A Case of Acute Fibrin Pupillary Block Diagnosed by Ultrasonic Biomicroscopy

Won Hyuk Lee; Yong Suk Kang; Young Hoon Hwang; Mi Sun Sung; Jun Woo Shin; Joo Hwa Lee

doi:10.3341/jkos.2011.52.1.117

Journal List > J Korean Ophthalmol Soc > v.52(1) > 1008899

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Lee, Kang, Hwang, Sung, Shin, and Lee: A Case of Acute Fibrin Pupillary Block Diagnosed by Ultrasonic Biomicroscopy

Original Article

J Korean Ophthalmol Soc 2011;52(1):117-121.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.1.117

A Case of Acute Fibrin Pupillary Block Diagnosed by Ultrasonic Biomicroscopy

Won Hyuk Lee, MD¹, Yong Suk Kang, MD¹, Young Hoon Hwang, MD², Mi Sun Sung, MD¹, Jun Woo Shin, MD¹, Joo Hwa Lee, MD¹

¹Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

²Department of Ophthalmology, The Armed Forces Capital Hospital, Seoul, Korea

Address reprint requests to Joo Hwa Lee, MD Department of Ophthalmology, Sanggye Paik Hospital #761 Sanggye-dong, Nowon-gu, Seoul 139-707, Korea Tel: 82-2-950-1096, Fax: 82-2-935-6904, E-mail: joohlee@paik.ac.kr

Received 11 April 2010 Revised 10 September 2010 Accepted 24 November 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of fibrin pupillary block diagnosed by ultrasonic biomicroscopy (UBM) and treated by argon neodymium:YAG (Nd:YAG) laser in a patient with uveitis.

Case summary

A 56-year-old man visited the hospital for decreasing visual acuity and a sudden onset of pain in the right eye. Best corrected visual acuity was 0.02 in the right eye and 1.0 in the left eye. Intraocular pressure (IOP) was 48 mm Hg in the right eye and 18 mm Hg in the left eye. Slit-lamp examination revealed diffuse corneal stromal edema with Descemet's folds and uniform shallowing of the anterior chamber, with 360 degrees of peripheral iridocorneal touch in the right eye. A fibrin membrane was present across the pupil. UBM showed a fibrin membrane across the pupil, uniform shallowing of the anterior chamber, and peripheral angle closure. The lens was displaced posteriorly. A sequential Nd:YAG laser membranectomy was performed that same day, with immediate deepening of the anterior chamber and normalization of the IOP.

Conclusions

UBM can play an invaluable role in the diagnosis of fibrin pupillary block by showing the presence of a fibrin pupillary membrane, accumulation of aqueous in the posterior chamber, and a clear separation between the iris and the lens. Nd:YAG laser membranectomy can be performed effectively in a fibrin pupillary block.

Keywords: Fibrin pupillary block, Membranectomy, Nd, YAG laser, Ultrasound biomicroscopy

References

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Figure 1.

Photographs of anterior segment and ultrasound biomicroscopic findings at the first visit. Anterior chamber shallowing with peripheral iridocorneal touch, and a fibrin membrane are noted across the pupil (A, B, C). Ultrasound biomicroscopy shows a fibrin membrane across the pupil (arrow), uniform shallowing of the anterior chamber, and peripheral angle closure (D). Lens is displaced posteriorly (arrow head) and separated from the iris and fibrin membrane by a large clear space (D).

Figure 2.

Photographs of anterior segment and ultrasound biomicroscopic findings after laser treatment. The anterior chamber deepened considerably and fibrin membrane is partially disrupted after Nd:Yag laser membranectomy (A, B, C). Ultrasound biomicroscopy reveals deepened anterior chamber (D).

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