Cost effectiveness of phacoemulsification in developing countries

Abstract

The following day, the visual acuity was hand movements. Fundus and ultrasound examination ( Figure 1a) confirmed extensive suprachoroidal haemorrhage. A full blood count (FBC) showed thrombocytopenia (platelet count 87 Â 10 9 /l). Haematology opinion was sought; investigations including a blood film and autoimmune screen were normal. Quinine was stopped and the platelet count has gradually risen. With conservative management, the left visual acuity has improved to 6/6 at 4 months post-surgery despite the presence of macular choroidal folds (Figures 1b and c). CommentExpulsive suprachoroidal haemorrhage is a rare but potentially devastating event during intraocular surgery. Occult thrombocytopenia is the only identifiable risk factor for haemorrhage in this patient. Extensive haematological investigation has strongly suggested quinine drug-induced immune thrombocytopenia (DITP). The rise in platelet count since cessation of quinine supports this.Quinine causes DITP by stimulating production of antibodies against platelet membrane glycoproteins causing platelet destruction. Treatment includes drug withdrawal and control of bleeding. 2 We believe this is the first reported case of quinine-induced thrombocytopenia associated with intraocular haemorrhage.Awareness of quinine use in the elderly population is important. The Royal College of Ophthalmologists local anaesthetic guidelines suggest a pre-operative FBC only for patients with a history of systemic disease or abnormal examination. 3 We feel that occult thrombocytopenia significantly contributed to the suprachoroidal haemorrhage in this case and recommend an FBC prior to intraocular surgery for all patients taking quinine.