Korean J Ophthalmol.  2011 Oct;25(5):362-365. 10.3341/kjo.2011.25.5.362.

A Case of Cholesterosis Bulbi with Secondary Glaucoma Treated by Vitrectomy and Intravitreal Bevacizumab

• Park J
• Lee H
• Kim YK
• Chae JD
• Lee HJ

• KMID: 1098643
• DOI: http://doi.org/10.3341/kjo.2011.25.5.362

Abstract

We report on a case of cholesterosis bulbi concurrent with secondary glaucoma. A 36-year-old man, with a history of long-standing retinal detachment in his right eye after the irrigation and aspiration of a congenital cataract, presented with a clinical picture of elevated intraocular pressure and ocular pain. Upon slit-lamp examination, we found a ciliary injection and a pseudohypopyon of polychromatic crystals. Gonioscopic examination revealed a large amount of crystals deposited on the trabecular meshwork and mild rubeosis iridis, but the neovascularization of the angle could not be clearly confirmed due to the presence of so many crystals. Pars plana vitrectomy was performed to remove clusters of crystals and bevacizumab was injected intravitreally to treat iris neovascularization. Aqueous aspirate was examined by light microscopy and the typical highly refringent cholesterol crystals were identified. Intraocular pressure returned to a normal level after the bevacizumab injection, although severe cholesterosis was still evident in the anterior chamber. To our knowledge, this would be the first Korean case of cholesterosis bulbi combined with chronic retinal detachment and presumed neovascular glaucoma, which was treated by pars plana vitrectomy and intravitreal bevacizumab injection.

Keyword

Bevacizumab; Cholesterosis bulbi; Chronic retinal detachment; Secondary glaucoma

MeSH Terms

Adult
Angiogenesis Inhibitors/therapeutic use
Anterior Chamber/*metabolism
Antibodies, Monoclonal, Humanized/*therapeutic use
*Cholesterol
Eye Diseases/complications/metabolism
Follow-Up Studies
Glaucoma/surgery
Glaucoma, Neovascular/drug therapy/*etiology/surgery
Humans
Intraocular Pressure
Male
Vitrectomy/*methods

Figure

• 

  Fig. 1 (A) Preoperative anterior segment photograph of affected eye. A huge amount of crystals was noted in the anterior chamber, and some of the crystals were adhered to the iris surface or sedimented at the inferior angle, resembling a pseudohypopyon. (B) On the gonioscopic view, the trabecular meshwork was obscured by dense precipitates of crystals all over the angle. (C) A funnel-shaped retinal detachment was found upon B-scan ultrasonography. (D) Anterior segment photograph at one week post-operative. Iris neovascularization had started to regress, but the amount of crystals in the anterior chamber had not decreased markedly as compared with the preoperative status, due to the continuous influx of cholesterol crystals from the vitreous cavity.

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  Fig. 2 Microscopic analysis of unprocessed aqueous humor aspirate disclosed transparent rhomboidal crystals with notched corners that are typical of cholesterol.

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