One-year outcome of low dose laser cyclophotocoagulation for capsular tension ring-induced malignant glaucoma: A case report

Abstract

Rationale: Malignant glaucoma is a refractory glaucoma which often relentlessly worsened despite conventional therapy. Ultrasonographic biomicroscopy always cannot show the ciliary-block of malignant glaucoma. We report a case of capsular tension ring induced ciliary-block and successfully treated by low dose laser cyclophotocoagulation, with 1-year follow-up.

Patient concerns: A 75-year-old woman was referred for glaucoma with a history of cataract and lens zonular laxity, and surgery with combined phacoemulsification and capsular tension ring implantation. She subsequently underwent trabeculectomy for uncontrolled intraocular pressure on maximal medical therapy. One day later, the patient presented as shallow anterior chamber of Shaffer grade 1 and an elevated intraocular pressure of 51.0 mmHg in the right eye.

Diagnosis: Ciliary block caused by capsular tension ring and malignant glaucoma was observed.

Interventions: Low dose laser cyclophotocoagulation was performed under retrobulbar anesthesia.

Outcomes: One day later, the patient's intraocular pressure decreased to 14.3 mmHg on topical atropine 1% and 2 classes of intraocular pressure lowering medications. The patient discontinued topical atropine and intraocular pressure lowering medications 4 months postoperatively and her condition had remained stable for 1 year without any medications. The patient had a satisfactory recovery benefited from the low dose laser cyclophotocoagulation.

Lessons: Low dose laser cyclophotocoagulation in this challenging case of capsular tension ring-induced malignant glaucoma provided an effective and fast recovery of anterior chamber depth over a 1-year period.

Figure 1

A and B, UBM showed shallowing of the AC and angle closure in the right eye. C and D, UBM showed shallowing of the AC and angle open in the left eye. B and D showed inferior anterior chamber angle. AC = anterior chamber, UBM = ultrasonographic biomicroscopy.

Figure 2

A and B, UBM showed ciliary block on day 1 after trabeculectomy. C and D, UBM showed that ciliary sulcus diameter (horizontal yellow line) had smaller size than CTR and the ACD deepened slightly after maximum topical medical therapy. B and D showed inferior anterior chamber angle. Yellow arrow showed the acoustic shadow of CTR. ACD = anterior chamber depth, CTR = capsular tension ring, UBM = ultrasonographic biomicroscopy.

Figure 3

UBM showed the relief of inferior ciliary block on day 2 after LDCP. Yellow arrow may be a patent communication from the posterior space of the lens to the posterior chamber caused by LDCP. LDCP = low dose laser cyclophotocoagulation, UBM = ultrasonographic biomicroscopy.

Figure 4

A, Slit-lamp examination and UBM showed the depth of central AC in the right eye during 1 year of follow-up. B, The ACD sustained 1.93 mm. AC = anterior chamber, ACD = anterior chamber depth, UBM = ultrasonographic biomicroscopy.