Twenty-four hours after an otherwise uneventful phacoemulsification with in-the-bag IOL implantation, a patient presents with blurred vision. The anterior chamber is deep and quiet, the IOL is well centred, and intraocular pressure measures 42 mm Hg. The most likely cause is:

• A Ghost cell glaucoma from occult vitreous haemorrhage
• B Steroid-induced ocular hypertension
• C Malignant glaucoma with anterior rotation of the iris-lens diaphragm
• D Retained ophthalmic viscosurgical device obstructing trabecular outflow ✓

Explanation

Incomplete removal of the viscoelastic agent at the end of surgery is the commonest cause of a deep, quiet anterior chamber with markedly raised pressure on the first postoperative day. Management is observation with topical antihypertensives, since residual viscoelastic clears within days. Steroid response takes longer than one day, malignant glaucoma shows a shallow or flat anterior chamber, and ghost cell glaucoma requires prior vitreous haemorrhage, none of which fits this presentation.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.