Persistent high intraocular pressure after cataract combined with vitrectomy: a case report

Introduction and importance: When pars plana vitrectomy combined with cataract extraction, postoperative intraocular pressure (IOP) elevation is a common complication, especially in cases of incorporated eye trauma. Case presentation: A 51-year-old man was admitted to the hospital after sustaining a basketball injury to his right eye, experiencing a persistent dark shadow in his vision for 1 month. An eye examination revealed a visual acuity of 50/100, improving to 80/100 with −1.25DS correction in the right eye, and 100/100 in the left eye. IOP was measured at 25.0 mmHg in the right eye and 15.3 mmHg in the left. The cornea was clear, and the right anterior chamber appeared normal, but aqueous humor flash (++), along with an increase in anterior chamber cells (++). The right pupil was irregularly shaped with a diameter of about 5 mm and had an impaired pupillary light reflex. Lens opacity was noted as C 2 N 2 . The vitreous body contained significant blood turbidity, with numerous small dark red hemorrhages at the posterior pole. The patient underwent phacoemulsification and intraocular lens implantation, vitrectomy, gas-liquid exchange, and retinal laser photocoagulation in the right eye. Post-operatively, the patient experienced elevated IOP, which was managed through multiple anterior chamber fluid punctures to control the pressure before discharge. Clinical discussion: It is not uncommon for patients with persistent high IOP after cataract combined with vitrectomy. The patient reported in this case was unwilling to undergo further anti-glaucoma surgery. After multiple anterior chamber punctures and drainage, the IOP was finally controlled. There are not many reports in the literature on such patients. Conclusion: To investigate the causes of elevated IOP following blunt ocular trauma and vitrectomy, and to provide guidance for clinical diagnosis and treatment.