The peeping vitreous blob

A 69-year old male after right eye (RE) cataract surgery with posterior capsular rent with intraocular lens in sulcus on postoperative day 1 complained of severe pain in his RE. On examination, the uncorrected visual acuity was finger counting at 1 meter (Fc1mtr), and the intraocular pressure (IOP) in RE was 42 mm HG with microcystic edema and a shallow anterior chamber (Van-Herick grade 0) with a vitreous blob at the pupillary margin. The patient was diagnosed as pupillary block glaucoma due to vitreous blob at the pupillary area [Fig. 1]. Multiple neodymium-doped yttrium aluminum garnet (Nd-YAG) peripheral iridotomies (PIs) were done, following which the anterior chamber (AC) got deepened after PI. At 1 week, RE vision was 20/30, and IOP was 17 mm Hg. On examination, vitreous blob was seen at the pupillary area, not touching the endothelium; AC was deep (Van-Herick grade 4) with patent PI. At 1 month, the patient was asymptomatic with the best corrected vision in RE being 20/20 and IOP, determined using a Goldman Applanation Tonometer, of 14 mm Hg. Vitreous blob was present at the pupillary border not touching the endothelium with deep AC, with multiple patent PI. Fundus examination was normal with no tractions seen because of the peeping vitreous blob, which warranted us to keep the patient under observation.Figure 1: Vitreous blob in the anterior chamberAfter confronting such a case of big blob of vitreous, this reminds us of the vitreous wick syndrome,[1] and Fig. 1 depicts an atypical form of a blob wick which neither has touched the endothelium nor had established any connection with the extraocular environment. Vitreous wicking syndrome is a condition in which vitreous prolapses into the anterior chamber and passes through a microscopic wound breakdown that allows for the formation of a vitreous wick onto the extraocular surface. The complication of wicking in the literature had been most commonly reported after intracapsular cataract extraction with rare occurrences being reported after posterior capsulotomies, corneal relaxation incisions, and intravitreal injections, and it takes nearly 2–4 weeks time for its onset.[2] As reported by Rice and Michels,[3] whenever there is connection to the external milieu, a surgical approach as done by them is warranted, may it be anterior vitrectomy, repairing of the internal aspect of fistula, or re-evaluating the tunnels sutures. In one of their cases with epithelial ingrowth, trans-scleral and trans-corneal cryotherapy combined with the use of an intraocular gas bubble to provide a thermal insulating was done. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.