Purpose. To demonstrate the importance of ultrasonographic biomicroscopy for following the clinical course of an intracorneal hematoma of unknown origin. Methods. A 64-year-old woman was referred to the Nagoya University Hospital because of a decrease in vision in her left eye. Her visual acuity was 20/70 (uncorrectable) in the left eye and the slit-lamp biomicroscopic examination showed a dark red-colored intracorneal hematoma in the central area of the left eye at the pre-Descemet's membrane level. Because the hematoma was small without any epithelial involvement and ultrasonographic biomicroscopy (UBM) and slit-lamp biomicroscopy showed a low risk of a pupillary block, she was followed without surgical treatment. Results. The hematoma turned yellow and grew smaller, and UBM images showed an internal liquified cyst 10 months after her initial visit. The cystic legion was detected as a low-echoic cavity by UBM 2 months before it was observed by slit-lamp biomicroscopy. The hematoma was almost resolved 2.5 years after the onset, and the visual acuity OS improved to 20/30. Conclusion. The intracorneal hematoma occurred without any obvious cause and should be classified as spontaneous. UBM combined with slit-lamp biomicroscopy was useful in estimating the extent of the hematoma and thus the risk of pupillary block. It was also helpful in deciding whether surgical treatment was necessary.
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