Delayed traumatic phacocele following trabeculectomy.

A 56-year-old woman with a history of trabeculectomy in both eyes sustained blunt trauma to the right eye at home. She initially presented with pain, loss of vision, total hyphema, and hypotony with no evidence of rupture or tissue prolapse. Prompt anterior chamber wash out revealed a partially subluxated crystalline lens behind the pupil, but the globe was intact. At 1 month postoperatively, subconjunctival displacement of the crystalline lens was detected. The patient gave a history of severe bouts of coughing and sneezing a few days earlier. During removal of phacocele, the trabeculectomy wound was intact with no evidence of leakage. A shallow concentric furrow was noticed across the flap approximately 3 mm from the limbus. It is believed that repeat trauma pushed the crystalline lens through the weakened trabeculectomy scleral flap. The wound later self-sealed.