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First Author: T.Akcetin TURKEY
Co Author(s): N. Dincer K. Eltutar
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To evaluate the diagnostic and therapeutic methods of the fibrin-dependent pupillary block glaucoma (PBG)
Istanbul Education and Research Hospital, Istanbul, Turkey
Six days after an uneventful cataract surgery,severe acute fibrinous iridocyclitis and seclusio pupillae were identified on a 79 year-old male patient who had systemic hypertension. Pain, redness and acute elevation of intraocular pressure with a shallow anterior chamber was observed in his operated eye. Due to severe corneal edema, anterior chamber details could not be distinguished.
After systemic and topical anti-glaucoma treatment, corneal edema was reduced, and a complete fibrin membrane was observed across the pupil by slit lamp examination.A complete fibrin membrane across the pupillary space, shallow anterior chamber and deep posterior chamber was confirmed by using Ultrasonic Biomicroscopy (UBM). The intraocular lens (IOL) was actually displaced posteriorly, with a large clear space between the IOL and the iris. Despite topical and subconjunctival corticosteroid therapy, and Nd:YAG laser membranotomy, the fibrin membrane was not resolved.After 25 ?g of tissue plasminogen activator (tPA) was injected intracamerally, the fibrin membrane was completely dissolved, and improved the pupillar block.
Anterior segment imaging techniques, in particular UBM, is a powerful diagnostic technique towards differentiation of acute angle-closure glaucoma mechanism. Fibrin-dependent PBG has been successfully treated with intracamaral injection of tPA.