Reduced Accommodation Without Mydriasis After Micropulse Cyclophotocoagulation in a Young Congenital Glaucoma Patient: A Case Report

BACKGROUND Micropulse cyclophotocoagulation (MPCPC) is a commonly used procedure to reduce intraocular pressure (IOP) in glaucoma patients. While it is generally considered safer than traditional transscleral cyclophotocoagulation (TSCPC), complications such as transient mydriasis and reduced accommodation due to short ciliary nerve damage have been reported. However, isolated loss of accommodation without pupillary involvement has not been previously documented. We report a case of reduced accommodation without pupil dilation in a young patient after MPCPC. CASE REPORT A 26-year-old woman with primary congenital glaucoma, previously treated with goniotomy and trabeculectomy, had uncontrolled intraocular pressure (IOP) despite maximum medical therapy. Her best-corrected visual acuity (BCVA) was 20/60 in the right eye and 20/300 in the left. Micropulse cyclophotocoagulation (MPCPC) was performed in the right eye, and an Ahmed glaucoma valve was placed in the left eye on the same day. The postoperative IOP was 22 mmHg in the right eye and 16 mmHg in the left eye. After 2 weeks, the patient reported blurry vision in the right eye with BCVA of 20/60 in the right eye, and the anterior segment examination was unremarkable. After 6 months, she continued to experience blurry vision at near distance in her right eye. Refraction revealed a need for glasses with a near vision add of +1.5. CONCLUSIONS This case illustrates isolated accommodative dysfunction without pupillary involvement following MPCPC in a patient with congenital glaucoma, showing the need for awareness of this potential outcome, especially in young, phakic patients with a history of ocular surgeries.