Grand Rounds

A patient presented with a several-year history of unilateral worsening blurry vision and increasing intraocular pressure (IOP) in the left eye. The patient was found to have elevated IOP at an outside facility and was started on Latanoprost, Dorzolamide-Timolol, and Brimonidine eye drops in the affected eye as well as oral acetazolamide 250mg BID. The patient reported prior complex cataract extraction in the right eye resulting in open posterior capsule, anterior vitrectomy, peripheral iridectomy, and AC IOL placement. Past medical history is significant for COPD. They deny a family history significant for glaucoma. Upon presentation, visual acuity was 20/40 in the right eye and HM in the left eye. IOP was 20mmHg in the right eye and 13mmHg in the left eye. Slit lamp examination of the left eye disclosed AC cell, inferior whitish debris, a patent LPI, peripupillary atrophy, pseudoexfoliative material on the anterior lens capsule, as well as a white cataract. There was no posterior view for fundus exam. B-Scan demonstrated moderate cupping, mobile vitreous opacities, and total PVD. UBM disclosed a Morgagnian cataract with abundant liquified cortex, poor zonular support, and AC cell. The patient was signed up for planned cataract extraction in the left eye via anterior approach with the assistance of flexible iris retractors, capsular support hooks, trypan blue dye, needle decompression, and likely sutured capsular tension segment(s). During the case after placement of iris and capsule hooks, extensive zonular dehiscence was noted and the case was converted to pars plana vitrectomy and pars plana lensectomy with scleral fixated 3 piece IOL via the Yamane technique. The patient’s visual acuity improved to 20/50 from HM in the left eye as of the POM1 visit. A corneal suture was removed at POM1 visit so the final BCVA is unknown as the patient was not refracted and decided to continue the remainder of follow up at an outside facility nearer home. IOP was 14 mmHg in the right eye and 21 mmHg in the left eye on latanoprost once nightly in both eyes. The scleral-fixated IOL was centered and stable at last follow up with fundus exam notable for moderate optic nerve cupping.

Presentation Date: 08/14/2025
Issue Date: 07/03/2026