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CASE REPORT: PHACOMORPHIC GLAUCOMA IN A MARFAN-LIKE SYNDROME
1. Azlindarita A.M. Abdullah1,2
2. Norlina Ramli¹
3. Fadzlina A.Rahman¹
4. Nurull Bahyah Sulman¹
¹Ophthalmology Department, Faculty of Medicine, University of Malaya, Malaysia
²Faculty of Medicine, MARA Technology University (UiTM), Malaysia
Purpose:
To report a case of lens subluxation glaucoma leading to malignant glaucoma in a patient with Marfan Syndrome
Method:
Interventional case report
Results:
A 42 year old lady with marfanoid features presented with left eye sudden loss of vision and pain for two days. She had a prior history of left eye redness for 14 days. She had been doing intensive reading with her head in a forward position for a month beforehand. At presentation the left eye vision was perception of light. Examination revealed hazy cornea, shallow anterior chamber (AC) with an intumescent lens bulging forward through a dilated pupil, causing iridocorneal touch. The intraocular pressure (IOP) was 48mmHg. The right eye had a shallow AC mainly inferiorly, but superior AC was deep, suggesting lens subluxation. The patient underwent emergency left eye lens aspiration and intraocular lens (IOL) implantation but returned 3 days later with a very shallow AC and high IOPs. A diagnosis of malignant glaucoma was made based on UBM. She subsequently underwent core vitrectomy with synechiolysis.The vision remained poor after the surgery due to decompensated cornea. The right eye subsequently developed inferior lens subluxation into the AC and raised IOP, requiring intracapsular cataract extraction and ACIOL.
Conclusion:
Prolonged accommodative effort (lens becomes more globular) along with the head forward posture may have contributed to the lens being subluxated forward. Anterior rotation of the ciliary body caused by the zonules pulling it forward may have contibuted to the development of malignant glaucoma post cataract extraction.
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