Secondary Angle-Closure Glaucoma Associated With Congenital Acorea That Developed Into Endophthalmitis After Glaucoma Drainage Implant Surgery: A Case Report

We report a rare case of unilateral secondary angle-closure glaucoma associated with congenital acorea in a 10-month-old male infant. Acorea is a rare congenital eye abnormality characterized by the complete absence of the pupil. The left cornea of this patient measured 13.0 mm vertically and horizontally, with opacities observed. The anterior chamber was absent, and the pupil was completely occluded. Intraocular pressure (IOP) was 26 mmHg, and axial length was 25.3 mm. The fundus was not visible due to acorea. The patient was diagnosed with secondary angle-closure glaucoma due to acorea. To relieve angle closure, a pupil was created under general anesthesia. After blunt dissection with viscoelastic, a vitreous cutter was inserted through a corneal incision, and central iridectomy was performed. Anterior chamber depth was normalized immediately. Despite initial surgical pupil formation and two trabeculotomies, IOP remained uncontrolled, requiring sequential implantation of an Ahmed glaucoma valve and a Baerveldt glaucoma implant. Although the postoperative IOP stabilized, the patient developed endophthalmitis six months later due to <i>Haemophilus influenzae</i>. Despite intensive treatment, the infection developed into phthisis bulbi after tube exposure. This case highlights the potential for secondary angle-closure glaucoma in patients with acorea and emphasizes the risk of severe postoperative complications, including endophthalmitis, following glaucoma drainage device implantation in infants.