Pupillary Block and Secondary Iridocorneal Angle Closure Due to Posterior Chamber Air Following Deep Anterior Lamellar Keratoplasty.

BACKGROUND

To describe the mechanism and non-invasive management of pupillary block and secondary angle closure caused by posterior migration of an anterior chamber air bubble following deep anterior lamellar keratoplasty (DALK).Material and method: A case report.

CASE PRESENTATION: A 27-year-old male with advanced keratoconus underwent DALK. On postoperative day 1, he developed pupillary block and secondary angle closure due to an air bubble that had migrated from the anterior to the posterior chamber. Intraocular pressure (IOP) was elevated, and the anterior chamber was shallow. Conservative treatment with mydriatics, systemic IOP-lowering agents, and head elevation led to rapid improvement. No surgical intervention was needed, and the graft remained clear, with a normal IOP, during follow-up.

DISCUSSION: Pupillary block caused by intracameral air has been reported mainly after endothelial keratoplasty procedures, whereas it is extremely rare following DALK. Unlike previously reported DALK cases that were associated with reverse pupillary block mechanisms, the present case involved posterior chamber migration of an anterior chamber air bubble, resulting in secondary angle closure.

CONCLUSIONS

Although rare, pupillary block and secondary angle closure caused by an anterior chamber air bubble after DALK may occur. Early intervention with medical treatment and simple postural adjustment can help avoid surgical intervention.