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Letters |

Progressive Synechial Angle Closure From an Enlarging Soemmering Ring

Yungtai Kung, BS; Sung Chul Park, MD; Jeffrey M. Liebmann, MD; Robert Ritch, MD
Arch Ophthalmol. 2011;129(12):1631-1632. doi:10.1001/archophthalmol.2011.344.
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Angle closure in pseudophakic eyes is uncommon and its mechanism varies. Inflammation with posterior synechiae, zonular disruption with vitreous prolapse, and ciliary block with aqueous misdirection may predispose to angle closure and elevated intraocular pressure.

Proliferation of the remaining lenticular epithelial cells after cataract extraction may form a circumferential structure at the level of the lens (Soemmering ring). This typically benign structure has been reported to cause pupillary block, leading to angle closure.1 We describe a patient who had progressive synechial angle closure without pupillary block, due to an enlarging Soemmering ring after phacoemulsification.

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Figure. Ultrasound biomicroscopy images at the 6-o’clock (A) and 12-o’clock (B) positions taken 2 years earlier and at the 6-o’clock (C), 12-o’clock (D), 9-o’clock (E), and 3-o’clock (F) positions at presentation. The Soemmering ring (arrows) is shown as a hyperechoic ellipsoid structure (A and B) that is larger in the area of peripheral anterior synechiae (B). The Soemmering ring has enlarged compared with 2 years earlier (A and B vs C and D) with the progression of peripheral anterior synechiae (A vs C). E, Note the absence of a prominent Soemmering ring at the 9-o’clock position, where there are no peripheral anterior synechiae. G, Anterior segment optical coherence tomography reveals peripheral anterior synechiae at both sides of angles without iris bombé.

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