LAUSR

maximum being 44mm Hg and being controlled only with addition of oral acetazolamide is another marker of permanent angle closure. Phacomorphic glaucoma lasting for longer duration is known to cause permanent angle closures.2 In such cases it is advisable to perform combined cataract surgery with filtering surgery. Cataract surgery alone is not likely to lower IOP as the angles are closed by peripheral anterior synechiae. Gonioscopy findings of both eyes before and after PI would have been helpful in confirming the correct diagnosis. Right-eye (OD) findings like IOP, angles, and optic nerve head status have not been mentioned. These findings and response to PI in OD would have helped in guiding management. As it was an uncomplicated phacoemulsification surgery with no intraoperative complications, possibility of needle injury during peribulbar block should be considered. Inadvertent needle entering globe during block causes retinal and vitreous hemorrhages with a sudden lowering of IOP. We would like to know whether surgery was performed under topical anesthesia or under peribulbar block. Decompression retinopathy has been reported most commonly (84%) after trabeculectomy surgery due to sudden lowering of IOP intraoperatively.3 Need to lower IOP preoperatively in glaucoma patients cannot be overemphasized. Sudden lowering of IOP is also known to cause macular wipeout in glaucomatous eyes and hypotonic maculopathy even in eyes with normal IOP. Use of presurgery oral acetazolamide or hyperosmotic agents like mannitol would have been appropriate in this case. It is also important to do guarded anterior chamber entry so as to avoid sudden fall in IOP. Paracentesis alone has been reported to be associated with decompression retinopathy.4 Other factors predisposing to decompression retinopathy are IOP spikes or rapid increase in IOP over a short duration which can interfere with capillary auto regulation.5