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Purpose To evaluate the intraocular pressure (IOP) change and associated factors 6 months after phacoemulsification in eyes with primary angle-closure suspect (PACS) and eyes with primary angle closure (PAC) that had no medical therapy. Setting Singapore National Eye Center, Singapore, Singapore. Design Retrospective case series. Methods Patients with PACS or PAC (with corrected distance visual acuity <20/40) who had uneventful phacoemulsification were recruited. Patients were excluded if they were on IOP-lowering medications within 6 months preoperatively and postoperatively. Preoperative gonioscopy, A-scan biometry, anterior segment optical coherence tomography, and automated refraction were reviewed. Factors related to the percentage of and absolute IOP change were assessed using multiple linear regression analyses after adjusting for age, sex, and diagnosis. Results The study evaluated 85 patients (85 eyes; 52 PACS, 33 PAC) after 7 eyes (1 PACS, 6 PAC) were excluded because of poor quality imaging. Overall, IOP decreased by 19.9% from the preoperative mean of 16.1 mm Hg ± 3.1 (SD) to 12.9 ± 2.7 mm Hg. The IOP change between the PACS group (−3.3 ± 2.8 mm Hg; −20.6%) and the PAC group (−3.2 ± 4.7 mm Hg; −19.6%) was similar ( P > .05). In multiple linear regression analyses, a higher preoperative IOP (β = 0.68, P < .001) and fewer clock hours of peripheral anterior synechiae (PAS) (β = −0.30, P = .03) predicted a greater absolute change in and percentage of reduction in IOP, respectively. Conclusions The mean IOP reduction 6 months after phacoemulsification was 20%. Less IOP reduction was observed in the presence of lower preoperative IOP and more extensive PAS. [ABSTRACT FROM AUTHOR]

Purpose To present cases of uveitis-glaucoma-hyphema (UGH) syndrome due to reverse pupillary block in sulcus-placed posterior chamber intraocular lenses (PC IOLs) that were managed with laser peripheral iridotomy (LPI). Setting Community-based subspecialty clinics. Design Retrospective interventional case series. Methods A chart review of patients with a sulcus-placed PC IOLs presenting with UGH syndrome and reverse pupillary block with posterior iris bowing as diagnosed by gonioscopy and anterior segment optical coherence tomography was carried out. Laser peripheral iridotomy was performed in the eyes included in the study. The main outcome measure was clinical resolution of UGH syndrome. Results The study included 6 eyes of 6 patients with a mean age of 59.8 years (range 43.0 to 66.0 years) who presented with unilateral UGH syndrome a mean of 28.7 months (range 0.3 to 84.0 months) after PC IOL implantation. All patients were previously myopic, with 5 (83.3%) having a history of vitrectomy. The mean axial length was 27.0 mm ± 1.4 (SD). An LPI was used to treat the reverse pupillary block with resultant improvement in iris profile and resolution of UGH syndrome in all eyes. The mean intraocular pressure decreased from 30.5 ± 10.0 mm Hg on 0.5 ± 0.8 glaucoma medications to 15.5 ± 3.2 mm Hg postoperatively on 0.7 ± 1.2 medications. Conclusions The UGH syndrome due to reverse pupillary block occurred after sulcus-placed PC IOLs in susceptible patients, those with axial myopia, and post-vitrectomized eyes. The cases were managed with LPIs. Financial Disclosure Dr. Ahmed is a consultant to Alcon Laboratories, Inc. and Abbott Medical Optics, Inc. No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

