Lens-Particle Glaucoma

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Lens-Particle Glaucoma

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Lens-particle glaucoma, a subclassification of lens-induced glaucoma, [1, 2, 3, 4, 5] is a type of secondary open-angle glaucoma involving intraocular retention of fragmented lens debris. Following surgery or injury, lens material may be sequestered within the capsular bag or dislocated into other areas of either the posterior eye or the anterior eye. Characteristically, large lens pieces spontaneously fragment further into small (sometimes invisible) particles that eventually migrate into the anterior chamber and obstruct aqueous outflow. [6] Lens-particle glaucoma is not associated with decentration or dislocation of an intact lens.

The mechanism involves the following 4 processes: (1) presence of a nonintact lens capsule, usually violated during trauma or intraocular surgery; (2) subsequent release of microscopic lens debris into the anterior chamber, sometimes associated with dislocation of larger lens fragments in the anterior or posterior segment; (3) obstruction of trabecular meshwork by lens particles [6] and inflammatory components [7] ; and (4) reduction of the outflow facility of an open anterior chamber angle, resulting in elevation of intraocular pressure (IOP).

United States

The incidence of lens-particle glaucoma has not been specifically reported. The frequency of penetrating eye injury in the United States has been estimated at 3.1 per 100,000 person-years, [8] with a predominance of young males.

Mortality is not associated with this condition. Morbidity is rare.

No known racial predilection exists.

No known gender predilection exists for lens-particle glaucoma. However, penetrating eye trauma, a risk factor for lens-particle glaucoma, has been reported to occur more commonly in young adult males. [8] Alcohol abuse is a significant comorbidity in this population.

All ages are affected, ranging from infancy (especially when involving congenital cataract surgery) to late adulthood. Penetrating eye injuries occur most frequently in young adults. However, lens-particle glaucoma probably occurs most commonly in elderly persons as a complication of cataract surgery.

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Richter CU. Lens-induced open-angle glaucoma. Ritch R, Shields MB, and Krupin T. The Glaucomas. 2nd. St. Louis, Mo: 1996. 2: 1026-31.

Serle JB. Nontraumatic lens-induced glaucoma. Higginbotham ET, Lee DA. Management of Difficult Glaucoma. Boston, MA: 1994. 263-73.

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Epstein DL, Jedziniak JA, Grant WM. Obstruction of aqueous outflow by lens particles and by heavy-molecular-weight soluble lens proteins. Invest Ophthalmol Vis Sci. 1978 Mar. 17(3):272-7. [Medline].

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Kim TH, Kim SJ, Kim E, Chung IY, Park JM, Yoo JM, et al. Spontaneous anterior lens capsular dehiscence causing lens particle glaucoma. Yonsei Med J. 2009 Jun 30. 50(3):452-4. [Medline]. [Full Text].

Hemalatha C, Norhafizah H, Shatriah I. Bilateral spontaneous rupture of anterior lens capsules in a middle-aged woman. Clin Ophthalmol. 2012. 6:1955-7. [Medline]. [Full Text].

While B, Mudhar HS, Chan J. Lens particle glaucoma secondary to untreated ?congenital cataract and persistent fetal vasculature. Eur J Ophthalmol. 2012 Oct 25. [Medline].

Arranz-Marquez E, Fatela-Cantillo B, Figueroa M, Teus MÁ. [Late onset lens particle glaucoma in Marfan syndrome]. Arch Soc Esp Oftalmol. 2015 Jan. 90 (1):40-3. [Medline].

Pahk PJ, Adelman RA. Ocular trauma resulting from paintball injury. Graefes Arch Clin Exp Ophthalmol. 2008 Nov 26. [Medline].

Su Y, Mao Z, Liu Y, Yang Y, Liu X. Late-onset lens particle glaucoma as a consequence of posterior capsule rupture after pars plana vitrectomy. Eye Sci. 2012 Mar. 27(1):47-9. [Medline].

Barnhorst D, Meyers SM, Myers T. Lens-induced glaucoma 65 years after congenital cataract surgery. Am J Ophthalmol. 1994 Dec 15. 118(6):807-8. [Medline].

Kee C, Lee S. Lens particle glaucoma occurring 15 years after cataract surgery. Korean J Ophthalmol. 2001 Dec. 15(2):137-9. [Medline].

Hassan NA, Reddy MA, Reddy SS. Late occurrence of lens particle glaucoma due to an occult glass intralenticular foreign body. Middle East Afr J Ophthalmol. 2009 Apr. 16(2):97-9. [Medline]. [Full Text].

Richter CU, Arzeno G, Pappas HR, Steinert RF, Puliafito C, Epstein DL. Intraocular pressure elevation following Nd:YAG laser posterior capsulotomy. Ophthalmology. 1985 May. 92(5):636-40. [Medline].

