• 7 SECTIONGlaucoma Angle Closed

Aphakic and Pseudophakic Iris Bombe

Key Facts

•Frequency has decreased with modern cataract surgery

•Increased risk with anterior chamber and iris-fixated lenses

•Has been reported with posterior chamber lenses

•Decreased incidence with peripheral iridectomies and anterior vitrectomies in children

Mechanism

•Aphakic iris bombe: adherence between iris and anterior hyaloid face or vitreous with bulging forward of iris

•Pseudophakic iris bombe: adherence between iris and lens implant with bulging forward of iris

Clinical Findings

•May be asymptomatic

•Pain

•Photophobia

•Redness

•Corneal edema

•Iris bombe

•Peripheral anterior synechiae

•Synechiae to hyaloid face or lens implant

Ancillary Testing

•Gonioscopy

•Ultrasound biomicroscopy

Differential Diagnosis

•Malignant glaucoma

•Chronic angle closure

•Inflammatory glaucoma

•Neovascular glaucoma

Treatment

•Topical and/or oral hypotensive agents

•Topical steroid drops

•Cycloplegia to break or prevent synechiae

•Peripheral iridectomy

Prognosis

•Decreased incidence with modern surgery

•Good prognosis if discovered and treated early

• 7 SECTIONGlaucoma Angle Closed

Epithelial Down-growth

Key Facts

•Conjunctival epithelium grows into eye through penetrating wound or any incision that is incompetent

•Epithelium grows over corneal endothelium, trabecular meshwork, and iris

•Occurs in 0.09–0.12% of patients after cataract surgery

•Has been reported after clear cornea phacoemulsification

•May present decades after penetrating injury or intraocular surgery

Clinical Findings

•Thin gray translucent membrane growing over endothelium (Fig. 7.17) and iris (Fig. 7.18)

•Flattening of iris stroma

•Wound leak

•Peripheral anterior synechiae

•Pupillary block

Ancillary Testing

•Argon laser application to iris results in white burns in affected area (200-μm spot size at 300–500 mW)

•Gonioscopy shows peripheral anterior synechiae

Differential Diagnosis

•Inflammatory glaucoma

•Neovascular glaucoma

•Iridocorneal endothelial syndrome

•Acute or subacute angle closure glaucoma

Treatment

•Radical surgery to excise affected areas

•Glaucoma drainage devices have been effective in controlling IOP

Prognosis

•Poor because of high rate of recurrence and destruction of intraocular structures

•Results vary depending on degree of intraocular structure involvement