Spontaneous late-onset pupillary block in a pseudophakic, vitrectomized eye despite prior Nd:YAG capsulotomy: a diagnostic challenge.

Pupillary block is a well-established mechanism of secondary angle closure, most commonly observed in phakic eyes or shortly after cataract surgery. It may also occur in association with intraocular inflammation, such as uveitis. In pseudophakic eyes that have undergone pars plana vitrectomy (PPV), the risk of pupillary block is generally considered low due to disruption of the anterior hyaloid and altered vitreous dynamics, which facilitate aqueous humor flow. Additionally, Nd: YAG laser posterior capsulotomy further reduces resistance between the posterior and anterior chambers, thereby decreasing the likelihood of block formation []. Nevertheless, pupillary block can still occur under rare circumstances. We report a unique case of acute pupillary block glaucoma occurring five years after combined phacoemulsification and PPV in a pseudophakic, vitrectomized patient with prior YAG capsulotomy. This case is particularly noteworthy due to the absence of identifiable predisposing factors, suggesting a truly spontaneous onset. Written informed consent was obtained from the patient for the publication of this case report and accompanying images. A 78-year-old woman with a 15-year history of well-controlled primary open-angle glaucoma (POAG) presented to the emergency department with sudden-onset severe ocular pain, brow headache, nausea, and vomiting in the left eye. Her ophthalmic history included combined phacoemulsification, PPV, and posterior chamber intraocular lens (PCIOL) implantation performed five years earlier for a full-thickness macular hole. Two years postoperatively, she underwent bilateral Nd: YAG posterior capsulotomy for posterior capsule opacification. Her glaucoma regimen included fixed-dose dorzolamide-timolol and bimatoprost.