Unusual presentation of angle-closure glaucoma treated by phacoemulsification

Area of Science:

• Ophthalmology
• Glaucoma Research
• Cataract Surgery Techniques

Background:

• Primary angle-closure glaucoma (PACG) can lead to acute intraocular pressure (IOP) elevation.
• Mydriasis during fundus examination can precipitate IOP spikes in susceptible individuals.
• Patent iridotomy does not always prevent angle closure in PACG patients.

Observation:

• A 70-year-old female with a history of PACG experienced acute IOP elevation to 40 mm Hg post-mydriasis.
• Gonioscopy revealed significant appositional angle closure despite a patent iridotomy.
• Medical IOP control was initiated prior to surgical intervention.

Findings:

• Sutureless cataract surgery, including phacoemulsification and IOL implantation, was performed.
• Postoperatively, visual acuity improved, and anterior chamber parameters (angle width, depth) normalized.
• The patient maintained normal IOP without medication, even after subsequent mydriasis, 18 months post-surgery.

Implications:

• Cataract surgery can be a viable treatment for appositional angle closure and IOP elevation in specific PACG cases.
• This approach offers a long-term solution for managing IOP in selected post-PACG patients.
• The findings suggest a potential role for cataract surgery beyond refractive correction in glaucoma management.