Pupillary Block Glaucoma After Pars Plana Vitrectomy with Air-Fluid Exchange in Pseudophakic Air-Filled Eye

Pupillary block is seen after pars plana vitrectomy (PPV) with gas or silicone oil endotamponade in aphakic eyes. A case of a pseudophakic patient with pupillary block glaucoma related to the migration of air into the anterior chamber was reported. A 76-year-old woman underwent combined PPV with air endotamponade and uncomplicated cataract extraction for epiretinal membrane and cataract. On postoperative day 1, she had an 80% air fill of the anterior chamber. She returned 6 days later with pupillary block glaucoma. She was managed with a surgical peripheral iridectomy, posterior synechiolysis, and evacuation of the air from the anterior chamber. The risk of pseudophakic pupillary block glaucoma after PPV with air tamponade may be increased with inflammation due to combined PPV and cataract extraction, zonular weakness, and efflux of air from the vitreous cavity into the anterior chamber. Early detection and treatment is recommended to avoid permanent sequelae.