Objective: Implanting intraocular lens (IOL) in proper direction is important in cataract surgery to reduce the possibility of undesirable complications. We experienced a case who underwent vitrectomy combined with cataract surgery and developed secondary angle closure glaucoma caused by IOL misdirection. Goniosynechialysis (GSL) and repositioning of IOL successfully ameliorated the high intraocular pressure (IOP).

Methods: A 64-year-old male with massive vitreous hemorrhage underwent vitrectomy combined with cataract surgery. In implanting IOL, posterior capsule was accidentally raptured, and we were obliged to implant IOL reversely in the ciliary sulcus. A month postoperatively, the capture of IOL by iris and the shallow anterior chamber with iris bombe formation led to the elevated IOP up to 60 mmHg. Laser iridotomy and maximum anti-glaucoma medications including oral carbon anhydrase inhibitor could not control IOP. Subsequently, we performed GSL and IOL repositioning to correct the lens direction and the IOP was successfully reduced to normal level.

Conclusions: Reversely sulcus-implanted IOL should be repositioned to prevent secondary angle closure glaucoma.