Delayed Vitreous Blockade of Trabeculectomy Ostium by Old Previous Laser Capsulotomy

Late rise of Intraocular Pressure (IOP) following filtering surgery can be due to blockage of internal ostium with iris, blood or vitreous or bleb fibrosis, progression of disease and loss of efficacy of drugs. In our patient, rise of IOP was due to internal blockade of ostium with vitreous which was identified on slit lamp evaluation and gonioscopy and confirmed by anterior segment OCT (ASOCT). The source of this vitreous was laser capsulotomy performed two years prior to trabeculectomy. The patient underwent right eye anterior vitrectomy. Postoperative IOP was well controlled without any anti-glaucoma medication with a follow up of eight months. This case highlights the importance of gonioscopy in well controlled patients of glaucoma who have sudden rise of IOP, even if they have a functioning bleb and also highlights that a very simple procedure of anterior vitrectomy can help in long term control of IOP in these patients.