A middle-aged patient with a past ocular history of a congenital cataract in the left eye, status-post cataract extraction without intraocular lens placement as child, subsequent iris-sutured intraocular lens placement in 2018, and multiple failed endothelial keratoplasties (2019 and 2022), and elevated intraocular pressure status-post glaucoma tube shunt implantation (March 2023), presented to the emergency department in November 2023 with pain in the left eye. At presentation his vision was hand motions only and an intraocular pressure of 19 mm Hg on no glaucoma medications. On slit-lamp examination, he was found to have a shallow anterior chamber with nearly 360 degrees of iridocorneal adhesions and an exuberant superotemporal bleb resulting in inferonasal deviation of the globe. The enlargement of the bleb was thought to be secondary to an inflammatory process, so the patient was started on topical and oral steroids and orbital magnetic resonance imaging was obtained, which demonstrated an enlarged bleb but no mass or infiltrative orbital process. There was no improvement after one week of medical management, so the patient was taken to the operating room for drainage of the bleb, closure of the tube with permanent suture, and transscleral cytophotocoagulation. On post-operative day one, the bleb was significantly smaller in size, the globe had returned to its anatomic position, and the intraocular pressure was 10 mm Hg.
Presentation Date: 01/18/2024
Issue Date: 01/19/2024