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Intraoperative malignant glaucoma during femtosecond laser-assisted cataract surgery: A case report
1Aier Eye Hospital of Wuhan University, Wuchang District, Wuhan, China.
Rationale:
Femtosecond laser-assisted cataract surgery (FLACS) has grown in popularity among ophthalmologists as a novel surgical technique. However, malignant glaucoma (MG) is a complication of FLACS. Herein, we report a case of MG following FLACS.
Patient Concerns:
A 66-year-old woman presented with complaints of blurred vision in the right eye and a foreign body sensation in both eyes. Ophthalmological examinations showed that the corrected distance visual acuity was 20/50 and 20/25 in the right and left eyes, respectively. Without any topical anti-glaucoma medication, the intraocular pressure (IOP) was 20 mmHg in the right eye and 17 mmHg in the left eye. Slit-lamp examination of the right eye revealed a transparent cornea with a defect in the punctate overlying epithelium; the central anterior chamber depth was shallow the peripheral iris laser shot was visible, the pupil was normal, and the lens was mainly cortical opacified.
Diagnoses:
Based on the patient's symptoms, examination results, and preliminary diagnoses, age-related cataract in the right eye, binocular post-antiglaucoma surgery, pseudophakicin in the left eye, and Sjogren syndrome were included.
Interventions:
FLACS was performed to facilitate anterior capsulotomy and segmentation of the nucleus in the right eye. MG occurred after the femtosecond procedure, and with the treatment of medicines combined with phacoemulsification, IOP was eventually normal without further antiglaucoma therapy.
Outcomes:
IOP was 16 mmHg on postoperative day 1. Ocular ultrasonography revealed no choroid detachment or hemorrhage in the right eye. Two weeks postoperatively, uncorrected visual acuity was 20/25, and IOP remained normal with no further antiglaucoma treatment on 1 month postoperatively.
Conclusions:
We describe the occurrence of MG after FLACS and illustrate that miosis and bubble formation after FLACS may be risk factors for MG during FLACS.
Insights
Malignant glaucoma (MG) can occur after femtosecond laser-assisted cataract surgery (FLACS). This case report highlights potential risk factors like miosis and bubble formation during FLACS, emphasizing the need for vigilance.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Glaucoma Research
Background:
- Femtosecond laser-assisted cataract surgery (FLACS) is a rapidly advancing technique in ophthalmology.
- Malignant glaucoma (MG) is a recognized, albeit rare, complication associated with cataract surgery.
- Understanding the specific risks and presentations of MG post-FLACS is crucial for patient safety.
Observation:
- A 66-year-old female patient presented with decreased vision and foreign body sensation post-FLACS.
- Examination revealed a shallow anterior chamber and other signs suggestive of potential glaucomatous changes.
- The patient had a history of cataract and prior glaucoma surgery.
Findings:
- Malignant glaucoma (MG) developed subsequent to femtosecond laser-assisted cataract surgery (FLACS).
- The patient's intraocular pressure (IOP) was managed successfully with medication and phacoemulsification, normalizing without further antiglaucoma treatment.
- Postoperative IOP remained stable, and visual acuity improved significantly.
Implications:
- Miosis and intraoperative bubble formation during FLACS may be identified as potential risk factors for developing malignant glaucoma.
- This case underscores the importance of recognizing and managing MG in the context of modern cataract surgery techniques.
- Further research into FLACS-associated complications can refine surgical protocols and improve patient outcomes.
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