Fibrin Membrane Pupillary-Block Glaucoma After Uneventful Cataract Surgery Treated with Intracameral Tissue Plasminogen Activator

To evaluate the diagnostic and therapeutic methods of fibrin-dependent pupillary-block glaucoma (PBG). A 79-year-old male patient with hypertension was admitted to hospital with symptoms of pain and redness 6 days after an uneventful cataract surgery. He had acute elevation of intraocular pressure with a shallow anterior chamber. Because of severe corneal edema, the anterior chamber details could not be distinguished. After systemic and topical antiglaucoma treatment, corneal edema was reduced and a complete fibrin membrane was observed across the pupil on slit lamp examination. A complete fibrin membrane across the pupillary space, shallow anterior chamber, and deep posterior chamber was confirmed by ultrasonic biomicroscopy (UBM). The intraocular lens (IOL) was actually displaced posteriorly, with a large clear space between the IOL and iris. Despite topical and subconjunctival corticosteroid therapy as well as Nd:YAG laser membranotomy, the fibrin membrane was not resolved. Tissue plasminogen activator (tPA) (25 mu g) was injected intracamerally and the fibrin membrane was completely dissolved, improving the pupillar block. Anterior segment imaging techniques, especially UBM, are a powerful diagnostic technique for differentiating the technique for the analysis of the mechanisms underlying acute angle-closure glaucoma mechanism. Fibrin-dependent PBG was successfully treated with an intracameral injection of tPA