Abstract

This case report presents a rare complication following combined phacoemulsification and excisional goniotomy using the Kahook Dual Blade in a patient with primary angle-closure glaucoma. A male in his 60s developed persistent visual disturbances, including bothersome floaters and halos, postoperatively. These symptoms were attributed to the accumulation of brownish retrolental pigments in the patellar fossa, likely originating from the trabecular meshwork and migrating posteriorly through a pre-existing laser peripheral iridotomy (LPI). The complication persisted despite initial conservative treatment with topical steroids. Ultimately, a neodynamium yttrium aluminium garnet hyaloidotomy was performed, successfully dispersing the pigments and resolving the visual symptoms. This case underscores the importance of recognising and managing this rare but significant complication of excisional goniotomy, and suggests a preventive strategy involving a dispersive viscoelastic barrier over the LPI to reduce the risk of pigment migration.