LAUSR

A 54-year old man was referred for a senior opinion. His vision had acutely dropped in his right eye from 6/6 to hand movements following Nd:YAG laser peripheral iridotomy (LPI) for treatment of pigmentary glaucoma. A dense rosette posterior subcapsular cataract had formed in his right eye rapidly after surgery. Within four weeks the cataract resolved spontaneously and his vision returned to 6/6. It is hypothesized that a dual mechanism caused the rapidly formed cataract. Shock waves stemming from Nd:YAG laser resulted in a reversible misalignment of the lenticular fibers, and localized direct damage to capsule caused osmotic imbalance and fluid collection between lamellae. Restoration of the osmotic balance, repair, and formation of lens fibers and clearing of vacuoles led to resolution of the cataract. Proximity of the concave iris to the lens equator in pigmentary glaucoma was a predisposing factor. This highlights the importance of exercising great caution in using LPI in cases of pigmentary glaucoma, using higher laser power and considering initial conservative management of this complication.