Cover Image

Management of Pseudophakic Malignant Glaucoma in Sunset Syndrome: A Case Report and Literature Review

Ioannis-Nikolaos CHALKIAS, Efthymios CHALKIAS, Anastasios HALKIAS

Abstract


To present an interesting case of pseudophakic malignant glaucoma in sunset syndrome, which potentially points to a correlation between a posterior chamber intraocular lens (PCIOL) subluxation and development of aqueous misdirection. Furthermore, we underlined the effectiveness of YAG-laser hyaloidotomy as a first line treatment for malignant glaucoma. This is a case report and literature review. A 76-year-old male with primary open angle glaucoma (POAG) with a history of left monocular diplopia due to inferior dislocation of the PC IOL (sunset syndrome), presented with a sudden onset of pain in the left eye and decreased visual acuity with corrected distance visual acuity (CDVA) of 20/60, seven years after an uneventful left phacoemulsification. The anterior chamber (AC) was shallow, the intraocular pressure (IOP) elevated and the PCIOL extruded in AC. Aqueous misdirection was diagnosed and treated with YAG laser hyaloidotomy. A gush of fluid emerged with simultaneous deepening of the AC and the IOP dropped immediately to 24 mmHg and later to 9 mmHg. A prophylactic YAG peripheral iridotomy was also performed. An IOL exchange surgery with anterior chamber IOL placement was performed a few days later resulting in a final CDVA of 20/30. We argue that postoperative subluxation of a PC IOL is likely to be an initiating event for aqueous misdirection.


References


Graefe A. Beitr├Ąge zur Pathologie und Therapie des Glaucoms. Albrecht von Graefes Archiv Ophthalmol. 1869;15(3):108-252. doi: 10.1007/bf02721215

Duy TP, Wollensak J. Ciliary block (malignant) glaucoma following posterior chamber lens implantation. Ophthalmic Surg. 1987;18(10):741-4. pmid: 3431802

Cashwell LF, Martin TJ. Malignant glaucoma after laser iridotomy. Ophthalmology. 1992;99(5):651-8; discussion 8-9. doi: 10.1016/s0161-6420(92)31913-x pmid: 1594208

Luntz MH, Rosenblatt M. Malignant glaucoma. Surv Ophthalmol. 1987;32(2):73-93. doi: 10.1016/0039-6257(87)90101-9 pmid: 3317956

Simmons RJ. Malignant glaucoma. In: Epstein D, editor. Chandler and Grant's Glaucoma. 3rd ed. Philadelphia: Lea & Febiger; 1986.

Quigley HA. Angle-closure glaucoma-simpler answers to complex mechanisms: LXVI Edward Jackson Memorial Lecture. Am J Ophthalmol. 2009;148(5):657-69 e1. doi: 10.1016/j.ajo.2009.08.009 pmid: 19878757

Choudhary A, Sahni J, Kaye SB. Late spontaneous anterior dislocation of an intraocular lens (IOL) with the capsular bag. Eye (Lond). 2005;19(1):101-2. doi: 10.1038/sj.eye.6701419 pmid: 15094719

Jehan FS, Mamalis N, Crandall AS. Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients. Ophthalmology. 2001;108(10):1727-31. doi: 10.1016/s0161-6420(01)00710-2 pmid: 11581041

Chang DF. Prevention of bag-fixated IOL dislocation in pseudoexfoliation. Ophthalmology. 2002;109(11):1951-2. doi: 10.1016/s0161-6420(02)01212-5 pmid: 12414390

Park TK, Chung SK, Baek NH. Changes in the area of the anterior capsule opening after intraocular lens implantation. J Cataract Refract Surg. 2002;28(9):1613-7. doi: 10.1016/s0886-3350(02)01378-0 pmid: 12231321

Schlotzer-Schrehardt U, Naumann GO. Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol. 2006;141(5):921-37. doi: 10.1016/j.ajo.2006.01.047 pmid: 16678509

Chandler PA, Simmons RJ, Grant WM. Malignant glaucoma. Medical and surgical treatment. Am J Ophthalmol. 1968;66(3):495-502. doi: 10.1016/0002-9394(68)91535-3 pmid: 5676357

Simmons R, Thomas J. Yaqub Malignant glaucoma. The glaucomas. St Louis: CV Mosby; 2008. p. 1251-63.

Francis BA, Babel D. Malignant glaucoma (aqueous misdirection) after pars plana vitrectomy. Ophthalmology. 2000;107(7):1220-2. doi: 10.1016/s0161-6420(00)00109-3 pmid: 10889085

Byrnes GA, Leen MM, Wong TP, Benson WE. Vitrectomy for ciliary block (malignant) glaucoma. Ophthalmology. 1995;102(9):1308-11. doi: 10.1016/s0161-6420(95)30870-6 pmid: 9097767

Pasaoglu IB, Altan C, Bayraktar S, Satana B, Basarir B. Erratum to "Surgical Management of Pseudophakic Malignant Glaucoma via Anterior Segment-Peripheral Iridectomy Capsulo-Hyaloidectomy and Anterior Vitrectomy". Case Rep Ophthalmol Med. 2013;2013:940497. doi: 10.1155/2013/940497 pmid: 23533878

Tang J, Du E, Li X. Combined Surgical Techniques for the Management of Malignant Glaucoma. J Ophthalmol. 2018;2018:9189585. doi: 10.1155/2018/9189585 pmid: 30595912

Debrouwere V, Stalmans P, Van Calster J, Spileers W, Zeyen T, Stalmans I. Outcomes of different management options for malignant glaucoma: a retrospective study. Graefes Arch Clin Exp Ophthalmol. 2012;250(1):131-41. doi: 10.1007/s00417-011-1763-0 pmid: 21858468

Harbour JW, Rubsamen PE, Palmberg P. Pars plana vitrectomy in the management of phakic and pseudophakic malignant glaucoma. Arch Ophthalmol. 1996;114(9):1073-8. pmid: 8790091

Krepste L, Zemaitiene R, Miliauskas A. Clinical Characteristics and Outcomes of Malignant Glaucoma after Different Procedures Treated with Pars Plana Vitrectomy: A 10-Year Retrospective Study. Medicina (Kaunas). 2018;54(4). doi: 10.3390/medicina54040065 pmid: 30344296

Halkias A, Magauran DM, Joyce M. Ciliary block (malignant) glaucoma after cataract extraction with lens implant treated with YAG laser capsulotomy and anterior hyaloidotomy. Br J Ophthalmol. 1992;76(9):569-70. doi: 10.1136/bjo.76.9.569 pmid: 1420065

Pakravan M, Esfandiari H, Amouhashemi N, Veisi A, Torkian P, Yazdani S. Mini-vitrectomy; a Simple Solution to a Serious Condition. J Ophthalmic Vis Res. 2018;13(3):231-5. doi: 10.4103/jovr.jovr_192_17 pmid: 30090177

Park M, Unigame K, Kiryu J, Kondo T. Management of a patient with pseudophakic malignant glaucoma; role of ultrasound biomicroscopy. Br J Ophthalmol. 1996;80(7):676-7. doi: 10.1136/bjo.80.7.676 pmid: 8795388


Full Text: Free Full Text PDF

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.