Iatrogenic Phacomorphic Glaucoma Secondary To An Intumescent Cataract Following Nd:Yag Capsulotomy: A Case Report

To report a case of a patient who developed secondary angle-closure glaucoma due to pupillary block caused by an intumescent cataract, as a complication of Nd:YAG laser capsulotomy.

The case was managed at the Department of Ophthalmology, University Clinical Center named after Prof. K. Gibiński in Katowice, Poland.

A 43-year-old woman presented to our institution with acute, painful vision loss in the right eye. The patient reported a previous Nd: YAG capsulotomy in an eye that had never undergone cataract surgery.  A history of unspecified ophthalmic surgery performed many years ago in another country was reported; however, no medical records were available and the exact nature of the procedure could not be ascertained. Intraocular pressure (IOP) exceeded 80 mmHg on three consecutive measurements using Goldmann applanation and handheld rebound tonometry, and was accompanied by severe ocular pain, redness, and conjunctival hyperemia. The visual acuity in the right eye was restricted to light perception.
Slit lamp biomicroscopy revealed corneal epithelial edema, flat anterior chamber and intumescent cataract with a ruptured anterior lens capsule. Right eye esotropia was also noted on examination.The patient underwent combined surgical management, including pars plana vitrectomy and cataract phacoemulsification, accompanied by topical and systemic corticosteroid therapy and prophylactic antibiotic treatment. Intraoperative findings revealed a previously implanted phakic intraocular lens, which was explanted, and pupillary sphincter atony, attributed to approximately 7 days of elevated intraocular pressure. The patient is currently under follow-up, with intraocular pressure well controlled, and is awaiting implantation of an intraocular lens (IOL) as the next stage of treatment.

This case report presents a successful treatment strategy for phacomorphic glaucoma, combining surgical management with adjunctive topical and systemic corticosteroid therapy and highlights the significant role of careful preprocedural assessment of lens status before YAG laser capsulotomy to avoid serious iatrogenic complications, including lens-induced glaucoma.