Evaluating The Anterior Segment In Phacomorphic Glaucoma By Dilraj S. Grewal, Md - OCULUS Pentacam Interpretation Manual

9.4 Evaluating the anterior segment in phacomorphic glaucoma
by Dilraj S. Grewal, MD
A 76-year-old caucasian female patient presented with acute pain and redness in her right eye.
Her IOP was elevated to 58, she had microcystic edema and her pupil was minimally reactive
with her vision at "count fingers" in her right eye and 20/40 in her left. She had undergone an
uncomplicated aortic valve repair 4 days prior to presentation. Prior ocular history was significant
for an episode with similar symptoms in her left eye 7 years prior, which had also occurred a
few days following a major surgery. At that time she had undergone bilateral laser peripheral
iridotomies, which were patent on examination. On slitlamp biomicroscopy she was found to have
a very shallow anterior chamber but no irido-corneal touch.
Pentacam® Scheimpflug imaging
evidenced by a shallow ACD of 1.75 mm, an ACV of 65 mm
eye. An anterior vaulting of the lens was visible on the Scheimpflug image.
Her IOP was emergently controlled with intravenous Diamox and IOP lowering drops. Once the
corneal edema had cleared in 3 days she underwent an uneventful phacoemulsification and
posterior chamber IOL implantation. Post-operative Scheimpflug
a significantly increased ACV and ACD and widening of the ACA. Her IOP was 17 off all medications
postoperatively and her vision improved to 20/40. In this case the Scheimpflug images helped
us confirm the diagnosis of phacomorphic glaucoma in an eye with a very shallow chamber and
elevated IOP in the presence of a patent PI and demonstrated a deepening of the anterior chamber
following lens extraction.
Figure 55: Scheimpflug Image showing very low ACV, shallow ACD, narrow ACA and
anterior vaulting of the lens in OD
(Figure 55) confirmed the diagnosis of phacomorphic glaucoma as
and ACA of 17.5 degrees in the right
3
(Figure 56) images demonstrated
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