Fibrin membrane pupillary-block glaucoma after uneventful cataract surgery treated with intracameral tissue plasminogen activator: a case report

A 62-year-old man with diabetes mellitus developed acute elevation of intraocular pressure with a shallow anterior chamber five days after uneventful cataract surgery. Initially, slit lamp examination provided only limited information due to severe corneal edema. After resolution of corneal edema with systemic glaucoma therapy, a complete fibrin membrane was observed across the pupil by slit lamp examination. Anterior segment optic coherence tomography clearly revealed a thin fibrin membrane covering the entire pupillary space, a shallow anterior chamber, and a deep posterior chamber. The intraocular lens was not observed by anterior segment optic coherence tomography. In contrast, ultrasound biomicroscopy, which has superior penetration depth, was able to visualize the intraocular lens deep in the posterior chamber. Injection of tissue plasminogen activator into the anterior chamber resulted in complete fibrinolysis and released the pupillary block.This case suggests that ocular anterior segment imaging modalities, especially ultrasound biomicroscopy, serve as powerful diagnostic tools to identify mechanisms of acute angle closure glaucoma, which is often accompanied by poor intraocular visibility. This is the first reported case of fibrin pupillary-block glaucoma after cataract surgery successfully treated with intracameral tissue plasminogen activator.Fibrin membrane pupillary-block glaucoma is an uncommon complication after phacoemulsification cataract surgery [1]. Severe corneal edema due to elevated intraocular pressure often prevents a thorough slit lamp examination, making early diagnosis difficult. Corneal edema similarly interferes with laser iridotomy. We present here a case of fibrin membrane pupillary-block glaucoma that was diagnosed with help of ocular anterior segment imaging devices and successfully treated with tissue plasminogen activator.The patient was a 62-year-old Japanese man with diabetes mellitus on insulin therapy for 20 years. He visited