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Aspirin/phenylephrine/tropicamide Microhyphaema, recurrent bilateral microhyphaema and bilateral intraocular pressure spikes: case report

A 68-year-old woman developed microhyphaema during preoperative treatment with aspirin. Additionally, she developed recurrent bilateral microhyphaema and spikes in bilateral intraocular pressure following mydriatic treatment with phenylephrine/ tropicamide [not all dosages and durations of treatments to reaction onsets stated]. The woman presented with ocular hypertension (OHT) for evaluation of bilateral cataracts. At that time, her corrected distance visual acuity (CDVA) was 20/70 on the right eye and 20/50 the left eye. The intraocular pressure (IOP) was right eye 18mm Hg and left eye 14mm Hg. Thereafter, a slit-lamp examination shows bilateral posterior subcapsular cataract. Gonioscopy identified Shaffer grade IV angles in both eyes. On fundus examination, the cup-to-disc ratio was 0.4 and 0.5 in the right eye and left eye, respectively. She was on latanoprost and brimonidine/dorzolamide/timolol. She had a history of selective laser trabeculoplasty in both eyes. Her medical history was significant for lupus. She had been receiving oral 81mg aspirin [acetylsalicylic acid] prednisone, vitamin E, and omega-3-fatty-acid [omega 3] as preoperative medications. She underwent combined gonioscopy-assisted transluminal trabeculotomy (GATT), which was uncomplicated, and cataract extraction first in the left eye, and after 5 months in the right eye. Thereafter, a small amount of blood reflux from the collector channels was noted during surgery after trabeculotomy. Therefore, the anterior chamber was washed. To avoid hypotony and bleeding, a small amount of viscoelastic was left in the eye. Thereafter, her hyphaemia had been cleared in both eyes by the first month. Thereafter, she remained stable with IOP of 14 mmHg on four antiglaucoma medications in the right eye and 15mm Hg on three antiglaucoma medications in left eye. The CDVA, after the surgery, was 20/20 in both eyes. After 8 months of left eye surgery and 3 months after right eye surgery, she underwent routine evaluation. At that time, no abnormalities were noted on a a slit-lamp examination. The IOP was 16mm Hg in both eyes. After that, a gonioscopy demonstrated peripheral anterior synechiae (PAS) in four quadrants in both the eye and inferiorly and nasally in her left eye. Thereafter, she received eye drops of phenylephrine/tropicamide 1% /2.5% (T-P Ofteno; Sophia Laboratories, Mexico) for fundus evaluation, and mydriasis was achieved. An hour following the mydriatic treatment, slit-lamp evaluation demonstrated 3+ both eyes and 4+ left eye erythrocytes in the anterior chamber. The woman was prescribed prednisolone acetate and aspirin was stopped. After 2 weeks, remission of hyphaemia was achieved. 12 months later of left eye surgery and 7 months after right eye surgery, she was evaluated again for routine control. The slit-lamp evaluation revealed 0.5+ erythrocytes in both the eye. A gonioscopic examination of the left eye