Case Report

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

10.5152/imj.2015.91886

  • Tülay Alpar Akçetin
  • Kadir Eltutar
  • Nurhan Dinçer
  • Fatma Esin Özdemir

Received Date: 25.02.2013 Accepted Date: 30.12.2014 İstanbul Med J 2015;16(1):42-44

Objective:

To evaluate the diagnostic and therapeutic methods of fibrindependent pupillary-block glaucoma (PBG).

Methods:

A 79-year-old male patient with hypertension was admitted to hospital with symptoms of pain and redness 6 days after an uneventful cataract surgery.

Results:

He had acute elevation of intraocular pressure with a shallow anterior chamber. Because of severe corneal edema, the anterior chamber details could not be distinguished. After systemic and topical antiglaucoma treatment, corneal edema was reduced and a complete fibrin membrane was observed across the pupil on slit lamp examination.

A complete fibrin membrane across the pupillary space, shallow anterior chamber, and deep posterior chamber was confirmed by ultrasonic biomicroscopy (UBM). The intraocular lens (IOL) was actually displaced posteriorly, with a large clear space between the IOL and iris.

Despite topical and subconjunctival corticosteroid therapy as well as Nd:YAG laser membranotomy, the fibrin membrane was not resolved. Tissue plasminogen activator (tPA) (25 μg) was injected intracamerally and the fibrin membrane was completely dissolved, improving the pupillar block.

Conclusion:

Anterior segment imaging techniques, especially UBM, are a powerful diagnostic technique for differentiating the technique for the analysis of the mechanisms underlying acute angle-closure glaucoma mechanism. Fibrin-dependent PBG was successfully treated with an intracameral injection of tPA.

Keywords: Fibrin membrane, pupillary block glaucoma, cataract surgery, ultrasound biomicroscopy, tissue plasminogen activator