Iris bombe with dramatic visual acuity improvement after laser peripheral iridotomy

Ramalho, M; Pina, S; Santos, C; Coutinho, I; Vaz, F

http://hdl.handle.net/10400.10/1195

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Abstract(s)

Objective/Purpose To describe a case report on a patient with iris bombe with a dramatic visual acuity improvement following iridotomy. Materials/Patients A 34-year-old man, with a background of ankylosing spondylitis, who had been hospitalized in other Institution for 3 weeks in the previous month due to uveitis and on topical steroids, presented with decrease in visual acuity in his right eye (OD) since the eve. On ophthalmic examination, visual acuity was counting fingers at 2 meters in OD. The biomicroscopy of the right eye revealed inflammatory cells (Grade 3+) in the anterior chamber and extensive posterior synechae with iris bombe and iridocorneal touch in all quadrants, also presented a transparent cornea and an intraocular pressure of 30 mmHg. The anterior chamber depth was 0.81 mm with an anteriorly dislocated anterior surface of the crystalline lens as obtained with Oculus Pentacam®. A laser peripheral iridotomy was performed and medicated with topical combination of timolol and dorzolamide bid and oral acetazolamide 500 mg bid. Methods Stratus-OCT and Oculus Pentacam imaging were obtained. Results and Conclusion One day after the iridotomy the patient presented visual acuity of 8/10 in OD. The biomicroscopy of the right eye revealed inflammatory cells (Grade 3+) in a large anterior chamber, a patent iridotomy and an intraocular pressure of 12 mmHg. The anterior chamber depth was 2.52 mm. Iris bombe and acute pupillary block glaucoma are uncommon severe complications of uveitis. The initial treatment for extensive posterior synechiae is pupillary dilation in order to free a portion of the iris and reduce pupillary block. Many times laser iridotomy is required for resollution and prevention of recurrence of pupillary block. In this patient the initial visual loss is probably related to a myopization due to the anteriorly dislocated crystalline that resolved rapidly with the reformation of the anterior chamber.