A Long Tale of Angle Closure Glaucoma and Complications: The Fight Is Still On!

A lady diagnosed with chronic narrow angle glaucoma in 1987 underwent iridectomy and iridoplasty of both eyes. Due to uncontrolled intraocular pressure (IOP) of the right eye, trabeculectomy was done. Further IOP control was maintained by medication which had to be changed many times due to local and systemic adverse events. She developed malignant glaucoma of the right eye and subsequently suffered repeated episodes of malignant glaucoma in both eyes. In 2021, she developed blurred vision with development of malignant glaucoma in the right eye which could not be controlled with conservative treatment, and pars plana vitrectomy with hyaloidectomy had to be performed. She suffered repeated episodes of hyphema in the right eye after that with ecchymotic patches on her face and body. Considering clopidogrel to be the cause of these bleeding episodes, it was stopped with cessation of bleeding. IOP remained uncontrolled despite these measures, and diode cyclophotocoagulation was done which resulted in low IOP and macular edema of the right eye with Descemet’s folds in the cornea, which was treated with steroid eye drops followed by nepafenac eye drops. The right eye cornea developed thinning in two areas, and all medication had to be stopped immediately with intense lubrication. She continues to have 6/60 vision in the right eye with due to hypotony and has controlled IOP.