title: Spontaneous hyphaema secondary to bleeding from an iris vascular tuft in a patient with a supratherapeutic International normalised ratio: case report.
abstract: BACKGROUND
  Iris vascular tufts are rare iris stromal vascular hamartomas. Patients with iris vascular tufts generally remain asymptomatic until presenting with a spontaneous hyphaema or with mild intraoperative pupil margin haemorrhage during anterior segment surgery. This is the first reported case of spontaneous hyphaema from iris vascular tuft related to a documented supratherapeutic International Normalised Ratio as a predisposing factor. At 86 years of age, this patient also represents the oldest documented first occurrence of bleeding from an iris vascular tuft.
  
  
  METHODS
  An 86 year old Caucasian lady presented with sudden and persisting loss of vision in her right eye, ocular pain and vomiting. She had a supratherapeutic International Normalised Ratio of 3.9 related to Warfarin use. Her intraocular pressure in the right eye was raised at 55 mmHg, with a 1.6 mm hyphaema and multiple iris vascular tufts visible around the entire pupil.
  
  
  CONCLUSIONS
  The present case highlights the risk of anticoagulation therapy as a predisposing factor for spontaneous hyphaema and adds to the management considerations for this condition. It also demonstrates the need for Ophthalmologists to be aware of iris vascular tufts as a cause for spontaneous hyphaema, independent of age and systemic associations.
authors.affiliation: Department of Ophthalmology, Prince of Wales Hospital, High Street, Randwick, NSW, 2031, Australia. kgjooi@yahoo.com.au.
authors.forename: Kenneth G J
authors.initials: KG
authors.lastname: Ooi
authors.affiliation: Department of Ophthalmology, Prince of Wales Hospital, High Street, Randwick, NSW, 2031, Australia. rohangupta19@gmail.com.
authors.forename: Rohan
authors.initials: R
authors.lastname: Gupta
authors.affiliation: University of Sydney, Camperdown, NSW, 2006, Australia. swan7117@uni.sydney.edu.au.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Wang
authors.affiliation: Department of Ophthalmology, Prince of Wales Hospital, High Street, Randwick, NSW, 2031, Australia. spgdance@gmail.com.
authors.forename: Samuel
authors.initials: S
authors.lastname: Dance
authors.affiliation: Department of Ophthalmology, Prince of Wales Hospital, High Street, Randwick, NSW, 2031, Australia. aborovik@gmail.com.
authors.forename: Armand
authors.initials: A
authors.lastname: Borovik
authors.affiliation: Department of Ophthalmology, Prince of Wales Hospital, High Street, Randwick, NSW, 2031, Australia. iancfrancis@gmail.com.|University of New South Wales, Kensington, NSW, 2052, Australia. iancfrancis@gmail.com.
authors.forename: Ian C
authors.initials: IC
authors.lastname: Francis
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001285:Atropine / Q000008:administration & dosage; D005130:Eye Hemorrhage / Q000150:complications*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006222:Hamartoma / Q000150:complications*; D006801:Humans; D006988:Hyphema / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D019934:International Normalized Ratio; D007499:Iris Diseases / Q000150:complications*; D009184:Mydriatics / Q000008:administration & dosage; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives; D011655:Pulmonary Embolism / Q000188:drug therapy; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents; D005938:Glucocorticoids; D009184:Mydriatics; D009883:Ophthalmic Solutions; D014859:Warfarin; D001285:Atropine; C009935:prednisolone acetate; D011239:Prednisolone