Comprehensive Surgical Management Of Luxated Hypermature Cataract With Pupillary Block Glaucoma Using Modified Canabrava Sfiol Combined With Pars Plana Vitrectomy: Successful Outcome Despite Postoperative Choroidal Detachment

To present the surgical management and clinical course of a complex case of hypermature cataract luxation associated with pseudoexfoliation syndrome (PEX) and uncontrolled secondary pupillary block glaucoma, complicated postoperatively by choroidal detachment.

Albanian Eye Center

A 73-year-old patient presented with severe visual impairment in the right eye (BCVA: counting fingers at 1 meter) and markedly elevated intraocular pressure (IOP: 45 mmHg) despite maximal topical antiglaucoma therapy. Examination revealed a dense hypermature cataract with lens instability in the setting of PEX, causing pupillary block and secondary ocular hypertension.

A single-session combined surgery was performed under Sub-Tenon anesthesia, including phacoemulsification, pars plana vitrectomy (PPV), endolaser photocoagulation, and scleral-fixated intraocular lens (SFIOL) implantation using the modified Canabrava technique.

On postoperative day 4, ocular hypotony (IOP 3 mmHg) and choroidal detachment were detected by B-scan ultrasonography. The case was managed conservatively with intensified ambulatory medical therapy and close dynamic follow-up. By day 9, choroidal detachment showed regression and IOP normalized (17 mmHg). A transient inferior vitreous hemorrhage resolved gradually.

At 3 months, BCVA improved to 0.8 (8/10), IOP was 12 mmHg, the SFIOL was well centered, and fundus examination was normal.

Luxated hypermature cataract in PEX patients represents a highly challenging surgical scenario. Even when complicated by postoperative choroidal detachment and hypotony, careful ambulatory medical management and dynamic monitoring may lead to excellent anatomical and functional outcomes. This case underlines the importance of comprehensive surgical planning and structured postoperative follow-up in complex anterior–posterior segment procedures.