Purpose: Iridocorneal endothelial (
ICE) syndrome is well known to cause refractory
glaucoma in young adults. Commonly acclaimed mechanism for
trabeculectomy failure in these cases include accelerated subconjunctival
fibrosis, abnormal endothelial proliferation, and closure of ostium. In the following article, we present a case of
Iridocorneal endothelial syndrome that presented with refractory
glaucoma after
trabeculectomy due to rapidly progressive peripheral anterior synechiae causing angle closure and corneal decompensation that mandated a tailored surgical approach of management. Methods: This is a descriptive case report based on electronic medical records, patient observation, surgical intervention, and follow-ups. Case description: A thirty-eight-year-old-male presented to us with signs suggestive of
iridocorneal endothelial syndrome with gonioscopy revealing peripheral anterior synechiae (PAS) over four clock-hours temporally. Uncontrolled intraocular pressure (IOP) despite maximal medical
therapy mandated augmented
trabeculectomy with anti-fibrotics. The
bleb failed within 3 weeks of
trabeculectomy, with evidence of progressive crawling PAS causing endothelial decompensation and raised IOP. He underwent Ahmed
glaucoma valve (AGV) implant surgery with viscosynechiolysis and sectoral
iridectomy under
antiviral cover. This helped control IOP and retain corneal clarity, with no recurrence of PAS in the affected area. Conclusion: Progressive peripheral synechiae in
ICE syndrome can cause early
bleb failure and refractory
glaucoma. Careful viscosynechiolysis and sectoral
iridectomy alongside a second implant surgery can help salvage visual functions and preserve corneal clarity while preventing further progression of PAS in these eyes.