Simultaneous bilateral acute angle-closure glaucoma in a patient with subarachnoid hemorrhage.
OBJECTIVE
To present an unusual case of simultaneous bilateral acute angle-closure (AAC) glaucoma in a patient with subarachnoid hemorrhage due to an aneurysm involving the right middle cerebral artery.


METHODS
A 60-year-old woman with a clinically inexplicable bilateral nonreacting mydriasis after brain surgery underwent an ophthalmologic consultancy. The bilateral mydriasis was diagnosed as an unusual clinical presentation of simultaneous bilateral AAC glaucoma. One week after the AAC was bilaterally resolved, the patient underwent echographic examination because of the outbreak of a unilateral relapsed ocular hypertensive attack that required an ultrasound biomicroscopy (UBM) to be accurately diagnosed and treated.


RESULTS
The bilateral AAC regressed completely after pharmacologic therapy. UBM evaluation of the eye with recurrence of the angle-closure glaucoma attack was necessary to confirm the diagnosis of unilateral relapsed angle-closure glaucoma due to an unresolved pupillary block. A viscoelastic-aided opening of the angle and peripheral surgical iridectomy were performed. UBM and tonometry were performed intraoperatively to confirm the success of the surgical treatment.


CONCLUSIONS
The UBM allowed us to identify the pupillary block as the main mechanism involved in the pathogenesis of this unusual case of simultaneous bilateral AAC glaucoma. Despite the fact that drug-induced supraciliary uveal effusion and mydriasis due to surgical anesthesia have been frequently reported to contribute to this complication, we presumed that simultaneous intravenous administration of sedative drugs and adrenergic agonists, in a patient with individual biometric predisposing factors to the angle-closure, created the anatomic conditions which induced the pupillary block with obliteration of the trabeculum.
Ceruti
Piero
P
Department of Neurological and Visual Sciences, Eye Clinic, University of Verona, Verona, Italy. pierre77@libero.it
Morbio
Roberta
R
Marraffa
Michele
M
Marchini
Giorgio
G
D000208:Acute Disease; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D007839:Functional Laterality; D015812:Glaucoma, Angle-Closure / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D007429:Intraocular Pressure; D032801:Iridectomy; D007498:Iris / Q000601:surgery; D033401:Microscopy, Acoustic; D008875:Middle Aged; D011681:Pupil Disorders / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D014065:Tonometry, Ocular
D000959:Antihypertensive Agents