Late reflux bleeding following gonioscopy-assisted transluminal trabeculotomy

A 60-year-old gentleman came for a routine check-up 2 months after an uneventful Gonioscopy-Assisted Transluminal Trabeculotomy for uncontrolled primary open-angle glaucoma. His intraocular pressure (IOP) was 14 mm Hg. He was not on anticoagulants. Goldmann two mirror gonioscopy revealed a good cleft [Fig. 1a]. As the gonioscopy was continued, a progressive filling of the cleft with blood reflux was noted [Fig. 1b-d]. Gonioscopy was abandoned immediately. The anterior chamber (AC) was well formed with few dispersed red blood cells when re-examined an hour later. The patient was started on topical steroids and reviewed in a week. IOP was normal, and the AC was quiet. We report this to highlight the risk of late-onset hyphema following ocular compression/decompression and/or changes in the episcleral venous pressure after ab interno trabeculotomy surgeries.[1,2]Figure 1: (a): Goniophotograph showing good cleft following gonioscopy-assisted transluminal trabeculectomy (black arrowheads). (b-d): Goniophotograph showing progressive blood reflux during gonioscopy (black arrowheads)Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.