Fibrin Pupillary-block Glaucoma after Uneventful Phacovitrectomy in a Patient with Proliferative Diabetic Retinopathy (PDR): A Case Report
Article Sidebar
Main Article Content
Abstract
Background: Fibrin pupillary-block glaucoma is an uncommon complication after phacoemulsification or vitrectomy. Various treatment modalities relieving fibrin pupillary-block have been reported, such as intracameral recombinant tissue plasminogen activator (rTPA), argon–neodymium: YAG (Nd:YAG) laser iridotomy, Nd:YAG laser membranotomy, and medical dilation.
Objective: To report a patient with proliferative diabetic retinopathy (PDR) who developed fibrin pupillary-block glaucoma after uneventful phacovitrectomy and was successfully treated with Nd:YAG laser membranotomy.
Methods: Retrospective case report.
Results: The patient was a 59-year-old Thai male with PDR, epiretinal membrane and tractional macular edema in his left eye. Combined phacoemulsification with pars plana vitrectomy (PPV) was performed. On postoperative day 7, the patient presented with blurred vision from corneal microcystic epithelial edema associated intraocular pressure (IOP) spike due to the presence of fibrin membrane obstructing the pupil opening and was diagnosed with fibrin pupillary-block glaucoma. Nd:YAG laser membranotomy was performed and resulted in complete resolution of pupillary block.
Conclusion:Laser Nd:YAG membranotomy provides safe and effective resolution of fibrin pupillary-block glaucom.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Demetriades AM, Gottsch JD, Thomsen R, et al. Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology. Am J Ophthalmol. 2003;135(3):291-296.
Lahey JM, Francis RR, Kearney JJ. Combining phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy. Ophthalmology. 2003;110(7):1335-1339.
Treumer F, Bunse A, Rudolf M, Roider J. Pars plana vitrectomy, phacoemulsification and intraocular lens implantation. Comparison of clinical complications in a combined versus two-step surgical approach. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2006;244(7):808-815.
Park SP, Ahn JK, Lee GH. Morphologic changes in the anterior segment after phacovitrectomy for proliferative diabetic retinopathy. J Cataract Refract Surg. 2009;35(5):868-873.
Occhiutto ML, Freitas FR, Maranhao RC, Costa VP. Breakdown of the Blood-Ocular Barrier as a Strategy for the Systemic Use of Nanosystems. Pharmaceutics. 2012;4(2):252-275.
Khor WB, Perera S, Jap A, Ho CL, Hoh ST. Anterior segment imaging in the management of postoperative fibrin pupillary–block glaucoma. J Cataract Refract Surg. 2009;35(7):1307-1312.
Khan S, Elashry M. The Nd:YAG laser as first-line treatment for fibrin pupillary-block glaucoma following uncomplicated cataract surgery. Oxf Med Case Reports. 2019;2019(1).
Yoshino H, Seki M, Ueda J, Yoshino T, Fukuchi T, Abe H. Fibrin membrane pupillary-block glaucoma after uneventful cataract surgery treated with intracameral tissue plasminogen activator: a case report. BMC Ophthalmol. 2012;12(1):3.
Liu Y, Luo L, He M, Liu X. Disorders of the blood-aqueous barrier after phacoemulsification in diabetic patients. Eye. 2004;18(9):900-904.
Amorim M, Martins B, Fernandes R. Immune Fingerprint in Diabetes: Ocular Surface and Retinal Inflammation. Int J Mol Sci. 2023;24(12).
Liu Y, Luo L, He M, Liu X. Disorders of the blood-aqueous barrier after phacoemulsification in diabetic patients. Eye. 2004;18(9):900-904.
Xu H, Chen M. Diabetic retinopathy and dysregulated innate immunity. Vision Res. 2017;139:39-46.
Bennett S, Studsgaard A, Telinius N. Topical dilation as first-line treatment for fibrin membrane pupillary-block glaucoma following uncomplicated cataract surgery. BMJ Case Rep. 2023;16(4).