Posterior Approach in Management of Phacomorphic Angle Closure

This article presents a case of posterior lensectomy through 3-port pars plana vitrectomy for the management of phacomorphic angle closure. A 67-year-old man presented to the outpatient department with headache and decreased vision in his left eye for the past 3 days. Visual acuity 2/60, intraocular pressure (IOP) >60 mm Hg, and the anterior chamber (AC) depth Van Herick grade 1. A complete ophthalmologic examination revealed a phacomorphic angle closure. Serial management was performed consisting of mannitol 20% intravenously, laser peripheral iridotomy, and trabeculectomy. However, the depth of the AC became more shallow, and the IOP remained high. Lens extraction as definitive therapy could not be performed because of the adhesion of the iris and anterior lens capsule to the corneal endothelium; thus, posterior lensectomy using 3-port pars plana vitrectomy, and phacofragmatome was performed. Once the corneal thickness was returned to normal, and the AC depth was sufficient, the patient underwent secondary intraocular lens implantation. A significant improvement in visual acuity, normal IOP, and AC depth were achieved after the management of the posterior approach. Thus, this posterior approach should be considered a good option of management technique in cases with phacomorphic angle closure with very shallow AC depth and a fragile cornea.