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Purpose: To report a case of severe panuveitis and neovascular glaucoma (NVG) occurring seven years after cataract surgery, caused by a sequestered and dislocated crystalline nucleus.

Methods: A 71-years-old African American male presented with a “shut-eye”, excruciating pain, and vision of light perception (LP). Clinical findings included an IOP of 62 mmHg, dense keratic precipitates (KP), and bullous corneal edema. The presentation was highly suggestive of primary NVG. Initial management to achieve ocular quiescence included intensive topical steroids, Muro128, dorzolamide/timolol, brimonidine and an intravitreal bevacizumab injection. Once corneal clarity improved, a large mass was visualized at the vitreous base, prompting surgical exploration.

Results: Intraoperatively, a complete crystalline nucleus – retained since the patient’s cataract surgery seven years prior – was discovered dislocated inferiorly and incarcerated under the intraocular lens haptic. The nucleus was associated with a localized, shallow inferior retinal detachment and a small retinal dialysis. Following 25-gauge pars plana vitrectomy, the nucleus was successfully removed. Subretinal fluid was drained through the dialysis, and endolaser was applied to secure the inferior retina. Postoperatively, the inflammation and detachment resolved completely. The patient’s IOP stabilized at 12 mmHg, and visual acuity improved from LP to 20/25.

Conclusion: This case highlights a rare, long-term complication of cataract surgery where a crystalline nucleus remained sequestered for seven years before inducing life-threatening ocular hypertension and panuveitis. It serves as a critical reminder to consider retained lens material in the differential diagnosis of unilateral panuveitis and glaucoma, and demonstrates that prompt vitrectomy under adequate visualization through a cleared cornea can achieve excellent anatomical and functional outcomes.