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 Table of Contents  
Year : 2022  |  Volume : 2  |  Issue : 4  |  Page : 990-991

Nd:YAG laser membranectomy for fibrin pupillary block after uneventful cataract surgery

1 Fellow Cataract and Glaucoma Services, Centre for Sight, New Delhi, India
2 Fellowship in Corneal Diseases, Chairman, Medical Director and Senior Consultant, Centre for Sight, New Delhi, India
3 Senior Consultant, Glaucoma and Cataract Services, Centre for Sight, New Delhi, India

Date of Submission24-Feb-2022
Date of Acceptance05-May-2022
Date of Web Publication11-Oct-2022

Correspondence Address:
Dr. Swati Singh
B5/24 Centre for Sight, Safdarjung Enclave, New Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_478_22

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Keywords: Cataract surgery, fibrinoid pupillary block, inflammatory glaucoma, Nd: Yag membranectomy, pupillary block glaucoma

How to cite this article:
Taneja S, Sachdev MS, Johri M, Singh S. Nd:YAG laser membranectomy for fibrin pupillary block after uneventful cataract surgery. Indian J Ophthalmol Case Rep 2022;2:990-1

How to cite this URL:
Taneja S, Sachdev MS, Johri M, Singh S. Nd:YAG laser membranectomy for fibrin pupillary block after uneventful cataract surgery. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Nov 27];2:990-1. Available from: https://www.ijoreports.in/text.asp?2022/2/4/990/358173

A 54-year-old woman with no past ocular or systemic illness underwent an uncomplicated femtosecond laser-assisted cataract surgery with a single piece hydrophobic acrylic posterior chamber intraocular lens (PCIOL) in her right eye (RE). Her uncorrected distance visual acuity (UDVA) was 20/20, intraocular pressure (IOP) was 14 mm, cornea was clear, and anterior chamber (AC) was well formed with occasional cells till 18 days postsurgery when she presented with a complaint of pain and blurring of vision in the RE. She was putting prednisolone acetate 1% eye drops four hourly. On presentation, her UDVA was 20/60 improving to 20/40 with pinhole and IOP was 38 mm in RE. On examination, conjunctival congestion, hazy cornea, shallow AC with grade 4 cells, miosed (2 mm) pupil, and a fibrinoid membrane attached at the pupillary edges completely blocking the pupillary opening [Figure 1]a was seen. Her left eye (LE) was unremarkable. An anterior segment optical coherence tomography (ASOCT) showed narrow angles [Figure 2]a and a fibrinous membrane causing pupillary block [Figure 3]a. We used Nd: YAG laser to disrupt the membrane using seven shots of 1.2 mJ. ASOCT done post laser showed widened AC angle [Figure 2]b and disrupted pupillary membrane [Figure 3]b. Fundus examination done post laser was normal. She was prescribed topical cycloplegic, antiglaucoma medications and steroid-antibiotic drops and tablet acetazolamide. After three days, the eye was quiet with remnant fibrin membrane retracted on IOL surface temporally [Figure 1]b with UDVA 20/20 and IOP 13 mm.
Figure 1: Slit lamp image of the RE showing (a) dense fibrinoid pupillary membrane with corneal haze before laser membranectomy and (b) post membranectomy dilated pupil with retracted fibrinoid membrane temporally

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Figure 2: ASOCT scan showing (a). Pre Nd:YAG membranectomy narrow AC angle (b). Post Nd:YAG membranectomy opening of AC angle and increased AC depth

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Figure 3: ASOCT scan showing (a). Central membrane blocking the pupil (b). Disruption of central pupillary membrane post Nd: YAG laser relieving the pupillary block

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  Discussion Top

Delayed noninfectious fibrinoid response is a rare complication of cataract surgery[1] that can form membrane completely occluding the pupillary opening causing secondary angle closure glaucoma. Breakdown of blood–aqueous barrier has been proposed as a mechanism in patients with diabetes, autoimmune diseases, and post vitreoretinal surgery. Treatment methods described are using intracameral tissue plasminogen activator (tPA)[2] and Nd: YAG laser membranectomy.[3] Nd: Yag laser was effective in relieving the pupillary block and provided immediate benefits in this case.

Informed consent

Consent for publishing data and images was given by the patient.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Spitznas M. Fibrinous reaction occurs until 8 days after intraocular lens implantation. Arch Ophthalmol 1990;108:1666. doi: 10.1001/archopht. 1990.01070140020003.  Back to cited text no. 1
Yoshino H, Seki M, Ueda J, Yoshino T, Fukuchi T, Abe H. Fibrin membrane pupillary-block glaucoma after uneventful cataract surgery treated with intracameral tissue plasminogen activator: A case report. BMC Ophthalmol 2012;12:3. doi: 10.1186/1471-2415-12-3.  Back to cited text no. 2
Norris JW, Chirls IA, Santry JG, Norris JW. Severe fibrinous reaction after cataract and intraocular lens implantation surgery requiring neodymium: YAG laser therapy. J Cataract Refract Surg 1990;16:637-9.  Back to cited text no. 3


  [Figure 1], [Figure 2], [Figure 3]


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