Angle closure caused by a plateau-like iris associated with an enlarged Soemmering’s ring: a case report

Kitamura, Fumika; Inoue, Toshihiro; Kuroda, Utako; Tanihara, Hidenobu

doi:10.1186/s12886-016-0226-0

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…This is the first report of a unique AS-OCT finding in eyes with anterior displacement of the CTR-IOL complex, highlighting the usefulness of AS-OCT in detecting anterior displacement of the CTR-IOL complex. Another possible cause of secondary angle closure could be PAS following angle-closure glaucoma or enlargement of Soemmering's ring, as previously reported [12,13]. However, neither Soemmering's ring in the CTR-IOL complex nor PAS was observed in this case.…”

Section: Discussionsupporting

confidence: 54%

Secondary Angle Closure Caused by Anterior Displacement of Capsular Tension Ring and Intraocular Lens Due to Aqueous Misdirection

Goto,

Tomita,

Hiraiwa

et al. 2024

Cureus

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A capsular tension ring (CTR) is used for support to stabilize the capsular bag and intraocular lens (IOL) during and after cataract surgery. Although complications involving the CTR-IOL complex are not uncommon, cases of anterior displacement leading to complications are rare. This report presents a case of secondary angle closure caused by anterior displacement of the CTR-IOL complex due to aqueous misdirection and reports unique findings noted on anterior segment optical coherence tomography (AS-OCT). The patient, a 69-year-old woman, developed an acute angle closure crisis (AACC) and underwent cataract surgery with the implantation of a CTR and IOL. Post-surgery, there was an improvement in the central depth of the anterior chamber, but the patient experienced intermittent spikes in intraocular pressure. AS-OCT revealed a flat center of the iris and a closed anterior chamber angle which are plateauiris-like findings. Secondary angle closure was caused by the CTR-IOL complex which was anteriorly displaced and pushed the peripheral iris owing to aqueous misdirection syndrome. Three weeks after the initial surgery, the patient underwent CTR removal, anterior vitrectomy, and intrascleral lens fixation. After the second surgery, intraocular pressure was normalized without any medications, and the anterior chamber angle was enlarged. This case provides a better understanding of secondary angle closure caused by the anterior displacement of the CTR-IOL complex and highlights the importance of AS-OCT in the detection of such complications.

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Section: Discussionsupporting

confidence: 54%

Secondary Angle Closure Caused by Anterior Displacement of Capsular Tension Ring and Intraocular Lens Due to Aqueous Misdirection

Goto,

Tomita,

Hiraiwa

et al. 2024

Cureus

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“…More extensive chronic angle narrowing is probably due to the enlarging Soemmering’s ring. Kung 23 and more recently Kitamura 24 reported cases of angle-closure glaucoma in adult pseudophakias caused by an enlarged Soemmering’s ring. We observed two eyes with enlarged Soemmering’s rings leading to a small angle-opening distance and trabecular-iris angle in all quadrants, and one eye had an elevated borderline IOP.…”

Section: Discussionmentioning

confidence: 99%

The long-term anterior segment configuration after pediatric cataract surgery and the association with secondary glaucoma

Chen

Gong

Xie

et al. 2017

Sci Rep

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Secondary glaucoma constitutes major sight-threatening complication of pediatric cataract surgery, yet the etiology remains unclear. The purpose of this study was to investigate the long-term anterior segment configuration and the association with secondary glaucoma in pediatric pseudophakia. Ultrasound biomicroscopy (UBM) was performed on 40 eyes of 26 children underwent pediatric cataract surgery and intraocular lens (IOL) implantation. The anterior chamber depth (ACD), angle-opening distance at 500 μm (AOD500), trabecular-iris angle (TIA), central corneal thickness (CCT), structural abnormities, IOL position, IOP, and incidence of glaucoma were evaluated. High insertion of iris, in which the iris root is attached more anteriorly than normal, was seen in 13 eyes (32.50%). IOL was located in the capsular bag in 19 eyes and in the ciliary sulcus in 21 eyes. Logistic regression analysis identified high insertion of iris (OR 3.40, 95% CI 1.03–11.17, p = 0.03) and IOL implantation in sulcus (OR 1.39, 95% CI 1.07–4.85, p = 0.04) as independent risk factors for glaucoma. The presence of high insertion of iris and IOL implantation in ciliary sulcus may increase the long-term risk of the development of secondary glaucoma after pediatric cataract surgery.

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“…A series of 3 patients in angle closure due to a Soemmering’s ring were successfully treated with LPI [ 6 ]. Another patient had plateau iris and a Soemmering’s ring that improved with topical pilocarpine [ 7 ]. Similar to the cases of aphakic patients, it is the slow proliferation of lens epithelial cells that results in mechanical displacement of the iris and obstruction of the trabecular meshwork.…”

Section: Discussionmentioning

confidence: 99%

Angle closure secondary to lens remnants in a patient with presumed aphakia: case report

Lyons

Roddy

2022

BMC Ophthalmol

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Background Eyes with a short axial length or anterior chamber depth often develop narrowed anterior chamber angles in association with an enlarging crystalline lens. We report a case of a patient who presented in angle closure, with a distant history of prior intervention for congenital cataracts and was presumed to be aphakic. Case presentation A 78-year-old male presented with acute onset unilateral eye pain and blurred vision. He was found to have increased intraocular pressure, anteriorly bowed iris, and angle closure. Despite prior documentation of aphakia after treatment for congenital cataracts, detailed workup revealed residual crystalline lens material pushing the peripheral iris anteriorly. Further history confirmed that the patient underwent a procedure in the 1940’s to remove lens material centrally but was not truly aphakic. The patient was treated with anterior chamber paracentesis and intraocular pressure lowering drops. His intraocular pressure remains controlled with medical therapy alone. Conclusions Patients that appear to be aphakic centrally may still present with angle closure secondary to residual peripheral lens material. This case highlights the importance of keeping this etiology on the differential in a patient with presumed aphakia.

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Angle closure caused by a plateau-like iris associated with an enlarged Soemmering’s ring: a case report

Cited by 4 publications

References 8 publications

Secondary Angle Closure Caused by Anterior Displacement of Capsular Tension Ring and Intraocular Lens Due to Aqueous Misdirection

Secondary Angle Closure Caused by Anterior Displacement of Capsular Tension Ring and Intraocular Lens Due to Aqueous Misdirection

The long-term anterior segment configuration after pediatric cataract surgery and the association with secondary glaucoma

Angle closure secondary to lens remnants in a patient with presumed aphakia: case report

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