ESCRS - POCAT095 - Surgical Management Of Angle-Closure Glaucoma In Laron Syndrome: A Case Report From A High-Prevalence Region

Surgical Management Of Angle-Closure Glaucoma In Laron Syndrome: A Case Report From A High-Prevalence Region

Published 2026 - 44th Congress of the ESCRS

Reference: POCAT095 | Type: Case Report | DOI: 10.82333/fyd7-rx26

Authors: Dr Graciela Ruiz 1 , Dr Carolina Abendano* 1

1Clinica de Ojos Cornealasik,Loja,Ecuador

Purpose

The purpose of this case is to demonstrate the clinical and surgical management of a patient with Laron syndrome who presented with angle closure due to angle-closure glaucoma and branch retinal vein occlusion. In Loja Province (Ecuador), there is an area with a higher prevalence of this syndrome, and it is important to make these findings known to carry out evaluations, early diagnoses, and preventive treatments in this population.

Setting

We report the case of a 50-year-old female patient with Laron syndrome who presented to the clinic with headache, ocular pain, and vision loss in the left eye.

Report of case

Physical examination: OD (right eye): Visual acuity 20/25; IOP: 22 mmHg; refraction: hyperopia +2 diopters. Anterior chamber: shallow; iris: areas of atrophy; gonioscopy: Grade 0 angle (Shaffer); lens: N2. OS (left eye): Visual acuity: counts fingers at 5 cm; IOP: 57 mmHg; refraction: not assessable; conjunctiva: tortuous ciliary vessels; corneal edema with fine keratic precipitates; anterior chamber: shallow; iris: mid-dilated, non-reactive pupil; gonioscopy: Grade 0 angle (Shaffer) with goniosynechiae; lens: N3.

A diagnosis of acute glaucoma crisis was made.

  • Clinical treatment plan: IV mannitol, topical prednisolone, topical dorzolamide–timolol, oral acetazolamide, topical pilocarpine.
  • Fundus photography OS (left eye): Neovascularization at the level of the optic nerve; marked venous dilation; arteriolar narrowing and thrombosis of the superior temporal vein.
  • OCT OS: Retinal thinning, loss of ganglion cells, and retinal pigment epithelium detachment.
  • Ocular biometry: Hoffer Q formula = IOL 31.00 D.
    Anterior chamber: 1.48 mm. Lens thickness: 4.70 mm. Axial length: 19.53 mm.
  • Preoperative plan: Bilateral iridotomies (OU).
  • Surgical treatment plan: Phacoemulsification + implantation of an IQ 31.00 D intraocular lens.

Postoperative outcomes (OS): visual acuity improved to 20/40. Intraocular pressure decreased to 16 mmHg. Slit-lamp examination: mild residual mydriasis and areas of iris atrophy. A marked deepening of the anterior chamber was observed following surgery.

Conclusion/Take home message

This case highlights the complex clinical presentation and management of angle-closure glaucoma in a patient with Laron syndrome. In this patient, anatomical predisposition (short axial length and shallow anterior chamber) contributed to pupillary block and acute angle closure, leading to markedly elevated intraocular pressure and secondary vascular complications. Early and aggressive medical management was essential to control IOP during the acute phase. However, definitive management required a surgical approach. Cataract extraction combined with iridotomy was fundamental in deepening the anterior chamber, relieving pupilary block, reopening the angle, and achieving adequate IOP control.