Post-operative angle closure glaucoma following Descemet’s Membrane Endothelial Keratoplasty (DMEK)

Post-operative angle closure glaucoma following Descemet’s Membrane Endothelial Keratoplasty (DMEK)

This is an anterior segment OCT of a patient that underwent DMEK and cataract surgery the day prior. Intraoperatively, the anterior chamber was filled 80-90% with SF6 20% gas to hold the graft in place. She presented the following day with sudden onset of acute eye pain with headaches. OCT showed that the angle was closed with evidence of iridocorneal touch shown. Mechanistically, this was thought to be caused by either the anterior chamber gas tracking through the pupil into the posterior chamber and prolapsing the iris forward to close the angle or prolapsing the IOL forward to induce pupillary block. By the time the patient was repositioned and examined at the slit lamp, the gas had tracked back into the anterior chamber either through the patent peripheral iridotomy or pupil and the chamber was deep with a normal intraocular pressure.

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