fibrin and Glaucoma--Angle-Closure

Fibrin pupillary-block glaucoma is a rare complication after cataract surgery. The treatment for this condition is still controversial, since Nd:YAG laser fibrin membranotomy tends to reocclude and laser peripheral iridotomy entails the risk of damaging the corneal endothelium in the presence of corneal edema associated with elevated intraocular pressure.. A 62-year-old man with diabetes mellitus developed acute elevation of intraocular pressure with a shallow anterior chamber five days after uneventful cataract surgery. Initially, slit lamp examination provided only limited information due to severe corneal edema. After resolution of corneal edema with systemic glaucoma therapy, a complete fibrin membrane was observed across the pupil by slit lamp examination. Anterior segment optic coherence tomography clearly revealed a thin fibrin membrane covering the entire pupillary space, a shallow anterior chamber, and a deep posterior chamber. The intraocular lens was not observed by anterior segment optic coherence tomography. In contrast, ultrasound biomicroscopy, which has superior penetration depth, was able to visualize the intraocular lens deep in the posterior chamber. Injection of tissue plasminogen activator into the anterior chamber resulted in complete fibrinolysis and released the pupillary block.. This case suggests that ocular anterior segment imaging modalities, especially ultrasound biomicroscopy, serve as powerful diagnostic tools to identify mechanisms of acute angle closure glaucoma, which is often accompanied by poor intraocular visibility. This is the first reported case of fibrin pupillary-block glaucoma after cataract surgery successfully treated with intracameral tissue plasminogen activator.

Topics: Cataract Extraction; Fibrin; Glaucoma, Angle-Closure; Humans; Injections, Intraocular; Male; Middle Aged; Pupil Disorders; Tissue Plasminogen Activator

The purpose of this study was to evaluate the effectiveness of phacoemulsification and viscogoniosynechialysis in the management of patients with chronic angle-closure glaucoma (CACG). Fifty-six eyes of 45 recruited patients were classified into two groups: group 1 had medically controlled CACG (IOP 21 mmHg with maximum tolerated medications) including 21 eyes. All of the patients had at least one quadrant without peripheral anterior synechia in gonioscopy. After phacoemulsification, a viscoelastic agent was used for viscogoniasynecialysis. Success was defined as IOP

Topics: Aged; Angiogenesis Inhibitors; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Bevacizumab; Chronic Disease; Female; Fibrin; Follow-Up Studies; Glaucoma, Angle-Closure; Gonioscopy; Humans; Iris; Macular Edema; Male; Middle Aged; Ophthalmologic Surgical Procedures; Phacoemulsification; Postoperative Complications; Prospective Studies; Tomography, Optical Coherence; Treatment Outcome; Viscoelastic Substances

Postoperative fibrin pupillary-block glaucoma, an uncommon complication of intraocular surgery, develops when an inflammatory fibrin membrane occludes the pupil, resulting in peripheral angle closure. We present a series of 4 patients with this condition and describe the role of anterior segment optical coherence tomography and ultrasound biomicroscopy in distinguishing fibrin pupillary-block glaucoma from other forms of postoperative acute glaucoma. Specific to this condition is the presence of a fibrin membrane across the pupil and accumulation of aqueous in the posterior chamber, as would be expected in pupil block, but with a clear separation between the intraocular lens and the iris. The possible risk factors are discussed and various treatment modalities reviewed.

Topics: Aged; Anterior Eye Segment; Female; Fibrin; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iridectomy; Iris; Lasers, Solid-State; Lens Implantation, Intraocular; Male; Microscopy, Acoustic; Middle Aged; Phacoemulsification; Postoperative Complications; Pupil Disorders; Tomography, Optical Coherence