Case #25: Man in his 60s from Suginami (after an acute glaucoma attack: monofocal lens, monovision)

He first visited us with recurring temporary heaviness, redness and blurring in his right eye; his eye pressure was high at 50 mmHg (normal is 21 mmHg or below), and he was having an acute glaucoma attack. The same day we gave an intravenous drip of pressure-lowering medication and performed laser iridotomy, breaking the attack and lowering the pressure; but afterwards the shallow anterior chamber and narrow angle from forward displacement of the lens progressed, so cataract surgery was performed, also as glaucoma treatment.
His axial length was average, but with weak zonules the lens had shifted forward (toward the cornea), causing myopia of about −2.5 D; meanwhile his fellow left eye had already had cataract surgery at another clinic and was almost emmetropic (0 D), and he was used to seeing far with the left eye and near with the right, that is, monovision. So after discussion with him, we chose a lens for the right eye that would leave the current myopia.
The cataract nucleus was not very hard, but during surgery the zonules were, as expected, very weak with a risk of rupture, and by using a CTR (capsular tension ring), also to prevent postoperative intraocular lens displacement, we completed the surgery safely. After surgery he adapted to monovision as smoothly as before and was satisfied that he could see far and near without glasses.
Ideally there is less risk in having surgery before an acute glaucoma attack occurs, so we recommend early surgery especially for people with short eyes (eyes with strong presbyopia) who have reduced vision from cataracts.