Secondary Angle-Closure Glaucoma Associated With Congenital Acorea That Developed Into Endophthalmitis After Glaucoma Drainage Implant Surgery: A Case Report

TL;DR

A rare case of eye disease in an infant with congenital acorea led to glaucoma and severe infection after surgery.

Contribution

This case report documents a rare association between congenital acorea and secondary angle-closure glaucoma with postoperative endophthalmitis.

Findings

Secondary angle-closure glaucoma developed in an infant with congenital acorea.

Glaucoma drainage implant surgery led to endophthalmitis caused by Haemophilus influenzae.

The case highlights risks of severe complications following glaucoma surgery in infants with acorea.

Abstract

We report a rare case of unilateral secondary angle-closure glaucoma associated with congenital acorea in a 10-month-old male infant. Acorea is a rare congenital eye abnormality characterized by the complete absence of the pupil. The left cornea of this patient measured 13.0 mm vertically and horizontally, with opacities observed. The anterior chamber was absent, and the pupil was completely occluded. Intraocular pressure (IOP) was 26 mmHg, and axial length was 25.3 mm. The fundus was not visible due to acorea. The patient was diagnosed with secondary angle-closure glaucoma due to acorea. To relieve angle closure, a pupil was created under general anesthesia. After blunt dissection with viscoelastic, a vitreous cutter was inserted through a corneal incision, and central iridectomy was performed. Anterior chamber depth was normalized immediately. Despite initial surgical pupil formation and two trabeculotomies, IOP remained uncontrolled, requiring sequential implantation of an Ahmed glaucoma valve and a Baerveldt glaucoma implant. Although the postoperative IOP stabilized, the patient developed endophthalmitis six months later due to Haemophilus influenzae. Despite intensive treatment, the infection developed into phthisis bulbi after tube exposure. This case highlights the potential for secondary angle-closure glaucoma in patients with acorea and emphasizes the risk of severe postoperative complications, including endophthalmitis, following glaucoma drainage device implantation in infants.

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