Therapy-refractory Intraocular Pressure Decompensation Following Bilateral Complicated Cataract Surgery

History and Signs A 50-year-old patient was referred to our ophthalmology emergency service with a bilateral raised intraocular pressure of 40 mmHg on the right, 46 mmHg on the left eye following cataract surgery. On admission, refraction values were slightly myopic with a best corrected visual acuity of 0.25 on the right, 0.2 on the left. Iris transillumination defects could be seen in both eyes ([ Fig. 1 a ] and b ). There was a massive inflammatory response in the anterior segment with an injected conjunctiva, corneal microcystic edema with pigment, sanguis on the endothelium ([ Fig. 1 c ] and d ) and anterior uveitis (0.5+ cells right, 1+ cells left, [+] flare both eyes). Gonioscopy revealed a microhyphema on the left eye without any remaining cortex parts. The IOL was subluxated in both eyes. The retina seemed unaffected with only slight vitreous bleeding in the left eye. The intraocular pressure could not be decreased with maximum topical and systemic therapy (topical brimonidin, dorzolamide, timolol, latanoprost, steroids, intravenous acetazolamide and mannitol). An anterior chamber tap was performed on the left side to decrease the intraocular pressure, without success. Publication History Received: 01 November 2025 Accepted: 07 January 2026 Article published online: 23 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 14, 70469 Stuttgart, Germany