The Nd:YAG laser as first-line treatment for fibrin pupillary-block glaucoma following uncomplicated cataract surgery

A 43-year-old lady presented with painful, loss of vision in the right eye 2 weeks after cataract surgery. This is on a background of previous central retinal vein occlusion in the right eye and bilateral diabetic retinopathy. Her past medical history included mixed connective tissue disease for which she is on systemic immunosuppressants. Ocular examination revealed significant corneal oedema, a shallow anterior chamber with an intraocular pressure of 45 mmHg. Intraocular pressure lowering medications were administered and repeat examination identified a fine fibrinous membrane attached to the pupillary margin with a substantial third space that had formed between the posterior edge of the membrane and the anterior lens surface. The fibrin membrane was removed with Nd:YAG laser and intraocular pressure reduced to 12 mmHg. Post-procedural management included hourly dexamethasone 0.1% eye drops for 1 week and cyclopentolate 1%. There was no recurrence in the fibrin membrane.