BMJ Case Reports 2010; doi:10.1136/bcr.11.2009.2456
  • Unusual association of diseases/symptoms

Amsler-Verrey sign during cataract surgery in Fuchs heterochromic uveitis

  1. Christine Kiire
  1. Department of Ophthalmology, NHS Ayrshire and Arran, Ayr, UK
  1. Correspondence to Douglas Lyall, douglas_am_lyall{at}


Fuchs heterochromic uveitis (FHU) in its classic presentation is a unilateral, chronic, low grade, often asymptomatic anterior uveitis. It is characterized by a classic triad of iris heterochromia, cataract and keratic precipitates. Neovascularization of the iris and the anterior chamber (AC) angle (radial and circumferential) occurs in 6–22% of cases. This angle and iris new vessels can sometimes lead to a characteristic filiform haemorrhage and formation of hyphaema after AC paracentesis and is a hallmark of FHU known as Amsler–Verrey sign. This haemorrhage has been previously associated with trivial trauma, mydriasis, applanation tonometry, gonioscopy, or it may occur spontaneously. In the setting of cataract surgery it has been previously reported with the use of a Honan balloon. We report a case of cataract and FHU where the Amsler–Verrey sign developed intraoperatively during a phacoemulsification procedure. To the best of our knowledge, this is the first documented report of this sign occurring intraoperatively during cataract surgery.


  • 1 20-gauge micro vitreoretinal blade used to create paracentesis

  • 2 Intracameral anesthesia (1% preservative free lidocaine) injected into anterior chamber through paracentesis

  • 3 2.75 mm clear corneal wound was constructed in the superior cornea

  • 4 Injection of sterile air to maintain the anterior chamber

  • 5 0.1 % trypan blue (Vision Blue, DORC International, Netherlands) injected under the air bubble over the anterior capsule to allow even contact of the dye with the anterior lens capsule

  • 6 The dye is then washed out from the AC with balanced salt solution

  • 7 Fresh bleeding noted in the AC arising from the nasal angle

  • 8 A high density cohesive ophthalmic viscoelastic device (OVD) (1.4 % Sodium hyaluronate, Healon GV, Advanced Medical Optics, USA) was used to tamponade the bleeding and to maintain the AC

  • 9 Continuous curvilinear capsulorhexis (CCC) performed

  • 10 Cataract removed by phacoemulsification technique

  • 11 A single piece intraocular lens implant (IOL) is placed within the capsular bag.

  • Competing interests None.

  • Patient consent Obtained.

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