Anterior segment imaging in the management of postoperative fibrin pupillary–block glaucoma

Abstract

Postoperative fibrin pupillary-block glaucoma, an uncommon complication of intraocular surgery, develops when an inflammatory fibrin membrane occludes the pupil, resulting in peripheral angle closure. We present a series of 4 patients with this condition and describe the role of anterior segment optical coherence tomography and ultrasound biomicroscopy in distinguishing fibrin pupillary-block glaucoma from other forms of postoperative acute glaucoma. Specific to this condition is the presence of a fibrin membrane across the pupil and accumulation of aqueous in the posterior chamber, as would be expected in pupil block, but with a clear separation between the intraocular lens and the iris. The possible risk factors are discussed and various treatment modalities reviewed.

Fibrin Membrane Pupillary-Block Glaucoma After Uneventful Cataract Surgery Treated with Intracameral Tissue Plasminogen Activator: A Case Report

“…After cataract surgery, an increased IOP and a narrowed anterior chamber can develop due to fibrin membrane-dependent pupillary block, Soemmering's ring, posterior synechia, capsular block syndrome, and malignant glaucoma (1,2). Although fibrin membrane-dependent PBG is frequently seen after pars plana vitrectomy (PPV), there are a few studies on its development after cataract surgery (3).…”

“…In this particular situation, the aqueous accumulates in the posterior chamber as the fibrin membrane completely covers the pupilla. It was reported that 3 of these 4 patients had diabetes mellitus (DM) (2). On the other hand, previous reports suggest that the development of fibrin reaction after cataract surgery in patients with DM is associated with an impaired blood-aqueous barrier (5).…”

“…The incidence of the occurrence of fibrin after cataract surgery is between 2% and 8% in the general population (2). In ocular events such as uveitis and pseudoexfoliation syndrome, this rate increases in systemic diseases such as HT and DM (1, 2, 5, 6).…”

“…Fibrin membrane-dependent pupillary block glaucoma (PBG) is a rare complication seen after uneventful phacoemulsification cataract surgeries (1,2). The clinical picture coursing with peripheral angle closure and increased intraocular pressure (IOP) due to the pupillary space being completely covered with fibrin membrane is called as fibrin-induced PBG (2).…”

“…The clinical picture coursing with peripheral angle closure and increased intraocular pressure (IOP) due to the pupillary space being completely covered with fibrin membrane is called as fibrin-induced PBG (2). Severe corneal edemas developing because of increased IOP hinders biomicroscopic examination and makes early diagnosis difficult.…”