LAUSR

Dear Editor, Face-down positioning after macular hole surgery is routine. We describe a case of bilateral acute angle-closure glaucoma (AACG) as a complication of face-down positioning after macular hole surgery. A 65-year-old Korean female visited our clinic with a chief complaint of right visual disturbance lasting several months. On initial examination, the best-corrected visual acuity was 20 / 200 (oculus dexter, OD) and 20 / 20 (oculus sinister, OS). The intraocular pressure (IOP) as measured by Goldmann-applanation tonometry was 13 mmHg (OD) and 14 mmHg (OS). A slit-lamp examination revealed a shallow anterior chamber and moderate nuclear sclerotic cataract on both eyes. No glaucomatous optic neuropathy was evident on either eye, and a full-thickness macular hole was identified in the right eye on fundus examination. The patient underwent a pars plana vitrectomy with internal limiting membrane peeling and C3F8 gas tamponade. Postoperatively, the patient was positioned face down. On day 1, the IOP was 13 mmHg in both eyes, and topical treatment with moxifloxacin hydrochloride (Vigamox; Alcon Laboratories, Fort Worth, TX, USA), 1% prednisolone acetate (Pred-forte; Allergan plc., Dublin, Ireland) and 1% atropine sulfate (Isopto Atropine, Alcon Laboratories) was started. On the 7th postoperative day, the patient complained of visual disturbance and ocular pain in both eyes. Her visual acuity had dropped to hand motion in both eyes. On slitlamp examination, shallow anterior chambers with occluded angles (Shaffer grade 0) and mid-dilated fixed pupils were observed (Fig. 1A). The IOPs were 41 mmHg (OD) and 40 mmHg (OS) by Goldmann-applanation tonometry. Under the diagnosis of bilateral AACG, the patient received systemic treatment with intravenous 15% mannitol and 500 mg oral acetazolamide hydrochloride as well as topical therapy with timolol-dorzolamide f ixed combination (Cosopt; Merck & Co., Kenilworth, NJ, USA), brimonidine (Alphagan P, Allergan plc.), taf luprost (Taflotan; Santen Pharmaceutical, Osaka, Japan) and 2% pilocarpine (Isopto Carpine, Alcon Laboratories), and the IOP decreased to 22 mmHg (OD) and 12 mmHg (OS). After IOP and pain control with medical therapy, laser peripheral iridotomy with concomitant laser peripheral iridoplasty on both eyes was performed. After cessation of all medical treatment, the anterior chamber deepened, and the IOP remained within normal limits. Gonioscopy performed 2 weeks after laser Korean J Ophthalmol 2019;33(1):101-102 ht tps: / /doi.org /10.3341/k jo.2018.0061