A Case Report of Pigmentary Glaucoma following Cataract Surgery with Sulcus Fixated Intraocular Lens Implantation

A 43 yr Hindu male presented with gradual diminution of vision of right eye (RE) for 3 months. He had history of cataract surgery with posterior chamber intraocular lens (PCIOL) implantation in RE 1year back. O/E- VA- HM+ in RE. IOP 40mm Hg in RE. On slit lamp examination Krukenberg spindle was found on corneal endothelium. Gonioscopy revealed heavily pigmented trabecular meshwork and wide open anterior chamber angle of RE. He had iris transillumination defects associated with the intraocular lens haptics. Posterior segment examination revealed obliteration of physiological cup and thinning of neuroretinal rim. OCT showed RNFL thinning in all quadrants. HFA showed grossly diminished visual field with sparing of a central island of vision (Tubular vision). Patient was treated medically with topical timolol e/d 0.5 % twice daily and topical dorzolamide 2 % twice daily. On follow up monthly for 4 months IOP reduced to 22mm Hg but VA didnt improve in RE. Laser peripheral iridotomy was done in RE. IOP remained consistently below 20 since then. Conclusion- Pigmentary glaucoma due to cataract surgery should be diagnosed and treated early to maintain useful vision.