In the JournalsPerspective

Eyes with dislocated lenses may be misdiagnosed with acute primary angle-closure glaucoma

Neglected ocular history and signs of ocular trauma most commonly resulted in misdiagnosis in patients with acute angle-closure glaucoma secondary to lens dislocation, according to a study.

The retrospective study included 526 patients diagnosed with acute angle-closure glaucoma between 2003 and 2009.

All patients underwent a medical and ocular history; bilateral examination of the ocular anterior segment by slit-lamp microscopy; and bilateral assessment of anterior chamber depth, chamber angle and zonular status with ultrasound biomicroscopy.

Choice of surgical procedure was based on degree of angle closure, zonular dialysis and lens subluxation.

Study results showed 31 eyes of 31 patients (6%) had acute angle-closure glaucoma secondary to lens subluxation that was misdiagnosed as acute primary angle-closure glaucoma. These patients had a mean age of 59.3 years.

Anterior chamber depth was 1.34 mm in affected eyes and 2.27 mm in fellow eyes, which represented a statistically significant difference (P < .05).

Best corrected visual acuity improved significantly at 3 months after surgery. Mean IOP was 12.09 mm Hg without medication at final follow-up, the authors said.

Neglected ocular history and signs of ocular trauma most commonly resulted in misdiagnosis in patients with acute angle-closure glaucoma secondary to lens dislocation, according to a study.

The retrospective study included 526 patients diagnosed with acute angle-closure glaucoma between 2003 and 2009.

All patients underwent a medical and ocular history; bilateral examination of the ocular anterior segment by slit-lamp microscopy; and bilateral assessment of anterior chamber depth, chamber angle and zonular status with ultrasound biomicroscopy.

Choice of surgical procedure was based on degree of angle closure, zonular dialysis and lens subluxation.

Study results showed 31 eyes of 31 patients (6%) had acute angle-closure glaucoma secondary to lens subluxation that was misdiagnosed as acute primary angle-closure glaucoma. These patients had a mean age of 59.3 years.

Anterior chamber depth was 1.34 mm in affected eyes and 2.27 mm in fellow eyes, which represented a statistically significant difference (P < .05).

Best corrected visual acuity improved significantly at 3 months after surgery. Mean IOP was 12.09 mm Hg without medication at final follow-up, the authors said.

    Perspective

    This study emphasizes the importance of a complete ocular exam to determine if angle-closure glaucoma is primary or secondary, such as being induced by trauma to the crystalline lens. Newer diagnostic technology that provides anterior segment imaging can prove useful in the evaluation of these patients. It has been said that in certain patients with angle closure, making the eye pseudophakic is the ultimate solution because instantly solves the issue of a crowded anterior segment by replacing the 4 mm or thicker crystalline lens with a 1-mm thin IOL. That certainly holds true for the patients in this study with traumatic dislocation of the crystalline lens causing anterior displacement of the iris and angle-closure glaucoma. The take-home message for me is to thoroughly evaluate patients with angle closure to determine if there is evidence of traumatic lens dislocation. In addition, we should consider cataract surgery as way of restoring the angle anatomy and reducing anterior segment crowding in appropriate patients.

    • Uday Devgan, MD
    • Healio.com/Ophthalmology Section Editor

    Disclosures: Devgan has no relevant financial disclosures.