Recurrent closure of neodymium: YAG laser iridotomies requiring multiple treatments in pseudophakic pupillary block.

We present a rare case of repeated closure of Nd:YAG laser iridotomies and recurrent iris bombe configuration with angle-closure attacks in a pseudophakic eye. Until recently, patent Nd:YAG laser iridotomies were considered incapable of being closed, and the only reported closure was in an eye with concomitant iritis. Our patient developed iris bombe five times following extracapsular extraction, anterior vitrectomy, and anterior-chamber intraocular lens implantation. The first occurred following closure of the surgical iridectomy; the next three times, following closure of previously patent Nd:YAG iridotomies; and the final episode occurred despite patent iridotomies. This last time one drop of pilocarpine 2% was administered and resulted in immediate iris flattening and reopening of the third iridotomy. Possible mechanisms for closure of the Nd:YAG iridotomies in this case are discussed. We suggest the combination of Nd:YAG laser iridotomies and the stretching of the iris by pilocarpine might have liberated the trapped aqueous humor behind the iris, maintaining the patency of the iridotomies and the depth of the anterior chamber.