Refractory glaucoma in unilateral acute iris depigmentation after photorefractive keratectomy: A case report

Acute iris depigmentation (AID) as a cause of glaucoma is a recently recognized entity with no definitive etiology. This report highlights a case of a 26-year-old male with acute pain, redness, and pigmentation in the anterior chamber after use of topical moxifloxacin (0.5%) following photorefractive keratectomy (PRK). He presented with raised intraocular pressure (IOP) (39 mm Hg) and pigmentary storm in the left eye 25 days after PRK. He had an epithelial defect in the left eye for which he was started on moxifloxacin - dexamethasone eyedrop one week before the rise of IOP. Examination revealed posterior synechiae, pigments, cells in the anterior chamber, and heavily pigmented trabecular meshwork (TM). He was diagnosed with unilateral acute iris depigmentation (UAID). Conservative management was tried initially, but the condition was non-responsive. Gonioscopy-assisted transluminal trabeculotomy (hemi-GATT) with bent needle Ab-interno goniectomy (BANG) was subsequently done, and IOP was controlled on medication after the procedure.