G
UCOMA
lens in his left eye. The patient had left-sided visual acuity
of counting fingers and right-sided vision of 6/12. Dr.
Papandreou observed narrow anterior chamber angles
bilaterally and high intraocular pressures of 52 mm Hg in
the affected, left eye, which led to the diagnosis of pha-
comorphic glaucoma. IOP was 22 mm Hg in the patient's
right eye.
Dr. Papandreou's management of this case focused
first on reducing the very high IOP to prevent further
damage to the optic nerve, especially in the affected eye,
and to prevent synechia formation. The patient was imme-
diately administered mydriatics, corticosteroids, and aque-
ous suppressants, which addressed the acute nature of the
angle closure and successfully lowered the patient's IOP to
19 mm Hg in his left eye and 13 mm Hg in his right eye.
The following day, the patient underwent periph-
eral iridotomies and he was scheduled for conventional
phacoemulsification surgery within the week. The pupil of
the patient's right eye was partially dilated and minimally
reactive, without the existence of an afferent pupillary de-
fect, and there was a shallow, right-sided anterior chamber.
The patient underwent left-sided cataract surgery with
phacoemulsification. Dr. Papandreou stained the anterior
capsule with trypan blue under an air bubble to protect the
endothelium and facilitate the capsulorhexis. She inserted
a Malyugin ring to create more space for surgery due to
the atrophic small pupil of the left eye. The surgeon noted
zonular dehiscence and phacodonesis during the surgery,
and then decided to insert a capsular tension ring prior to
lens removal. The capsular bag remained intact and the
IOL was inserted into the bag.
continued from page 64
Secondary angle-closure glaucoma can be caused by lens
intumescence.
Source: Pekka Virtanen, MD
2020
3-7 October
RAI Amsterdam
Congress of the ESCRS
Amsterdam
38th
www.escrs.org
Instructional Course
Submission Deadline
31 October 2019
