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Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

Purpose: To report the incidence and management of haemorrhagic Descemet membrane detachment (HDMD) in canaloplasty and phacocanaloplasty., Methods: This study included 105 eyes of 92 patients with uncontrolled open angle glaucoma who underwent canaloplasty and phacocanaloplasty between 2010 and 2014. Eyes that developed either HDMD or non-HDMD were identified. The main outcome measures were the development of HDMD and non-HDMD, best corrected visual acuity, recovery time after Descemet membrane detachment (DMD), intra-ocular pressure (IOP) and number of antiglaucoma medications. Each eye was managed according to the time of development, type and extent of DMD., Results: Ten eyes (9.5%) developed DMD- four eyes underwent canaloplasty (3.8%) and six eyes underwent phacocanaloplasty (5.7%). Three of 10 eyes developed non-HDMD while seven of 10 developed HDMD, the majority of HDMD cases occurred in combination with phacocanaloplasty (five of seven). The non-HDMD eyes resolved completely within 2 weeks without intervention. One eye with HDMD was observed for 2 weeks, before a 15% sulphur hexafluoride (SF6) intracameral injection was given. The patient developed a dense corneal stain that was resolving slowly over 30 months. One eye with HDMD underwent YAG laser membranotomy 2 weeks after being identified, which regained corneal transparency 1 month after treatment, while the remaining five eyes underwent immediate surgical drainage and regained corneal transparency 1 day post-procedure., Conclusion: HDMD occurred in up to 6.7% in canaloplasty and phacocanaloplasty procedures, mostly during catheter withdrawal and the viscodilation step. Early recognition and management prevented further manipulation., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

We present an unusual case of congestion bleeding of the head and neck following myocardial infarction. A 51-year-old man presented with widespread facial petechiae and subconjunctival haemorrhages following a collapse associated with evolving electrocardiographic changes. Emergency coronary artery stent placement was undertaken. No cardiopulmonary resuscitation (CPR) was performed. We hypothesise that the presence of facial petechiae in our case following transient loss of consciousness due to a presumed ventricular arrhythmia in the setting of acute myocardial ischaemia, may have been precipitated by a Valsalva manoeuvre on regaining consciousness with sudden acute increase in venous pressure and consequent venous congestion of the head and neck, and that congestion bleeding of the face may occur in acute cardiac events without a history of CPR.

Purpose: To the best of our knowledge, no large population-based studies on the relationship between conjunctival haemorrhage and stroke have been conducted to date. Using a nationwide population-based data set, this study investigated the relationship between conjunctival haemorrhage and the subsequent risk of stroke within a 3-year period following diagnosis., Methods: We analysed data sourced from the Taiwan Longitudinal Health Insurance Database 2000. The study cohort consisted of 17 349 patients with conjunctival haemorrhage and 86 745 comparison subjects. Each patient was individually tracked for a 3-year period from their index date to identify all those who had subsequently received a diagnosis of stroke., Results:   The incidence rate of stroke was 2.44 (95% CI = 2.31-2.55) per 100 person-years in patients with conjunctival haemorrhage and 1.63 (95% CI = 1.59-1.68) per 100 person-years in comparison patients. After adjusting for patients' monthly income and geographic location, as well as for hypertension, atrial fibrillation, diabetes, hyperlipidaemia and coronary heart disease, stratified Cox proportional hazards regressions revealed a statistically significant hazard ratio for stroke in patients with conjunctival haemorrhage (HR = 1.33; 95% CI = 1.24-1.42, p < 0.001)., Conclusions: In this study, patients with conjunctival haemorrhage were found to be at a significant risk of stroke during a 3-year follow-up period after diagnosis., (© 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To evaluate the tear film characteristics of spontaneous subconjunctival hemorrhage patients by Schirmer test I and tear interferometry., Methods: Forty-six spontaneous subconjunctival hemorrhage patients and 46 controls were enrolled in the study. Schirmer test I and tear interferometry were performed in all 92 subjects. The results obtained were compared between the two groups., Results: The Schirmer test I value of the spontaneous subconjunctival hemorrhage patients was 6.93 (4.72) mm, and that of the controls was 14.70 (3.70) mm. A statistical difference was found between the two groups (independent samples t test, t=-8.79, p<0.001). The mean rank of the tear interferometry patterns of the spontaneous subconjunctival hemorrhage patients was 50.07, and that of the controls was 42.93. No statistical difference was found between the two groups (Mann-Whitney U test, Z=-1.85, p=0.064)., Conclusions: For the spontaneous subconjunctival hemorrhage patients, the Schirmer test I value was lower than that of the controls, whereas the tear interferometry patterns were comparable to that of the controls.

