Lens-Particle Glaucoma Follow-up

Updated: Aug 13, 2015
  • Author: Brian R Sullivan, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Follow-up

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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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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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. [31]

Pars plana vitrectomy for displaced nuclear fragments can be associated with complications [24, 29, 30, 31, 32, 33, 39] 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. [31, 37]

Visual outcome of pars plana vitrectomy is better when performed for retained cortex or epinucleus, compared with retained nucleus fragments. [24]

Studies have reported final visual acuities of 20/40 or better in approximately two thirds of cases of dropped nucleus requiring vitrectomy, [32, 33, 35, 38] but other recent data suggest a less favorable prognosis, which may be independent of the size of the retained nuclear fragment. [24]

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

For patient education resources, see the Glaucoma Center, as well as Lens-Particle Glaucoma, Glaucoma FAQs, and Understanding Glaucoma Medications.

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