A patient with past ocular history of congenital cataracts status post cataract extraction with posterior chamber intraocular lens insertion in both eyes was managed by an outside ophthalmologist for elevated intraocular pressure (IOP) in the right eye. The patient reported a maximum IOP of 40 mmHg in the right eye. The patient was treated with multiple topical agents. On presentation to our glaucoma service, IOP was 32 mmHg on dorzolamide-timolol, travoprost, pilocarpine and oral methazolamide therapy. Slit lamp examination showed a single piece acrylic IOL in the capsular bag, with a superotemporal haptic in the sulcus space. Gonioscopic evaluation revealed open angles with increased pigment in the right eye. Ultrasound biomicroscopy revealed the optic displaced superotemporally and tilted anteriorly with iris touch. Additionally, the superotemporal haptic in the sulcus space was also in contact with posterior iris. Fundus photos, optical coherence and Humphrey visual field testing confirmed glaucomatous damage in the right eye. The patient underwent combined lens exchange with secondary sulcus lens placement and goniotomy with 180 degrees of viscodilation. Postoperatively, the patient had initial IOP reduction to mid-teens but then developed elevated IOP and was restarted on maximum medical therapy including oral acetazolamide. In post-operative week 10, the patient underwent glaucoma drainage device implantation with postoperative improvement of IOP.
Presentation Date: 09/28/2023
Issue Date: 10/20/2023