Posters

Unusual acute pseudophakic cilio-vitreo-lenticular block

Poster Details

First Author: W.Akioud MOROCCO

Co Author(s): T. Abdelaoui   H. Brarou   M. Khamaily   K. Reda   A. Oubaaz        

Abstract Details

Purpose:

Cilio-vitreo-lenticular block also known as Malignant Glaucoma (MG) is an infrequent cause of secondary angle closure glaucoma. It can clinically be recognized by raised intraocular pressure (IOP) associated to a shallowing of the anterior chamber following a filtration or cataract surgery. It usually occurs early in the post operative follow up, however it can also present in different latencies, ranging from a day to many months.

Setting:

We describe a case of an unusual pseudophakic cilio-vitreo-lenticular block that spontaneously occurred many years after a cataract surgery. The MG, in this particular case, was due to a subluxation of the intra ocular lens and the capsular bag, as a result of zonular weakness.

Methods:

A 67 years old patient with no history of glaucoma or  previous trabeculectomy who had a regular cataract surgery 10 years ago, was referred to our emergency department with a severe acute headache, left eye redness and blurry vision right after getting up from prostration ( an Islamic prayer gesture) . The examination showed a visual acuity limited to hand movement, severe corneal edema, a diffusely shallow anterior chamber and moderately dilated and nonreactive pupils. The intraocular pressure was at 60 mmHg. The intra ocular lens (IOL) was immediately against the iris(fig1).

Results:

The patient immediately received per oral acetazolamide250mg QDS, IV mannitol, G travatan, iopidine1%, timolol0.25% and cyclopentolate1% , which  reduced the IOP to 52mmHg. A removal of the block IOL-capsular bag was conducted as well as an anterior vitrectomy , a diode laser cyclodestruction and the IOL was replaced with an anterior chamber Lens completed with a peripheral iridotomy ( fig2, 3, and 4)  The normal flow of the aqueous humour was restored and the IOP was reduced to 16mmHg. A week after the procedure, the patient’s visual acuity was of 2/10, with no corneal edema and a normal IOP at 14mmHg.(fig5)

Conclusions:

This case demonstrates that an MG can occur with a significant delay after a cataract surgery in patients with zonular weakness, highlighting the need to high level of caution while operating such patients as well as an accurate choice of the IOL and an adequate follow up.

Financial Disclosure:

None