Management of traumatic hyphema in a patient with Glanzmann thrombasthenia using intraoperative recombinant factor VIIa.

A 14-year-old boy with known Glanzmann thrombasthenia presented with total hyphema and high intraocular pressure (IOP) of 55 mmHg in the right eye following blunt trauma. Initial management included intravenous mannitol, triple antiglaucoma therapy, and platelet transfusion, resulting in partial hyphema regression and IOP reduction. However, persistent coagulated blood by day 3 necessitated surgery. Despite platelet transfusion perioperatively, anterior chamber irrigation, and anterior vitrectomy, bleeding continued until recombinant factor VIIa (rFVIIa) was administered intraoperatively. Postoperatively, visual acuity recovered to 20/20 and IOP normalized, with complete resolution and no recurrence over 1 year's follow-up.