Phacoantigenic glaucoma following uncomplicated cataract surgery

Session Details

Session Title: Presented Poster Session: Glaucoma

Venue: Poster Village: Pod 2

First Author: : A.Chiu UK

Co Author(s): :    A. Ansari   D. Mathews                    

Abstract Details

Purpose:

Phaco-antigentic glaucoma occurs in less than 1% of cataract surgeries. Managing this rare complication is challenging especially when there are few documented cases reported. We describe the challenges of managing a case of bilateral phaco-antigenic glaucoma following uncomplicated cataract surgery requiring viscocanalostomy.

Setting:

The Stanley Eye Unit, Abergele Hospital, North Wales.

Methods:

An 82-year-old atopic lady presented 4 days post left and 8 days post right uncomplicated cataract surgery with a painful injected right eye. On examination, the anterior chambers were deep with no hypopyon. IOP was raised at 38 RE and 24 left eye. However, IOP remained uncontrolled despite maximum medical treatment; she attended A+E 6 times within 11 days with IOPs of up to 48 RE and 46 LE. A vitreous biopsy was reported negative for infective organisms. Eventually bilateral viscocanalostomies were performed and vision improved to 0.24LogMAR both eyes with IOP 8 RE and 10 LE.

Results:

We postulate that an immune reaction was precipitated on exposure to lens particles during the first cataract surgery with presentation 8 days later which also coincided with similar response in the second eye at 4 days post operation .The earlier presentation in the second eye could be explained by the fact that the second eye was already sensitized following the onset of the immune reaction in the first eye. Phaco-antigenic glaucoma is a rare complication following cataract surgery. The most plausible diagnosis was phacoantigenic glaucoma. We believe this is the first reported case of phaco-antigenic glaucoma treated successfully by viscocanalostomy.

Conclusions:

Phaco-antigenic glaucoma is the rarest lens induced glaucoma complication of cataract surgery with limited case reports and managements. A diagnosis of phaco-antigenic glaucoma is often difficult in vivo and is a diagnosis by exclusion. This case highlights the importance of managing high IOP post operatively and if managed well can lead to excellent results. It further demonstrates that non-penetrating surgical option can be a good viable treatment for phaco-antigenic glaucoma.

Financial Disclosure:

None