Unveiling The Ring: Secondary Angle Closure Glaucoma In A Pseudophackic Eye Due To Soemmering Ring And The Role Of Ultrasound Biomicroscopy
Published 2025 - 43rd Congress of the ESCRS
Reference: PO836 | Type: Poster | DOI: 10.82333/pr92-jc39
Authors: Eleni Papafotiou* 1 , Konstantinos Flindris 2 , Elena Mylona 2 , Petros Asteris 3 , Chrysi Chatzipetrou 2 , Athanasios Kaliardas 2 , Ioannis Koumpoulis 2 , Ioannis Melissourgos 2
1General Hospital of Ioannina " G. Hatzikosta",Ioannina,Greece;Aristotle University of Thessaloniki,Thessaloniki,Greece, 2General Hospital of Ioannina " G. Hatzikosta",Ioannina,Greece, 3University Hospital of Ioannina,Ioannina,Greece
Purpose
To report a rare case of secondary angle closure in a pseudophakic eye, due to an enlarged Soemmering ring, associated with exfoliation syndrome (XFS).
Setting
Ophthalmology Department, General Hospital of Ioannina, Greece.
Methods
A 70-year-old male with a history of bilateral phacoemulsification presented with progressive visual deterioration and mild ocular pain in the left eye. Clinical examination included slit-lamp biomicroscopy, intraocular pressure (IOP) measurement, gonioscopy, Anterior Segment Optical Coherence Tomography (OCT) and ultrasound biomicroscopy (UBM). Initial treatment involved laser peripheral iridotomy and IOP-lowering medications.
Results
The patient exhibited pseudoexfoliation material at the pupillary margin,very shallow anterior chamber and significantly elevated IOP (35 mmHg OS) and Visual Aquity 20/100. IOP-lowering medications and laser peripheral iridotomy provided temporary IOP reduction. However, the IOP elevated again and the angle remained narrow, necessitating further surgical intervention. UBM identified a large hyperechoic structure in contact with the posterior iris surface, indicative of an enlarged Soemmering ring. Subclinical inflammation associated with exfoliation syndrome may have contributed to its excessive growth and to zonular instability. These two parametres created a forward-pushing mechanism which resulted in angle closure glaucoma.
Conclusions
This case highlights an uncommon but clinically significant cause of secondary angle closure in pseudophakic eyes. Awareness of Soemmering ring enlargement and its association with XFS is crucial for timely diagnosis and management. UBM is a valuable tool for differentiate underlying mechanisms and guide treatment decisions.