Recurrent hyphema in an aphakic child: Swan syndrome

In 1973, Swan(1) described 3 patients who developed hyphema months to years after uncomplicated cataract surgery. He noted focal vascularization from an ingrowth of episcleral vessels at the cataract wound site, resulting in recurrent intraocular bleeding. Swan syndrome has been reported following i ntracapsular cataract extraction, extracapsular cataract extraction (includ ing clear corneal incisions), iridocyclectomy, and glaucoma filtering proce dures.(2-4) Patients typically present with sudden painless blurred vision, often upon awakening, which may or may not be preceded by physical strain or trauma. Other patients are asymptomatic and diagnosed with hyphema or an terior chamber red blood cells on routine examination.(5) The hyphema often resolve spontaneously, making later diagnosis difficult. Gonioscopic visua lization of the abnormal wound vessels is necessary for diagnosis. Without active bleeding, however, the fibrovascular tuft may be easily overlooked. We report a case of Swan syndrome in a 16-month-old boy after cataract extr action was performed. To our knowledge, Swan syndrome has not been reported in the pediatric population. Children represent a significant proportion o f patients undergoing anterior segment surgery and Swan syndrome should be considered in the differential diagnosis of hyphema in this population.