Pupil occlusion due to a large dislocated Soemmering ring in an aphakic eye

Tube Obstruction of a Nonvalved Glaucoma Drainage Device by a Dislocated Soemmering's Ring

The authors report a case of tube obstruction of a nonvalved glaucoma drainage device (Aurolab aqueous drainage implant; AADI) with a dislocated Soemmering's ring (SR) leading to a postoperative intraocular pressure (IOP) spike after an initial IOP reduction. A 24-year-old man with bilateral aphakia, bilateral secondary glaucoma developed corneal decompensation in the left eye. The IOP in the left eye was 22 mm Hg with 3 topical IOP-lowering medications (timolol 0.5%, brimonidine 0.2%, and latanoprost 0.005%). To control the IOP before performing a penetrating keratoplasty, AADI was implanted. A good bleb and an IOP of 10 mm Hg were noted at 6.5 weeks postoperatively. The following day the patient developed an acute rise in IOP (42 mm Hg) because of tube obstruction of the AADI by a SR. The IOP spike was initially controlled with oral acetazolamide and topical IOP-lowering medications (fixed combination of timolol 0.5% and brimonidine 0.2%). Six days later, pars plana vitrectomy, SR removal, penetrating keratoplasty, and tube trimming were performed. Following this, the patient had good IOP control and a clear corneal graft at 1-year follow-up. In aphakic eyes undergoing nonvalved glaucoma drainage device implantation, a complete pars plana vitrectomy combined with any lens remnant removal may be considered. It helps to avoid tube obstruction because of these lens remnants, which can migrate anteriorly along with the aqueous currents.

Angle Closure Glaucoma Secondary to Enlarged Soemmering Ring That is Clinically Similar to Iris Tumour

Purpose

To report a case of a grown Soemmering ring that manifested as an iris tumour 24 years after cataract surgery.

Methods

A case report.

Results

A 27-year-old white man was presented with a suspected iris tumour in his left eye. He had undergone lensectomy in both eyes without intraocular lens implantation 24 years ago. Last year, he was treated by topical anti-glaucoma medication for left eye intraocular pressure (IOP) rising. Six months later, his ophthalmologist found two separate iris bumps. The patient was referred to an ocular oncologist and was to be treated with plaque brachytherapy as iris melanoma, but he denied. Ultrasound biomicroscopy (UBM) of the left eye showed significant angle narrowing due to separate ovoid hyper echoic masses behind the iris, which was clearly separated from the ciliary body. Retained and growth lens material caused a Soemmering ring to enlarge, which was the reason for glaucoma and iris bumping. The patient has been followed for more than one year without any changes being observed.

Conclusion

An enlarged and grown Soemmering ring should be considered in the differential diagnosis of any iris and ciliary body tumour, especially in patients who have had cataract surgery.

Persistent Corneal Decompensation due to Anterior Dislocation of Soemmering Ring Cataract

Purpose

We present a case of a patient with Soemmering ring after cataract surgery and a potential complication that can arise as a result of its presence.

Observations

A patient with history of ruptured globe status after repair and lensectomy, complicated by aphakic secondary open angle glaucoma, was referred for management of second injury to the same eye. This injury resulted in Soemmering ring dislocation into the anterior chamber. The cortical material caused a significant increase in intraocular pressure and corneal decompensation. Surgical removal of the Soemmering ring and Ahmed glaucoma tube implant was performed with control of intraocular pressures; however corneal edema could not be reversed.

Conclusions and Importance

This case report illustrates the serious consequences that can be caused by Soemmering rings without early surgical intervention. Care must be taken to completely remove cortical material during cataract surgery to prevent their formation.