Lens-Particle Glaucoma Follow-up

  • Author: Brian R Sullivan, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 16, 2012
 

Further Inpatient Care

  • Patients with lens-particle glaucoma rarely require hospital admission. Consider admission in the following situations:
    • IOP is elevated severely.
    • Intravenous mannitol is needed to control IOP.
    • There are immediate plans for further surgical intervention.
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Further Outpatient Care

  • Any patient who develops acute glaucoma following cataract surgery, Nd:YAG capsulotomy, or trauma requires careful follow-up to monitor IOP control and medical management and/or surgery to remove residual lens particles.
    • Depending on the degree of IOP control and the presence of other coexisting complications, patients may require daily to weekly follow-up care early in the postoperative period.
    • Treat and monitor intraocular inflammation.
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Inpatient & Outpatient Medications

  • See Medication.
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Complications

  • In addition to glaucoma, complications of retained intraocular lens particles include corneal decompensation, chronic uveitis, and cystoid macular edema.[26]
  • Pars plana vitrectomy for displaced nuclear fragments can be associated with complications[19, 24, 25, 26, 27, 28, 33] of persistent glaucoma, uveitis, corneal edema, bullous keratopathy, cystoid macular edema, epiretinal membrane, vitreous hemorrhage, retinal detachment, and choroidal hemorrhage.
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Prognosis

  • Prognosis is generally good with appropriately timed medical and surgical intervention.[26]
    • Visual outcome of pars plana vitrectomy is better when performed for retained cortex or epinucleus, compared with retained nucleus fragments.[19]
    • Studies have reported final visual acuities of 20/40 or better in approximately two thirds of cases of dropped nucleus requiring vitrectomy,[27, 28, 30, 32] but other recent data suggest a less favorable prognosis, which may be independent of the size of the retained nuclear fragment.[19]
    • Elevated IOP improves significantly in response to the surgical removal of intraocular lens material.
    • A nonsurgical approach may be equally successful in cases of small retained lens cortical fragments, if inflammation and IOP can be controlled acceptably, cellular processes in the trabecular meshwork are clearing the lens material.
    • Chronic open-angle glaucoma occurs in some patients following an episode of lens-particle glaucoma when lens particles have been reabsorbed.
    • The transient presence of lens debris in the anterior chamber angle has been theorized to possibly cause long-lasting trabecular dysfunction.
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Patient Education

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Contributor Information and Disclosures
Author

Brian R Sullivan, MD  Professor, Department of Ophthalmology, University of Texas Southwestern Medical Center

Brian R Sullivan, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard W Allinson, MD  Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD, is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Martin B Wax, MD  Clinical Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Ophthalmology Research and Development, Head, Ophthalmology Discovery Research, Alcon Labs, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Society for Neuroscience

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Supported in part by an unrestricted research grant from Research to Prevent Blindness, Inc, New York, New York.

At the time of writing and subsequently updating this article, the author had no financial interests in any of the products discussed herein, nor in any of the companies that manufacture or distribute them.

References

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Lens nucleus dislocated into the inferior vitreous during cataract surgery. Reprinted from Survey of Ophthalmology, Vol 43. Monshizadeh R, Nasrollah S, Haimovici R: Management of retained intravitreal lens fragments after cataract surgery. 397-403. Copyright 1999, with permission from Elsevier Science.
Ruptured lens capsule with elevated intraocular pressure following trauma. Courtesy of KS Kooner, MD.
 
 
 
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