J Korean Ophthalmol Soc.  2019 Aug;60(8):797-801. 10.3341/jkos.2019.60.8.797.

Pseudophakic Pupillary Block after Toxic Anterior Segment Syndrome

• Min CH
• Kwon J

• KMID: 2455464
• DOI: http://doi.org/10.3341/jkos.2019.60.8.797

Abstract

PURPOSE
We report a case of pseudophakic pupillary block after toxic anterior segment syndrome (TASS).
CASE SUMMARY
An 84-year-old woman underwent phacoemulsification and intraocular lens implantation in the posterior chamber. Six days after surgery, anterior chamber inflammation was seen. Twenty-five days after surgery, a sudden increase in intraocular pressure (IOP) associated with pupillary block was observed. Despite the use of IOP-lowering medication, the IOP was not controlled. Peripheral laser iridotomy failed. After surgical peripheral iridectomy, IOP decreased significantly and was controlled.
CONCLUSIONS
Despite the rarity of TASS combined with pseudophakic pupillary block, clinicians must be aware of this condition in patients showing prolonged inflammatory state and IOP elevation after surgery.

Keyword

Iridectomy; Pseudophakia; Toxic anterior segment syndrome

MeSH Terms

Aged, 80 and over
Anterior Chamber
Female
Humans
Inflammation
Intraocular Pressure
Iridectomy
Lens Implantation, Intraocular
Phacoemulsification
Pseudophakia

Figure

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  Figure 1 Slit-lamp anterior segment photographs after cataract surgery, which were taken at local clinic (left: 1 week, right: 10 days). The images show 2+ grade of inflammatory cells and fibrous membrane in the anterior chamber.

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  Figure 2 Ultrasonographs of the left eye. The images show clear posterior segment.

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  Figure 3 Photographs of anterior segment optical coherence tomography before surgical iridectomy. The images show iris bowing with iridocorneal touch.

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  Figure 4 Slit-lamp anterior segment photographs ([A] before surgical iridectomy, [B] after surgical iridectomy). (A) The images show iris bowing and posterior synechiae before surgery. (B) The images show relieved iris bowing and deep anterior chamber.

Reference

1. Gaton DD, Mimouni K, Lusky M, et al. Pupillary block following posterior chamber intraocular lens implantation in adults. Br J Ophthalmol. 2003; 87:1109–1111.

2. Samples JR, Bellows AR, Rosenquist RC, et al. Pupillary block with posterior chamber intraocular lenses. Arch Ophthalmol. 1987; 105:335–337.

3. Vajpayee RB, Angra SK, Titiyal JS, et al. Pseudophakic pupillary-block glaucoma in children. Am J Ophthalmol. 1991; 111:715–718.

4. Holland SP, Morck DW, Lee TL. Update on toxic anterior segment syndrome. Curr Opin Ophthalmol. 2007; 18:4–8.

5. Hwang KY, Yang JW, Lee YC, Kim SY. Toxic anterior segment syndrome following cataract surgery. J Korean Ophthalmol Soc. 2011; 52:690–695.

6. Ozcelik ND, Eltutar K, Bilgin B. Toxic anterior segment syndrome after uncomplicated cataract surgery. Eur J Ophthalmol. 2010; 20:106–114.

7. Sarobe Carricas M, Segrelles Bellmunt G, Jiménez Lasanta L, Iruin Sanz A. Toxic anterior segment syndrome (TASS): studying an outbreak. Farm Hosp. 2008; 32:339–343.

8. Cetinkaya S, Dadaci Z, Aksoy H, et al. Toxic anterior-segment syndrome (TASS). Clin Ophthalmol. 2014; 8:2065–2069.