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Phacomorphic Angle-closure Following Silicone Oil Tamponade in a Pediatric Patient.
J Glaucoma. 2018 06; 27(6):e106-e109.JG

Abstract

PURPOSE

The purpose of this study was to report a case of phacomorphic glaucoma following retinal detachment repair with silicone oil (SO) in a pediatric patient.

STUDY DESIGN

Case report.

METHODS

A chart review was conducted at St. Michael's Hospital and The Hospital for Sick Children (Toronto, Canada), where the patient received ophthalmic care from July 28, 2015 onwards.

RESULTS

A 14-year-old boy with a history of traumatic retinal detachment and proliferative vitreoretinopathy in the left eye, requiring 2 pars plana vitrectomies, membrane peel, and SO tamponade, presented with 1-day history of decreased vision in the left eye, severe headache, nausea, and vomiting. Visual acuity was hand motions; intraocular pressure (IOP) was 54 mm Hg; the pupil was middilated and minimally reactive with a reverse relative afferent pupillary defect. Slit-lamp examination revealed an injected eye with diffuse microcystic corneal edema, a shallow anterior chamber (AC), and an intumescent cataract. Gonioscopy demonstrated closed angles in 3 quadrants. Compared with his last examination 6 weeks prior, where only a mild posterior subcapsular cataract was noted, the patient's presentation was suggestive of rapid lens intumescence causing acute angle-closure glaucoma. He was given topical and systemic treatment, including intravenous mannitol, and his IOP reduced to 22 mm Hg after 7 hours. Urgent lensectomy was performed the following day. Preoperative ultrasound biomicroscopy revealed a greatly increased lens thickness of 5.12 mm and an AC depth of 1.12 mm. The integrity of both anterior and posterior lens capsules was confirmed intraoperatively, and SO remained confined to the posterior segment. Postoperatively, the iris returned to a normal configuration with open angles, and IOP was 16 mm Hg with no antiglaucoma medications at the last follow-up.

CONCLUSIONS

Acute angle-closure in children is a rare event. To our knowledge, this is the first reported case of phacomorphic glaucoma secondary to vitreoretinal surgery in the pediatric population. Although uncommon, ophthalmologists should be aware of this potential complication with the intraocular use of SO and administer urgent treatment accordingly.

Authors+Show Affiliations

Department of Ophthalmology and Vision Sciences, University of Toronto.Department of Ophthalmology and Vision Sciences, University of Toronto. Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada. Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA.Department of Ophthalmology and Vision Sciences, University of Toronto. Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.Department of Ophthalmology and Vision Sciences, University of Toronto. Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29613981

Citation

Leung, Victoria C., et al. "Phacomorphic Angle-closure Following Silicone Oil Tamponade in a Pediatric Patient." Journal of Glaucoma, vol. 27, no. 6, 2018, pp. e106-e109.
Leung VC, Fung SSM, Muni R, et al. Phacomorphic Angle-closure Following Silicone Oil Tamponade in a Pediatric Patient. J Glaucoma. 2018;27(6):e106-e109.
Leung, V. C., Fung, S. S. M., Muni, R., & Ali, A. (2018). Phacomorphic Angle-closure Following Silicone Oil Tamponade in a Pediatric Patient. Journal of Glaucoma, 27(6), e106-e109. https://doi.org/10.1097/IJG.0000000000000957
Leung VC, et al. Phacomorphic Angle-closure Following Silicone Oil Tamponade in a Pediatric Patient. J Glaucoma. 2018;27(6):e106-e109. PubMed PMID: 29613981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Phacomorphic Angle-closure Following Silicone Oil Tamponade in a Pediatric Patient. AU - Leung,Victoria C, AU - Fung,Simon S M, AU - Muni,Rajeev, AU - Ali,Asim, PY - 2018/4/4/pubmed PY - 2019/10/12/medline PY - 2018/4/4/entrez SP - e106 EP - e109 JF - Journal of glaucoma JO - J. Glaucoma VL - 27 IS - 6 N2 - PURPOSE: The purpose of this study was to report a case of phacomorphic glaucoma following retinal detachment repair with silicone oil (SO) in a pediatric patient. STUDY DESIGN: Case report. METHODS: A chart review was conducted at St. Michael's Hospital and The Hospital for Sick Children (Toronto, Canada), where the patient received ophthalmic care from July 28, 2015 onwards. RESULTS: A 14-year-old boy with a history of traumatic retinal detachment and proliferative vitreoretinopathy in the left eye, requiring 2 pars plana vitrectomies, membrane peel, and SO tamponade, presented with 1-day history of decreased vision in the left eye, severe headache, nausea, and vomiting. Visual acuity was hand motions; intraocular pressure (IOP) was 54 mm Hg; the pupil was middilated and minimally reactive with a reverse relative afferent pupillary defect. Slit-lamp examination revealed an injected eye with diffuse microcystic corneal edema, a shallow anterior chamber (AC), and an intumescent cataract. Gonioscopy demonstrated closed angles in 3 quadrants. Compared with his last examination 6 weeks prior, where only a mild posterior subcapsular cataract was noted, the patient's presentation was suggestive of rapid lens intumescence causing acute angle-closure glaucoma. He was given topical and systemic treatment, including intravenous mannitol, and his IOP reduced to 22 mm Hg after 7 hours. Urgent lensectomy was performed the following day. Preoperative ultrasound biomicroscopy revealed a greatly increased lens thickness of 5.12 mm and an AC depth of 1.12 mm. The integrity of both anterior and posterior lens capsules was confirmed intraoperatively, and SO remained confined to the posterior segment. Postoperatively, the iris returned to a normal configuration with open angles, and IOP was 16 mm Hg with no antiglaucoma medications at the last follow-up. CONCLUSIONS: Acute angle-closure in children is a rare event. To our knowledge, this is the first reported case of phacomorphic glaucoma secondary to vitreoretinal surgery in the pediatric population. Although uncommon, ophthalmologists should be aware of this potential complication with the intraocular use of SO and administer urgent treatment accordingly. SN - 1536-481X UR - https://www.unboundmedicine.com/medline/citation/29613981/Phacomorphic_Angle-closure_Following_Silicone_Oil_Tamponade_in_a_Pediatric_Patient L2 - http://dx.doi.org/10.1097/IJG.0000000000000957 DB - PRIME DP - Unbound Medicine ER -