DR. PRASANNA VENKATESH RAMESH

DR. SATHYAN PARTHASARATHY, DR. R. RAMESH, DR. SHRUTHY VAISHALI RAMESH

Abstract

A 24 year old male presented with defective vision in his OS following ICL surgery in OU done elsewhere. On examination, OS had corneal edema with IOP of 24 mmHg, despite maximal IOP lowering medications. He was diagnosed with secondary angle closure glaucoma, with pupillary block due to ICL, and was advised ICL explantation by them, as PI didn’t help. However on our examination with gonioscopy, he was re-diagnosed as secondary open angle glaucoma with 360 degree, dense pigment dispersion into the angles. AS-OCT supported this theory. Trabeculectomy seemed a better option than unilateral ICL explantation, as the patient had bilateral high myopia and ICL explantation may still not recover the obstructed meshwork; and the eye may still need subsequent trabeculectomy. Filtering surgery alone was performed and the IOP is still in low teens till last follow-up of 3 years, with ICL in-situ OU. The pearl here is gonioscopy remains unparalleled in dictating the direction of glaucoma treatment.