Case report

A 37-year-old man was diagnosed with angle-closure glaucoma during a routine screening by his local ophthalmologist. He reported a family history of glaucoma; medical history was unremarkable. He had a laser iridotomy in the right eye (OD). His intraocular pressure (IOP) OD continued to be elevated over 3 years, and he underwent laser trabeculoplasty. He first presented to our institution for blurred vision 1 week following laser trabeculoplasty. On examination, visual acuity (VA) was 20/60 OD and 20/20 in the left eye (OS). IOPs were 38 mmHg OD and 8 mmHg OS. There was corneal oedema and a ‘beaten-metal’ appearance to the endothelium OD. Gonioscopy revealed extensive peripheral anterior synechiae (PAS) inferiorly OD and normal angle structures OS. He had a cup-to-disc ratio of 0.8 OD and 0.6 OS. Visual field testing showed marked glaucomatous loss OD and a full field OS. Specular microscopy showed decreased endothelial cell count with significant pleomorphism OD (figure 1a) and normal endothelium OS (figure 1b). After failing maximal medical therapy, he underwent multiple glaucoma surgeries, including two trabeculectomies, a Molteno drainage implant, and Molteno implant revision surgery. He experienced corneal decompensation and cataract progression after his valve surgery and underwent a combined extracapsular cataract extraction with a penetrating keratoplasty. He was lost to follow-up for 10 years while seeking care at another institution.