Anomalous Direction of Peri lenticular Aqueous Humor Associated with Retinal Detachment

Male patient 61 years old previously diagnosed with glaucoma and a LASER application four months before our evaluation. He presented with pain, visual loss of the left eye and headache. In the physical examination he had conjunctival hyperemia, subepithelial corneal edema, flat anterior chamber grade 2, anterior synechiae, cataract, and intraocular pressure of 42mmHg. Ultrasonography demonstrated retina and choroid properly attached. Ultrabiomicroscopy showed anterior iris displacement that had contact with corneal endothelium without being the lens the cause. Maximal medical therapy was initiated and iridotomies performed, nevertheless, the patient had no improvement, hence the diagnosis of malignant glaucoma. Phacoemulsification+ intraocular lens implant+vitrectomy in the left eye was performed, where we found a Rhegmatogenous retinal detachment [1]. Causes and treatment of ocular hypertension and flat anterior chamber have been well described. The main diferencial diagnosis are pupillary block, malignant glaucoma, and choroidal hemorrhage. We presented an unusual case of malignant glaucoma that occurred associated with Rhegmatogenous retinal detachment. case of a grade 2 flat chamber, with ocular hypertension that did not respond to treatment for the usual diagnoses, this being a case of refractory glaucoma, in which a rhegmatogenous retinal detachment was found.