•Prepare the working paracentesis superotemporally as described above.

•Insert the cannula and irrigate the AC as described above.

47.2.2 Clotted Blood

Only bimanual technique is possible (see Fig. 47.1; “bimanual” here means that are two tools in the AC).

Fig. 47.1 The blood in the AC is partially clotted. While irrigation will result in partial removal of the hemorrhage, the blood seen inferiorly will require the use of the probe

•Insert an AC maintainer as described above.

•Prepare the working paracentesis superotemporally as described above.

•Insert a probe.1

–Always keep it in the correct plane, avoiding both the corneal endothelium anterior and the iris/lens posterior to it (see Fig. 2.1).

–Turn and keep the port sideways, never up or down.

–Aspirate first, and do not activate the cutting function until the clot is firmly grasped (port well occluded). This avoids a sudden drop in the IOP with resulting collapse of the AC as well as prevents cutting into the iris or the lens.

–Start in the epicenter where the AC is the deepest and gradually move toward the angle 360°.

•Irrigate the AC before the AC maintainer is withdrawn.

The blood in the AC is partially clotted. While irrigation will result in partial removal of the hemorrhage, the blood seen inferiorly will require the use of the probe.

1 It is a futile attempt to remove the clot with a forceps.