We present the case of a 26-year-old man with severe early hypotony after implantation of the Implantable Collamer Lens phakic intraocular lens (pIOL) in the left eye for hyperopia. To our knowledge, this is the first documented case of cyclodialysis cleft and secondary annular ciliochoroidal detachment after implantation of a pIOL, presumably provoked by a straightforward prophylactic surgical iridectomy. The initial diagnosis was determined using swept-source Fourier-domain anterior segment optical coherence tomography as gonioscopy and ultrasound biomicroscopy did not reveal the cleft. Conservative treatment was not effective. Argon laser photocoagulation resolved the problem. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose To report a series of eyes that developed malignant glaucoma after cataract surgery. Setting Private academic practice, Toronto, Ontario, Canada. Design Retrospective case series. Methods Eyes that developed malignant glaucoma after cataract surgery were treated with medical therapy. This was followed by laser iridozonulohyaloidotomy, anterior chamber reformation and intraocular lens (IOL) pushback, and finally with surgical iridozonulohyaloidovitrectomy if all other measures were unsuccessful. Refraction, intraocular pressure (IOP), gonioscopy, and anterior chamber depth (ACD) by anterior segment optical coherence tomography were analyzed before treatment and after treatment. Results The study evaluated 20 eyes of 18 female patients aged 44 to 86 years. Preoperatively, the mean refraction was +3.11 diopters (D) ± 2.89 (SD), the mean axial length was 21.30 ± 1.40 mm, and all eyes had narrow or closed angles. Malignant glaucoma was diagnosed a mean of 5.8 ± 7.1 weeks postoperatively. At diagnosis, the mean refraction was −2.15 ± 2.95 D; the mean ACD, 2.49 ± 0.72 mm; and the mean IOP, 28.3 ± 10.8 mm Hg on a mean of 1.3 ± 1.6 medications. Two eyes responded to cycloplegia, 7 to laser iridozonulohyaloidotomy, and 6 to anterior chamber reformation–IOL pushback; 5 eyes required vitrectomy. Posttreatment, the mean refraction was −0.56 ± 1.07 D; the mean ACD, 3.30 ± 0.50 mm; and the mean IOP, 14.4 ± 4.60 mm Hg on a mean of 1.2 ± 1.4 medications. Cycloplegia was discontinued in 17 eyes. Conclusion Malignant glaucoma can occur after phacoemulsification and presents with myopic surprise, anterior chamber shallowing and, possibly, elevated IOP. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

An 87-year-old woman presented 11 months after routine phacoemulsification cataract extraction and posterior chamber intraocular lens implantation in her left eye complaining of the abrupt onset of redness and decreased vision in that eye. Examination revealed a mild anterior chamber reaction and significant corneal edema. The eye was minimally responsive to topical steroid therapy, and initial serial slitlamp examinations with gonioscopy were unrevealing. After multiple head-positioning maneuvers were performed, a retained nuclear fragment was uncovered. The nuclear fragment was aspirated and liquefied by the phacoemulsification device in the anterior chamber. A retained nuclear fragment with an intact posterior capsule is a recognized cause of inflammation in the immediate postoperative presentation. Delayed presentation of symptoms is rare and presumably secondary to sequestration of the fragment behind the iris. We present a case and a review of the literature regarding sequestered retained nuclear fragments following what is initially thought to be uneventful cataract extraction. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose: To quantify angle changes after phacoemulsification extracapsular cataract extraction using Fourier-domain anterior segment optical coherence tomography (AS-OCT). Setting: Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taiwan. Design: Case series. Methods: Fourier-domain AS-OCT examinations were performed in patients between 15 and 91 years of age 1 week before and 1 week after cataract surgery. The angle, angle-opening distance at 500 μm, and trabecular–iris space area at 500 μm in the temporal and nasal quadrants were obtained. Patients were then grouped on the basis of age (<60 years or ≥60 years) and the results compared between groups. Results: Eighty-nine eyes of 80 patients were evaluated. The angle, angle-opening distance at 500 μm, and trabecular–iris space area at 500 μm increased significantly after cataract surgery in the entire study population (P<.001). There were larger postoperative differences in all 3 parameters in nasal and temporal measurements in patients 60 years or older (all P<.001). Conclusions: The angle changed significantly after cataract surgery, particularly in the temporal quadrant and its magnitudes. Postoperative angle changes were larger in older patients, which may be related to the increase in lens volume during the aging process. Fourier-domain AS-OCT can be used as a rapid and safe tool in addition to diagnostic gonioscopy in assessing anterior chamber angles. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

We report a case of bilateral Descemet membrane detachment (DMD) after canaloplasty in a 70-year-old Portuguese man with primary open-angle glaucoma. The patient developed bilateral DMD immediately following consecutive (1 week apart) canaloplasty surgery in both eyes. Slitlamp biomicroscopy, gonioscopy, and Fourier-domain optical coherence tomography (FD-OCT) findings are described. On postoperative day 1, in both cases, slitlamp biomicroscopy revealed an unscrolled inferonasal DMD and a clear cornea with deep and quiet anterior chambers. Gonioscopy showed an intact, lightly pigmented, and distended trabecular meshwork with no evidence of suture extrusion. High-resolution FD-OCT revealed a widely dilated canal of Schlemm, trabecular distention, and a retrocorneal hyperreflective membrane corresponding to a DMD. At 3 months, the DMD resolved spontaneously in both eyes. Although DMD is a known complication of canaloplasty, the occurrence of bilateral symmetrically located DMDs in our case suggests a possible anatomical predisposition in addition to factors induced by the surgical technique. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

