Topic outline

  • Grand Rounds

    A patient with a history of high myopia and contact lens intolerance underwent uncomplicated placement of phakic posterior chamber intraocular lenses in both eyes. She was started on a postoperative tapering course of topical steroid drops. She presentedat postoperative week 2 with left eye pain and bilateral blurry vision. She was found to have elevated intraocular pressures (IOP) in the mid-thirties in both eyes and examination demonstrated shallow anterior chambers, slightly high lens vaults, pigmenton the anterior lens surfaces, and narrow angles that were closed superiorly in both eyes. Baseline glaucoma studies showed no evidence of glaucomatous optic neuropathy or visual field defects. Ultrasound biomicroscopy showed shallow anterior chambers, very narrow angles mostly superiorly, and slightly anteriorly positioned natural lenses in both eyes. Diagnosis of ocular hypertension due to multiple mechanisms, including steroid response, pigment dispersion, and partial non-pupillary block angle closure,was made. The patient was treated with topical and oral IOP-lowering medications and steroid drops were tapered, and IOP normalized to the mid-teens. Given the patient continued to experience eye pain and she continued to have very narrow angles with the risk for potential chronic angle closure, she elected to undergo bilateral explantation of intraocular lenses. Postoperatively her IOP remained controlled, and she did not develop glaucoma.

    Presentation Date: 10/13/2022
    Issue Date: 11/18/2022