Fig. 2

Intraoperative findings in the initial surgery. Massive hyphema in the anterior chamber removed using a 25-gauge vitreous cutter (a). Massive vitreous hemorrhage is observed (b, c). As the removal of hemorrhage progresses (b, c), the intraocular lens is found in the hemorrhage of the posterior fundus (d; arrow); simultaneously, massive bleeding is observed from the vicinity of the optic disc (d, e, g; the arrowhead shows the bleeding site). Hemostasis is attempted by elevating the intraocular pressure and aspirating the blood using a 25-gauge cutter; however, it was difficult to achieve. Moreover, it was difficult to identify the bleeding site and coagulate with intraocular diathermy. The retina was pale at the temporal side (f; arrow), suggesting retinal ischemia because of impaired retinal circulation attributed to damage of the retinal artery. Retinal photocoagulation performed at the temporal side of the retina (f, arrow). The optic disc and macula cannot be observed until the end of the surgery (g) because of hemorrhage