Acute angle closure in a pseudophakic eye with pseudoexfoliative syndrome: management when conventional medical and laser therapies fail

Pseudoexfoliation syndrome is a common cause of secondary open-angle glaucoma but rarely presents with acute angle closure in pseudophakic eyes, where management may be challenging when conventional medical and laser therapies fail. We report the case of an 82-year-old pseudophakic woman with known pseudoexfoliation syndrome who presented with acute right eye pain, visual loss, an intraocular pressure of 65 mmHg, a shallow anterior chamber and vitreous prolapse into the anterior chamber. Medical therapy, anterior vitreous disruption and laser peripheral iridotomy failed to adequately reduce intraocular pressure. Office-based trans-pars plana needle aspiration of liquefied vitreous resulted in immediate deepening of the anterior chamber and reduction in intraocular pressure. Visual acuity recovered fully, and intraocular pressure remained controlled with topical therapy after 7 months. This case suggests that office-based trans-pars plana needle aspiration may represent a useful emergency management option in carefully selected patients with refractory acute angle closure associated with pseudoexfoliation syndrome.