Purpose: To document the clinical features of disc hemorrhage in patients with branch retinal vein occlusion (BRVO) and normal tension glaucoma (NTG), and to evaluate the relationship between BRVO and NTG with disc hemorrhages., Methods: From July 2001 to May 2006, sixteen patients with both NTG and BRVO in different eyes were successively collected from outpatient population of Seoul National University Hospital in this observational case series. The frequency and location of disc hemorrhages, history of associated systemic diseases, and the order of the time of diagnosis between NTG and BRVO were studied., Results: All patients had unilateral BRVO, and their mean age was 63.3+/-10.6 years. Disc hemorrhages were detected in eight patients (50%) during the mean follow-up of 26.8 months (range, 3-96 months). Six patients (75%) had disc hemorrhages in the non-BRVO eyes and two patients (25%) in BRVO eyes. Five hemorrhages (62.5%) were located at inferior-temporal quadrant of the optic disc. History of systemic hypertension was identified in 12 patients (75.0%). In 11 patients (68.8%), NTG was diagnosed at the same time as BRVO., Conclusions: A higher frequency of disc hemorrhages was identified in patients with both BRVO and NTG. Therefore, some cases of NTG, especially with disc hemorrhages, may share a common vascular pathophysiology with BRVO.

Purpose: To investigate the effect of subconjunctival injection of liposome-bound, low-molecular-weight heparin (LMWH) on the absorption rate of subconjunctival hemorrhages., Methods: Subconjunctival hemorrhages were induced in both eyes of 30 rabbits by the subconjunctival injection of 0.1 mL of autologous blood from auricular marginal veins. After 8 hours, randomized subconjunctival injections of one of three materials were made: 5 IU/mL liposome-bound LMWH (0.1 mL) in 18 eyes (group A), only liposomes (0.1 mL) in 14 eyes (group B), the free form of LMWH (5 IU/mL, 0.1 mL) in 14 eyes (group C), or no injection in 14 eyes (group D). Subconjunctival hemorrhages were photographed with a digital camera at 8, 24, 48, 72, 96, and 120 hours after induction of subconjunctival hemorrhages, sized with an image analyzer, and compared between groups., Results: Subconjunctival hemorrhages were absorbed faster in group A (liposome-bound LMWH injected) than in with group B (liposome injected). Comparison of groups A and C (free LMWH injected) showed statistical differences in the absorption rates at 96 and 120 hours except at 24, 48, and 72 hours. The mean elapsed time for the complete resorption of subconjunctival hemorrhages was shortest in group A among four groups, whereas group B and the control showed no significant differences. The ocular and systemic absorption of LMWH were significantly lower after injection of the liposome-bound than the free form., Conclusions: The subconjunctival injection of liposome-bound LMWH appears to enhance subconjunctival hemorrhage absorption in rabbits.

Aim: To study the visual performance in eyes with interface haemorrhage during laser assisted in situ keratomileusis (LASIK)., Methods: Case records of 20 patients, who had bleeding from the limbal vessels in one eye during LASIK (group 1) and uncomplicated surgery in the fellow eye (group 2) were studied. The parameters evaluated were uncorrected visual acuity (UCVA) best corrected visual acuity (BCVA), spherical equivalent of refraction (SEQ), contrast sensitivity, and glare acuity preoperatively and at 1, 3, and 6 months postoperatively., Results: The mean preoperative SEQ in group 1 and 2 eyes was -5.79 (2.3) D and -5.27 (1.68) D, respectively. The mean decimal UCVA at 6 months after LASIK in group 1 and 2 eyes were 0.6 (0.2) and 1.0 respectively (p<0.001). The mean decimal BCVA at 1 week after LASIK in group 1 and 2 eyes were 0.89 (0.04) and 1.0 respectively (p<0.05). However, all eyes had a BCVA of 6/6 at 1, 3, and 6 months after LASIK. The mean contrast sensitivity values preoperatively in group 1 and 2 eyes were 161.3 (8.7) and 172 (68.2) respectively. There was a significant decrease in group 1 at 6 months (102 (60.5) (p<0.01)) compared to group 2. The decimal glare acuity preoperatively in group 1 and 2 eyes was 0.95 (0.11) and 0.89 (0.12), respectively. It decreased significantly in group 1 (0.7) (0.1 (p<0.01)) compared to group 2 at the 6 month follow up., Conclusion: Occurrence of intraoperative interface haemorrhage may affect the visual performance following LASIK surgery.

The relationship between the condition of spontaneous subconjunctival haemorrhage (SCH) and hypertension was investigated. Seventy eight patients with SCH and 78 controls with unrelated ophthalmic conditions were compared. Blood pressure (BP) was significantly higher at presentation in the group with SCH at 149 (SD 27)/89 (SD 15) versus 142 (SD 25)/81 (SD 12). The proportion of hypertensives by WHO criteria (systolic blood pressure > 160 and/or diastolic blood pressure >95) was 46% on presentation compared with 23% of the control group. The morphology of the lesion did not influence the association with hypertension although there was a suggestion that the group with raised haemorrhages had a tendency to higher systolic blood pressure. It is recommended that all patients with SCH have their BP checked; this will result in the diagnosis of a significant number of new hypertensives.