A rare case of membrane pupillary-block glaucoma in a phakic eye with uveitis

Membrane pupillary-block glaucoma is a rare condition typically associated with fibrin formation due to postoperative inflammation following cataract surgery and vitrectomy.

A 55-year-old man with a history of Stevens-Johnson syndrome and anterior uveitis presented with decreased vision in his right eye. Examination revealed corneal epitheliopathy, anterior chamber cells, and cataract. Increased oral steroids resolved the ocular inflammation, but one month later, he developed severe ocular pain in the right eye. Examination revealed best-corrected visual acuity (BCVA) of light perception, and intraocular pressure (IOP) was markedly elevated at 49 mmHg in the right eye. Anterior segment optical coherence tomography (AS-OCT) confirmed a shallow anterior chamber and a membrane across the pupil without adhesion to the lens, leading to the diagnosis of membrane pupillary-block glaucoma. AS-OCT was helpful in differentiating this condition from iris bombe. Surgical interventions, including membrane perforation, cataract extraction, and anterior vitrectomy, successfully relieved the pupillary block. Postoperatively, IOP decreased to 15 mmHg, and decimal BCVA improved to 0.4.

This is the first reported case of membrane pupillary-block glaucoma in a phakic eye with uveitis, though it is typically reported postoperatively. AS-OCT is an invaluable diagnostic tool, which may enable prompt surgical intervention and lead to favorable outcomes.