Aphakic and Pseudophakic Glaucoma

Updated: Jun 10, 2016
  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Overview

Background

Glaucoma associated with aphakia, but particularly pseudophakia, are important considerations given the more than 1.25 million cataract surgeries performed each year.

Glaucoma in this article refers to conditions that cause increased intraocular pressure (IOP) soon after surgery as well as to those conditions that occur much later. Examples include viscoelastic-associated pressure rise measured in hours to ghost cell glaucoma occurring weeks after surgery.

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Pathophysiology

The pathophysiology is dependent on the mechanism involved and includes the following: distortion of the anterior chamber angle, viscoelastics, inflammation, hemorrhage, pigment dispersion, ghost cell, vitreous in the anterior chamber (AC), pupillary block (pseudophakic/aphakic), malignant glaucoma, and posterior capsulotomy.

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Epidemiology

Frequency

United States

Duke-Elder estimated a 12% incidence of postoperative glaucoma in 1969. [1] However, the landscape of postcataract complications has been altered by the advent of the intraocular lens (IOL) and fine wound-closure techniques. In the modern era, the incidence of glaucoma is dependent on both the methodology and the type of IOL used.

For instance, Cinotti has noted an increased incidence of glaucoma after extracapsular cataract extraction (ECCE) (7.5%) as compared to intracapsular cataract extraction (ICCE) (5.7%). [2]

Further, Stark has noted that AC IOL (5.5-6.3%) has been associated with an increased incidence of postoperative IOP elevation over iris-fixation (3.9-4.3%) lens and posterior chamber (PC) IOL (1.6-3.5%). [3] These figures are consistent with those reported by Hoskins, in which he observed 5.5% in AC IOL and 1.6% in PC IOL. [4] However, congenital cataract surgeries are associated with a higher incidence of glaucoma, and data range from 6.1-24%.

Mortality/Morbidity

Without good IOP control, glaucoma may result in blindness.

Age

This condition may occur at any age after cataract surgery; however, cataracts are most commonly found in the elderly population.

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