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DOI: 10.1055/a-2782-6493
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Therapy-refractory Intraocular Pressure Decompensation Following Bilateral Complicated Cataract Surgery

Therapierefraktäre intraokuläre Druckdekompensation nach bilateraler Kataraktchirurgie

Authors

  • Leah Raffaela Disse 

    1   Ophthalmology, University Hospital Zürich, Switzerland
    2   Ophthalmology, Eye Clinic Wettingen, Switzerland

  • Daniel Barthelmes 

    1   Ophthalmology, University Hospital Zürich, Switzerland

  • Marc Stahel

    1   Ophthalmology, University Hospital Zürich, Switzerland

  • Timothy Hamann 

    1   Ophthalmology, University Hospital Zürich, Switzerland

  • Frank Blaser

    1   Ophthalmology, University Hospital Zürich, Switzerland
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History and Signs

A 50-year-old patient was referred to our ophthalmology emergency service with a bilateral raised intraocular pressure of 40 mmHg on the right, 46 mmHg on the left eye following cataract surgery. On admission, refraction values were slightly myopic with a best corrected visual acuity of 0.25 on the right, 0.2 on the left. Iris transillumination defects could be seen in both eyes ([Fig. 1 a] and b). There was a massive inflammatory response in the anterior segment with an injected conjunctiva, corneal microcystic edema with pigment, sanguis on the endothelium ([Fig. 1 c] and d) and anterior uveitis (0.5+ cells right, 1+ cells left, [+] flare both eyes). Gonioscopy revealed a microhyphema on the left eye without any remaining cortex parts. The IOL was subluxated in both eyes. The retina seemed unaffected with only slight vitreous bleeding in the left eye. The intraocular pressure could not be decreased with maximum topical and systemic therapy (topical brimonidin, dorzolamide, timolol, latanoprost, steroids, intravenous acetazolamide and mannitol). An anterior chamber tap was performed on the left side to decrease the intraocular pressure, without success.



Publication History

Received: 01 November 2025

Accepted: 07 January 2026

Article published online:
23 February 2026

© 2026. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Chakrabarti A, Nazm N. Posterior capsular rent: Prevention and management. Indian J Ophthalmol 2017; 65: 1359-1369
    Search in Google Scholar
  • 2 Vajpayee RB, Sharma N, Dada T. et al. Management of Posterior Capsule Tears. Surv Ophthalmol 2001; 45: 473-488
    Search in Google Scholar
  • 3 Ang GS, Whyte IF. Effect and outcomes of posterior capsule rupture in a district general hospital setting. J Cataract Refract Surg 2006; 32: 623-627
    Search in Google Scholar
  • 4 Mohebbi M, Bashiri SA, Mohammadi SF. et al. Outcome of Single-piece Intraocular Lens Sulcus Implantation following Posterior Capsular Rupture during Phacoemulsification. J Ophthalmic Vis Res 2017; 12: 275-280
    Search in Google Scholar
  • 5 Chang DF, Masket S, Miller KM. et al. Complications of sulcus placement of single-piece acrylic intraocular lenses: Recommendations for backup IOL implantation following posterior capsule rupture. J Cataract Refract Surg 2009; 35: 1445-1458
    Search in Google Scholar
  • 6 Chang SH, Wu WC, Wu SC. et al. Late-onset secondary pigmentary glaucoma following foldable intraocular lenses implantation in the ciliary sulcus: a long-term follow-up study. BMC Ophthalmol 2013; 13: 22
    Search in Google Scholar
  • 7 Campbell DG, Simmons RJ, Grant WM. Ghost Cells as a Cause of Glaucoma. Am J Ophthalmol 1976; 81: 441-450
    Search in Google Scholar
  • 8 Papaconstantinou D, Georgalas I, Kourtis N. et al. Lens-induced glaucoma in the elderly. Clin Interv Aging 2009; 4: 331-336
    Search in Google Scholar
  • 9 Mehta R, Aref AA. Intraocular Lens Implantation in the Ciliary Sulcus: Challenges and Risks. Clin Ophthalmol 2019; 13: 2317-2323
    Search in Google Scholar