Specialists from the V.P. Filatov Institute of Eye Diseases and Tissue Therapy presented a clinical case of a rare form of secondary glaucoma—reverse pupillary block glaucoma. The condition developed in the postoperative period after ultrasound phacoemulsification with intraocular lens implantation.

The authors of the study are Nadiya Anatoliivna Ulyanova, Doctor of Medical Sciences, Professor, Senior Consultant Ophthalmologist, Head of the Department of Post-Traumatic Eye Pathology, Glaucoma and Lens Pathology, and Yulia Oleksandrivna Tatarina, Junior Research Fellow and Consultant Ophthalmologist.

Secondary glaucoma with reverse pupillary block is a rare ophthalmological condition. It is most often associated with postoperative changes. It requires timely diagnosis and a comprehensive treatment approach.

A 46-year-old male patient presented with immature, uncomplicated age-related cataract in both eyes. Before surgery, visual acuity in both eyes was 0.2. Intraocular pressure was within normal limits at 18–19 mmHg. There was no concomitant ophthalmic pathology. There was also no history of elevated intraocular pressure.

The patient underwent ultrasound phacoemulsification of the left eye with intraocular lens implantation. The surgery was uneventful. However, on the evening after surgery, the patient developed severe pain in the operated eye and the left side of the head. The pain progressively increased.

Examination revealed a sharp rise in intraocular pressure to 66.5 mmHg. This occurred despite maximum medical hypotensive therapy.

Further diagnostic evaluation included anterior segment optical coherence tomography and ultrasound. These methods revealed characteristic signs. There was tight adhesion of the intraocular lens to the pupillary margin. The anterior chamber was pathologically deep. The iris adhered to the zonular fibers.

As a result, a pathological mechanism developed. The iris functioned as a one-way valve. This disrupted the normal distribution of intraocular pressure between the anterior and posterior chambers.

Two days after surgery, laser basal iridotomy was performed. It reduced intraocular pain. It also partially lowered intraocular pressure to 26–27 mmHg.

Final stabilization was achieved four weeks after sinustrabeculectomy. This procedure fully normalized intraocular pressure. No further hypotensive therapy was required.

At follow-up examinations after one, three, and six months, intraocular pressure remained stable. It ranged from 15.8 to 18.4 mmHg. No medication was required.

This clinical case demonstrates the importance of diagnosing elevated intraocular pressure in the postoperative period. It also highlights the need for an individualized approach, even in standard ophthalmic procedures.