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목적 : Primary angle-closure glaucoma(PACG) is relatively more common in Asians and reported to constitute 8.7~19.3% of glaucoma patients in Korea. Pupillary block is known as the most important mechanism in development of angle closure. Laser iridotomy(LI) is known as an effective first-line treatment of angle closure glaucoma. Pseudophakic pupillary block is well-known complication of anterior chamber IOL implantation, but rarely occurs in posterior chamber IOL implantation. And relatively prompt LI occlusion after the cataract surgery is also uncommon.
방법 : We present a rare case of pseudopahkic pupillary block glaucoma with LI site occlusion after successful intracapsular phacoemulsification and in-the-bag IOL implantation.
A 75-year-old woman was diagnosed as having cataract and received cataract surgery on her both eyes. Eight years ago, she received PRP on her both eyes due to diabetic retinopathy. And she received sequential argon-YAG LI on her right eye 9 months ago under the impression of AACG. Before cataract surgery, patent LI with appropriate size was noted on her right eye, and prophylactic LI was also done on her left eye.
결과 : Cataract surgery was successfully performed on both eyes. One month after the surgery, IOP of right eye was 70mmHg with GAT. Furthermore, membranous material was noted at anterior to IOL occluding the iridotomy site. So we did another laser iridotomy on right eye, and consequently IOP was decreased to 10mmHg with GAT. 1 week later, the membranous material at anterior to IOL was not observed. 5 months after the surgery, IOP was 10mmHg with GAT without any glaucoma medication.
결론 : When acute glaucoma attack is occurred after uneventful in-the-bag IOL implantation in primary angle-closure glaucoma patients with patent LI, the probability of pseudophakic pupillary block in company with preexisting LI occlusion should be considered.
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