Pearl-type posterior capsule opacification as a possible predisposing factor for malignant glaucoma: a case report.

Area of Science:

• Ophthalmology
• Glaucoma Research
• Cataract Surgery Complications

Background:

• Malignant glaucoma (MG) is often linked to narrow angles or pseudoexfoliation (PEX)-induced zonular laxity.
• Posterior capsule opacification (PCO), including Elschnig's Pearls (EP) and Soemmering's ring (SR), can precipitate aqueous misdirection syndrome.

Purpose of the Study:

• To describe a rare case of malignant glaucoma (MG) caused by massive posterior capsule opacification (PCO).
• To highlight the diagnostic challenges and successful management of aqueous misdirection syndrome in this context.

Main Methods:

• A 78-year-old female presented with acute ocular pain, redness, blurred vision, and severe intraocular pressure (IOP) elevation.
• Initial medical management (acetazolamide, pilocarpine, mannitol) was ineffective.
• Treatment was switched to atropine, with laser iridotomy enlargement, posterior capsulotomy, and anterior hyaloidotomy performed.

Main Results:

• The patient presented with a shallow anterior chamber, angle closure, myopic shift, and PCO filling the posterior chamber.
• Medical management failed to reduce the significantly elevated IOP.
• The combined laser and surgical intervention rapidly controlled the condition, reducing IOP and resolving symptoms.

Conclusions:

• This case demonstrates PCO as a potential cause of malignant glaucoma (MG) and aqueous misdirection, particularly in patients with pseudoexfoliation (PEX).
• PCO can lead to iridocorneal angle narrowing and pupillary block, initiating aqueous misdirection.
• Early recognition and appropriate intervention, including laser procedures and capsulotomy, are crucial for managing this rare presentation of MG.