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Ophthalmology

An Unusual Spontaneous Acute Deepening of the Anterior Chamber

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Ophthalmology

Published Online: May 25, 2023

JAMA Ophthalmology Clinical Challenge

Article Information and Disclosures

Nicolas Morvant, MD^1,2;

Quentin de Bosredon, MD³;

Marie-Noëlle Delyfer, MD, PhD^1,2

Author Affiliations

¹Vitreo-retinal Unit, Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France
²University of Bordeaux, Inserm, Bordeaux Population Health Research Center, LEHA team, UMR 1219, Bordeaux, France
³Clinique Ophtalmologie Thiers, Bordeaux, France

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A 53-year-old woman presenting with a unilateral mild cortical and nuclear cataract associated with 20/32 visual acuity in her left eye was planning to undergo phacoemulsification. A few days before surgery, she noticed a sudden decrease in her left visual acuity measured at 20/80. Her eye specialist then observed a reverse pupillary block in her left eye and referred the patient to our department. At presentation, no other remarkable medical history was recorded and no precipitating factors identified. Slitlamp examination showed a unilateral deepening of the anterior chamber associated with signs of anterior uveitis (ie, keratic precipitates and severe aqueous flare, 3+) and posterior synechiae between the iris and the lens. In addition, fundus examination revealed an inferior retinal detachment without any associated visible tear. Intraocular pressure was 15 mm Hg in the right eye and 9 mm Hg in the left eye. Anterior segment optical coherence tomography images and fundus photographs of both eyes are shown in Figure 1.

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A 53-year-old woman presenting with a unilateral mild cortical and nuclear cataract associated with 20/32 visual acuity in her left eye was planning to undergo phacoemulsification. A few days before surgery, she noticed a sudden decrease in her left visual acuity measured at 20/80. Her eye specialist then observed a reverse pupillary block in her left eye and referred the patient to our department. At presentation, no other remarkable medical history was recorded and no precipitating factors identified. Slitlamp examination showed a unilateral deepening of the anterior chamber associated with signs of anterior uveitis (ie, keratic precipitates and severe aqueous flare, 3+) and posterior synechiae between the iris and the lens. In addition, fundus examination revealed an inferior retinal detachment without any associated visible tear. Intraocular pressure was 15 mm Hg in the right eye and 9 mm Hg in the left eye. Anterior segment optical coherence tomography images and fundus photographs of both eyes are shown in Figure 1.

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Article Information

Corresponding Author: Marie-Noëlle Delyfer, MD, PhD, Vitreo-retinal Unit, Ophthalmology Department, Bordeaux University Hospital, Place Amélie Raba-Léon, 33000 Bordeaux, France (marie-noelle.delyfer@chu-bordeaux.fr).

Published Online: May 25, 2023. doi:10.1001/jamaophthalmol.2023.1824

Conflict of Interest Disclosures: Dr Delyfer reported personal fees from AbbVie, Bayer, Horus Pharma, Novartis, Roche, and Théa. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References

Campbell DG . Iris retraction associated with rhegmatogenous retinal detachment syndrome and hypotony. a new explanation. Arch Ophthalmol. 1984;102(10):1457-1463. doi:10.1001/archopht.1984.01040031177013 PubMed Google Scholar Crossref

Geyer O , Neudorfer M , Rothkoff L , Michaeli-Cohen A , Lazar M . Iris retraction syndrome associated with nonrhegmatogenous retinal detachment. Acta Ophthalmol Scand. 1998;76(5):617-619. doi:10.1034/j.1600-0420.1998.760522.x PubMed Google Scholar Crossref

Goebel C , Crabtree GS , Altaweel MM . Management of iris retraction syndrome with heterochromia and retinal detachment. Case Rep Ophthalmol. 2021;12(3):809-815. doi:10.1159/000519148 PubMed Google Scholar Crossref

Tabibian D , Hoogewoud F , Mavrakanas N , Schutz JS . Misdirected aqueous flow in rhegmatogenous retinal detachment: a pathophysiology update. Surv Ophthalmol. 2015;60(1):51-59. doi:10.1016/j.survophthal.2014.07.002 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.