Pupillary Block Glaucoma in a Patient Who Underwent Inverted Implantation of Intraocular Lens: Case Report

Doganay S., Firat P., ÇANKAYA C., Koc B.

TURKIYE KLINIKLERI TIP BILIMLERI DERGISI, vol.32, no.2, pp.524-528, 2012 (SCI-Expanded) identifier identifier


Current report presents an interesting case who had pupillary block glaucoma in postoperative period related to the inverted implantation of intraocular three piece-lens with optic haptic angulation of 5 degrees. A 23-year-old female admitted for severe pain and loss of vision in her left eye for 7-8 hours. Visual acuity was 0.9 in right eye and finger counting from two meters in left eye. Biomicroscopic examination showed that posterior chamber intraocular lens located in ciliary sulcus and open posterior capsule in central area in right eye. Ciliary congestion and severe corneal edema were observed in left eye. Anterior chamber structures were not clearly observed, anterior chamber was shallow and iris was dome shaped. The optic of intraocular lens which was placed in posterior chamber, entirely shifted to anterior chamber through pupilla and formed a pupillary block. Intraocular pressure was 12 mmHg in right eye, 63 mmHg in left eye. The patient whose intraocular pressure got under control by medical therapy was performed peripheral iridotomy using Nd:YAG laser. One week after iridotomy, the visual acuity was 0.5 and the intraocular pressure was measured as 15 mmHg. After corneal opacity completely improved, it was noticed that intraocular lens was placed inversely within the posterior chamber. The lens optic within the anterior chamber was placed into the posterior chamber with a surgical intervention. In the fourth month following surgery, inferior half of the intraocular lens optic was decentralized again into the anterior chamber (without pupil blockage because of the iridotomy open at 1 o'clock) and intraocular pressure was measured as 12 mmHg. With a second surgical intervention, the intraocular lens was set into correct position by inverting it and it was centralized at ciliary sulcus.