Fibrous Proliferation Into Anterior Segment After Acute Angle-Closure Glaucoma

Purpose: To report clinicopathological features and management of a case of extensive fibrovascular proliferation into the anterior segment after acute angle-closure glaucoma (AACG). Methods: Interventional case report with pathological correlation. A 61-year-old white woman was referred with persistent corneal opacity in the right eye 3 months after AACG. Slit-lamp biomicroscopy of the right eye revealed corneal opacity with a retrocorneal membrane involving the posterior cornea, anterior iris, shallow anterior chamber, and dense mature cataract. The presence of a retrocorneal membrane was confirmed by anterior segment optical coherence tomography. Based on the clinical signs, a differential diagnosis of fibrovascular proliferation and/or epithelial downgrowth was entertained. She underwent penetrating keratoplasty combined with cataract extraction, anterior segment reconstruction with a custom artificial iris implantation. Results: Histopathological examination of the excised tissue confirmed fibrovascular proliferation. Four months after surgery, the corneal graft failed because of retrocorneal blood vessels, which were successfully managed with intracameral bevacizumab injection and repeat corneal transplant surgery. Conclusions: Fibrous proliferation involving the anterior segment is a rare complication of AACG. Penetrating keratoplasty combined with cataract extraction and iris reconstruction may help to maintain integrity of the anterior segment in these cases.