Unique Case Of Pseudophakic Angle Closure From Capsular Tension Ring

Present a the presentation and management of a unique case of pseudophakic angle closure glaucoma caused by an anteriorly dislocated capsular tension ring

Tertiary Eye Care Institution

82 year old chinese gentleman presenting with raised intraocular pressure in the presence of pseudophakia and secondary angle closure. While angle closure and intraocular pressures resolved after initiation of pharmacological glaucoma therapy, laser peripheral iridotomy and laser iridoplasty, he suffered recurrent angle closure attacks, all which resolved spontaneously. Ultrasound biomicroscopy revealed a plateau iris configuration with anteriorly displaced intraocular lens and capsular tension ring complex within a fibrosed capsular bag. Surgical management in the form of intraocular lens and capsular tension ring explantation, vitrectomy and sutured scleral fixation of a new intraocular lens was performed. There were no episodes of recurrent angle closure episodes after surgery.

Pseudophakic angle closure is a rare occurance. Ophthalmolgists should be aware of how to diagnose and pin-point the exact causative factor in such cases. One such cause is a capsular tension ring even with proper in the bag placement. This could be more common with more widespread use of capsular tension rings.