Pupillary block glaucoma after uneventful cataract surgery

Session Details

Session Title: Presented Poster Session: Glaucoma

Venue: Poster Village: Pod 2

First Author: : F.March de Ribot SPAIN

Co Author(s): :    A. March de Ribot   P. Gomez Faina   X. Nunez   T. Sellares   J. Gracia           

Abstract Details

Purpose:

To present a case with pupillary block glaucoma, secondary to fibrin membrane in the anterior chamber occurring after an uneventful cataract surgery.

Setting:

University Hospital, Ophthalmology Service

Methods:

A 73-year-old male arrived in the emergency department presenting vomits, severe pain and loss of visual acuity in the left eye for 2 days. He had a previous medical history of diabetes and hypertension. The left eye underwent to uneventful phacoemulsification 5 days before, this eye had a central retinal vein occlusion 4 years ago. The visual acuity was light perception and the intraocular pressure was 56 mmHg. The left eye presented red eye with ciliary injection, corneal edema, and pupillary block, with myosis and the presence of fibrin in the anterior chamber.

Results:

The patient presented pupillary block glaucoma, secondary to fibrin membrane. Treatment with peripheral iridotomy with YAG laser was realized, the procedure was difficult because of corneal edema. Two hours after this maneuver, the pain disappeared and the intraocular pressure dropped to normal values. Cycloplegic treatment was prescribed and ongoing the postoperative cataract antiinflammatory treatment. The fibrin membrane disappeared in one week.

Conclusions:

Detection of a thin fibrin membrane can be difficult in the presence of severe corneal edema associated with elevated IOP. Although fibrin membrane pupillary-block glaucoma is more common after pars plana vitrectomy, there are a few reports after cataract surgery. Hypertension and diabetes mellitus have been proposed as risk factors for fibrin formation after cataract surgery. Treatment can include laser peripheral iridotomy or intraocular tPA (25 μg). The differential diagnosis for a shallow anterior chamber associated with elevated IOP after cataract surgery includes the pupillary block (fibrin membrane, Soemmering's ring, and posterior synechia), capsular block syndrome and malignant glaucoma.

Financial Disclosure:

None