| 본문 : As there are only a few reports of pseudophakic pupillary block, we report a pseudophakic pupillary block patient who successfully treated with surgical peripheral iridectomy.
A 84-year-old female presented with decreased vision in left eye. 25 days ago, she had undergone cataract operation without complication in other clinic. The patients visual acuities were 20/30 OD, hand motion OS. Intraocular pressures in each eyes were 9mmHg on her right eye, and were uncheckable due to high IOP with applanation tonometer. The slit lamp biomicroscopy of OD showed clear cornea, deep and clear anterior chamber with wide open angle, whereas OS showed edematous cornea, shallow anterior chamber with iris bombe. Fibrous membrane and posterior synechiae on IOL was also seen. Anterior chamber cell reaction was uncheckable due to corneal edema.
To manage her increased intraocular pressure IV mannitol 20% 300ml was given. Dorzolamide/timolol twice a day, bimatoprost once a day, brimonidine tartrate twice a day was given with Acetazolamide 250mg TID to lower IOP. Moxifloxacine 0.5% and prednisolone acetate eye drops four times a day were also given. Laser peripheral iridectomy(PI) was performed but failed due to corneal edema. Day after, IOP of left eye was decreased by 35 mmHg. On slit lamp examination, corneal edema and iris bombe was still present. Anterior segment OCT shows 360 degree iris bombe with iris-corneal touch. We planned surgical peripheral iridectomy instead of laser PI due to iris-corneal touch.
After surgical PI, IOP was lowered by 5mmHg. Inflammatory response in the anterior chamber was moderate, some fibrillary materials were seen. Corneal edema was much improved and mild descemet’s folds were present. Retroillumination showed patent iridectomy site. Two weeks after surgery, the uncorrected visual acuity was 20/100 OS, and IOP was 7 mmHg. Corneal edema was much improved and anterior chamber cell was decreased by 1+, there were no fibrillary materials. Visual acuity was improved to 20/60 on the 2 month postoperative day and IOP maintained stable. The cornea, anterior chamber were clear, but iris-IOL synechiae 3-12 o/c was remained.
This is a case which emphasizes the importance of early postoperative management of TASS or inflammation.In absence of proper management, clinical course could become complicated and difficult to treat. |