Delayed angle closure in pseudophakia and repeated intravitreal therapy
Reviewed by Mahmoud Ahmed

The authors report two cases of acute angle closure many years after uneventful cataract surgery and posterior chamber intraocular lens (IOL) implantation. Both patients had neovascular age-related macular degeneration (AMD) and received regular intravitreal injections (24 and 25 injections in total). The first patient was found to have retained lens material in the capsular bag on ultrasound biomicroscopy (UBM) causing anterior displacement of the IOL and pupillary block. This resolved with laser iridotomy and topical treatment. The second patient had a more insidious course with progressive anterior chamber narrowing and increasing intraocular pressure. A previous iridotomy became closed. The condition progressed despite repeat iridotomy. A pars plana vitrectomy and Ahmed glaucoma valve were done after which the condition stabilised. Pupillary block and aqueous misdirection are very rare many years after successful cataract surgery. The authors propose an element of chronic vitreous expansion from repeated intravitreal injections as a predisposing factor. Careful assessment is needed to determine the most appropriate treatment in this rare scenario.

Late-onset angle closure in pseudophakic eyes with posterior chamber intraocular lenses.
Krawitz B, Misra P, Bearelly S, Al-Aswad L.
JOURNAL OF CATARACT & REFRACTIVE SURGERY
2020;46:e48-e51.