In a recent case report, Flowers et al1 described a case of pupillary block, angle-closure glaucoma produced by an anterior chamber air bubble in a nanophthalmic eye. Notable pharmacotherapy, including intravenous mannitol and acetazolamide sodium (Diamox) and oral isosorbide mononitrate, in addition to topical treatment, was applied to lower the pressure during a total span of 2 hours and 15 minutes.
I have routinely placed an air bubble in the anterior chamber at the conclusion of cataract surgery for each of the last 1123 successive cataract surgeries I have performed. Early in my experience, I encountered 2 cases of angle-closure glaucoma precipitated by too large an air bubble. One case occurred when the patient was on the operating table, and the other occurred approximately 8 hours postoperatively, similar to the published case report. Neither eye was nanophthalmic. In both instances, it was possible to immediately break the angle-closure attack
Shugar JK. Pupillary Block, Angle-closure Glaucoma Produced by an Anterior Chamber Air Bubble in a Nanopthalmic Eye. Arch Ophthalmol. 1997;115(3):432. doi:10.1001/archopht.1997.01100150434026
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