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PHOTO ESSAY
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
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_478_22

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  Abstract 


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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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
    
2.
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
    
3.
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
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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