Lim MC, Doe EA, Vroman DT, Rosa RH Jr, Parrish RK 2nd. Late onset lens particle glaucoma as a consequence of spontaneous dislocation of an intraocular lens in pseudoexfoliation syndrome. Am J Ophthalmol. 2001 Aug. 132(2):261-3. [Medline].

Jain SS, Rao P, Nayak P, Kothari K. Posterior capsular dehiscence following blunt injury causing delayed onset lens particle glaucoma. Indian J Ophthalmol. 2004 Dec. 52(4):325-7. [Medline].

Nguyen TN, Mansour M, Deschenes J, Lindley S. Visualization of posterior lens capsule integrity by 20-MHz ultrasound probe in ocular trauma. Am J Ophthalmol. 2003 Oct. 136(4):754-5. [Medline].

Kucukevcilioglu M, Hurmeric V, Ceylan OM. Preoperative detection of posterior capsule tear with ultrasound biomicroscopy in traumatic cataract. J Cataract Refract Surg. 2013 Feb. 39(2):289-91. [Medline].

McWhae JA, Crichton AC, Rinke M. Ultrasound biomicroscopy for the assessment of zonules after ocular trauma. Ophthalmology. 2003 Jul. 110(7):1340-3. [Medline].

Moisseiev E, Kinori M, Glovinsky Y, Loewenstein A, Moisseiev J, Barak A. Retained lens fragments: nucleus fragments are associated with worse prognosis than cortex or epinucleus fragments. Eur J Ophthalmol. 2011 Nov-Dec. 21(6):741-7. [Medline].

Aaberg TM Jr, Rubsamen PE, Flynn HW Jr, Chang S, Mieler WF, Smiddy WE. Giant retinal tear as a complication of attempted removal of intravitreal lens fragments during cataract surgery. Am J Ophthalmol. 1997 Aug. 124(2):222-6. [Medline].

Arbisser LB. Managing intraoperative complications in cataract surgery. Curr Opin Ophthalmol. 2004 Feb. 15(1):33-9. [Medline].

Arbisser LB, Charles S, Howcroft M, Werner L. Management of vitreous loss and dropped nucleus during cataract surgery. Ophthalmol Clin North Am. 2006 Dec. 19(4):495-506. [Medline].

Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. Surv Ophthalmol. 1999 Mar-Apr. 43(5):397-404. [Medline].

Terasaki H, Miyake Y, Miyake K. Visual outcome after management of a posteriorly dislocated lens nucleus during phacoemulsification. J Cataract Refract Surg. 1997 Nov. 23(9):1399-403. [Medline].

Margherio RR, Margherio AR, Pendergast SD, et al. Vitrectomy for retained lens fragments after phacoemulsification. Ophthalmology. 1997 Sep. 104(9):1426-32. [Medline].

Yang CS, Lee FL, Hsu WM, Liu JH. Management of retained intravitreal lens fragments after phacoemulsification surgery. Ophthalmologica. 2002 May-Jun. 216(3):192-7. [Medline].

Kapusta MA, Chen JC, Lam WC. Outcomes of dropped nucleus during phacoemulsification. Ophthalmology. 1996 Aug. 103(8):1184-7. [Medline].

von Lany H, Mahmood S, James CR, et al. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. Br J Ophthalmol. 2008 Apr. 92(4):493-5. [Medline].

Lai TY, Kwok AK, Yeung YS, et al. Immediate pars plana vitrectomy for dislocated intravitreal lens fragments during cataract surgery. Eye. 2005 Nov. 19(11):1157-62. [Medline].

Chen CL, Wang TY, Cheng JH, et al. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. Ophthalmologica. 2008. 222(4):277-83. [Medline].

Schaal S, Barr CC. Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. J Cataract Refract Surg. 2009 May. 35(5):863-7. [Medline].

Salehi A, Razmju H, Beni AN, Beni ZN. Visual outcome of early and late pars plana vitrectomy in patients with dropped nucleus during phacoemulsification. J Res Med Sci. 2011 Nov. 16(11):1422-9. [Medline]. [Full Text].

Stefaniotou M, Aspiotis M, Pappa C, Eftaxias V, Psilas K. Timing of dislocated nuclear fragment management after cataract surgery. J Cataract Refract Surg. 2003 Oct. 29(10):1985-8. [Medline].

Scott IU, Flynn HW Jr, Smiddy WE, et al. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. Ophthalmology. 2003 Aug. 110(8):1567-72. [Medline].

Brick DC. Risk management lessons from a review of 168 cataract surgery claims. Surv Ophthalmol. 1999 Jan-Feb. 43(4):356-60. [Medline].

Brian R Sullivan, MD Professor, Department of Ophthalmology, Chicago Stritch School of Medicine, Loyola University Medical Center

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

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department 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, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

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

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

Disclosure: Nothing to disclose.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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, Texas Medical Association

Disclosure: Nothing to disclose.

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.

Lens-Particle Glaucoma

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