
abstract: BACKGROUND
  Hyphema is a complication that can occur after glaucoma filtering surgery. Biomicroscopic examination of the anterior segment is commonly used to diagnose it and gonioscopy may provide a useful support to find the source of the haemorrhage. Unfortunately, when the blood hides the structure of the anterior segment the gonioscopic examination fails. In this case we performed ultrabiomiscroscopy with 50-80 MHz probes to overcome the limits of gonioscopy. The use of this technique to study the anterior segment of the eye has previously been reported in literature, but we illustrates its importance for performing a correct diagnosis in a specific case of hyphema.
  
  
  METHODS
  We report a case of a sixty-year-old caucasian male with recurrent hyphema in the left eye. The episodes of hyphema were four in two years and the patient came to the hospital for the first time in the last occasion. The past episodes were managed with topical corticosteroids and mydriatic drops. He referred surgical trabeculectomy in both eyes 5 years before the first symptoms and no specific eye trauma before the first episode. The examination of the anterior segment revealed a 2 mm hyphema in the left eye due to blood leakage through the superior iridectomy. Gonioscopy could not identify the source of the haemorrhage. B-scan ultrasound and ultrabiomiscroscopy, with 50-80 MHz probes, were performed. Ultrabiomiscroscopy, mainly with the probe of 80 MHz, provided images of high resolution of the structures of the anterior segment and it allowed the visualization of an abnormal vessel at the inner margin of the trabeculectomy opening, probably responsible of the recurrent hyphema.
  
  
  CONCLUSIONS
  Ultrabiomicroscopy proved to be a useful diagnostic technique for identifying the cause of the recurrent hyphema when other examination techniques are not applicable.
authors.affiliation: Ophthalmology Unit, NESMOS Department, S,Andrea Hospital, Faculty of Medicine and Psychology, University of Rome Sapienza, Via di Grottarossa, 1035 00189 , Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mannino
authors.forename: Sara
authors.initials: S
authors.lastname: Verrilli
authors.forename: Silvia
authors.initials: S
authors.lastname: Calafiore
authors.forename: Angela
authors.initials: A
authors.lastname: Ciarnella
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cutini
authors.forename: Cristina
authors.initials: C
authors.lastname: Mannino
authors.forename: Andrea
authors.initials: A
authors.lastname: Perdicchi
authors.forename: Santi Maria
authors.initials: SM
authors.lastname: Recupero
mesh_terms: D005901:Glaucoma / Q000601:surgery; D006801:Humans; D006988:Hyphema / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D033401:Microscopy, Acoustic / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014130:Trabeculectomy / Q000009:adverse effects