Delayed intracapsular hematoma after use of iris retractor hooks

Introduction: To the author’s knowledge, this is the first reported case of a delayed intracapsular hematoma after complex femtosecond laser–assisted cataract surgery (FLACS) and the use of iris retractor hooks for intraoperative floppy-iris syndrome. It is important that cataract surgeons be aware of this association. Patient and Clinical Findings: An 83-year-old man underwent FLACS with astigmatic keratotomy and intraocular lens implantation. Iris retractor hooks were used to counter intraoperative miosis. Hyphema, corneal edema, and subconjunctival hemorrhage were observed on postoperative day (POD) 1. The patient returned on POD 3 with further decrease in vision due to Descemet folds, advanced corneal edema, layered hyphema, and a dense intracapsular hematoma. Diagnosis, Intervention, and Outcomes: Minimal improvement of the hematoma occurred through 4 weeks, at which time the hematoma was drained with Nd:YAG laser posterior capsulotomy. The hematoma reabsorbed within 1 month with full recovery of vision. Conclusions: The iris retractor hooks in the setting of complex FLACS likely caused postoperative bleeding with accumulation of blood within the capsule. Nd:YAG laser posterior capsulotomy is an effective treatment option for nonclearing intracapsular hematoma.