Purpose: To correlate trabeculo-Descemet's membrane (TDM) changes with a late rise in intraocular pressure (IOP) in patients with successful viscocanalostomy.Setting: Consultores Oftalmolo´gicos, Hospital Oftalmolo´gico Santa Lucı´a, and Centro de Estudios Me´dicos e Investigacio´n, Buenos Aires, Argentina.Methods: Patients who had a viscocanalostomy between July 1998 and September 2001 were retrospectively studied. Gonioscopy was performed in all patients. A subgroup of patients who had a late increase in IOP and were successfully treated with neodymium:YAG (Nd:YAG) laser goniopuncture were studied to correlate gonioscopic findings. Ultrasound biomicroscopy was performed in 10 cases. Intraocular pressure measurements were taken before viscocanalostomy and before and after Nd:YAG treatment.Results: Sixty-eight eyes of 48 patients had a viscocanalostomy to control IOP. Twenty-six eyes had a late increase in IOP and were successfully treated with Nd:YAG laser goniopuncture. Before goniopuncture, 17 eyes (65.30%) had a concave TDM. The mean IOP in these patients increased from 14.27 mm Hg to 18.73 mm Hg (range 14 to 27 mm Hg). Goniopuncture was performed a mean of 10.7 months (range 1 to 36 months) after surgery. After Nd:YAG treatment, the TDM was flat in all patients who had a concave TDM before treatment. At the last examination, the mean IOP was 13.8 mm Hg, a mean decrease of 52.24% from the baseline preoperative IOP; 61.5% of eyes had a final IOP of 14.0 mm Hg or lower.Conclusions: A concave TDM was associated with a late IOP rise. The TDM was flat after laser goniopuncture and normalization of IOP. [Copyright &y& Elsevier]

A 79-year-old woman presented with a 1-week history of sudden onset of decreased vision, pain, and redness in the right eye. Ocular history included uneventful cataract surgery in both eyes more than 8 years prior to presentation. Slitlamp examination revealed significant corneal edema and mild iritis. Gonioscopy revealed a retained lens nuclear fragment in the inferior angle. Surgical removal of the fragment improved the patient’s condition. The retained nuclear fragment presumably lodged behind the iris at the time of the initial surgery and spontaneously moved forward more than 8 years later. To our knowledge, this is the longest reported delay between phacoemulsification and presentation of a retained nuclear fragment. Before this case, retained nuclear fragments had been associated with complications within a year of surgery only. We recommend gonioscopy in cases of sudden-onset corneal edema extending to the inferior limbus in patients with a history of phacoemulsification. [ABSTRACT FROM AUTHOR]

We report a case of bilateral intraocular hemorrhage from vascularization of cataract wounds. The patient experienced decreased vision following an episode of vomiting more than 2.5 years after phacoemulsification through a scleral tunnel incision in the right eye and combined trabeculectomy and extracapsular cataract extraction in the left eye. Gonioscopy demonstrated abnormal vessels in the region of the cataract wound superiorly and small hyphemas inferiorly in both eyes. The hemorrhages and elevated intraocular pressure normalized over weeks. The left eye had a recurrent hemorrhage 5 months later, which was successfully treated with argon laser goniophotocoagulation. [Copyright &y& Elsevier]

A 39-year-old man was referred with complaints of pain, redness, and reduced vision in the left eye after projectile trauma during hammering. Two years previously, anterior chamber phakic intraocular lenses (pIOLs) had been implanted to correct the patient''s high myopia. On presentation, the best corrected visual acuity was 20/30 in the right eye and 20/50 in the left eye. Slitlamp examination disclosed a central self-sealed corneal laceration in the left eye, and gonioscopy and a high-resolution computed tomography scan showed a metallic intraocular foreign body (IOFB) lodged in the anterior chamber angle. After the foreign body was removed, the patient regained his previous visual acuity. In this case, the pIOL may have prevented further penetration of the IOFB and protected the crystalline lens and posterior segment. [Copyright &y& Elsevier]

A 75-year-old woman presented with unexplained ocular hypertension 4 weeks after phacoemulsification. Steroid response was diagnosed initially until a misplaced capsular tension ring (CTR) was identified in the drainage angle. We describe the technique used to successfully remove the CTR from the drainage angle with minimal trauma. This case illustrates the importance of the initial surgical technique used for CTR insertion and emphasizes the role of gonioscopy in such a case. [Copyright &y& Elsevier]