alexa Acute Onset Secondary Pigmentary Glaucoma Followed by Second Intraocular Lens Implantation in a Patient with Atopic Dermatitis | Open Access Journals
ISSN: 2155-9570
Journal of Clinical & Experimental Ophthalmology
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Acute Onset Secondary Pigmentary Glaucoma Followed by Second Intraocular Lens Implantation in a Patient with Atopic Dermatitis

Keiko Sakuma1*, Teruhiko Hamanaka1, Akira Matsuda2 and Masao Ishida3
1Japanese Red Cross Medical Center, Tokyo, Japan
2Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan
3Ishida Eye Clinic, Jyoetsu City, Japan
Corresponding Author : Kieko Sakuma
Japanese Red Cross Medical Center
4-1-22 Hiroo, Shibuyaku
Tokyo 150-8935, Japan
E-mail: [email protected]
Received September 12, 2012; Accepted November 22, 2012; Published November 29, 2012
Citation: Sakuma K, Hamanaka T, Matsuda A, Ishida M (2012) Acute Onset Secondary Pigmentary Glaucoma Followed by Second Intraocular Lens Implantation in a Patient with Atopic Dermatitis. J Clin Exp Ophthalmol 3:255. doi:10.4172/2155-9570.1000255
Copyright: © 2012 Sakuma K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

A 36-year-old man underwent trabeculectomy in his right eye because of sudden onset open angle glaucoma (intraocular pressure (IOP): 48 mmHg) 11 months after the implantation of a second intraocular lens (IOL).

A 36-year-old man underwent trabeculectomy in his right eye because of sudden onset open angle glaucoma (intraocular pressure (IOP): 48 mmHg) 11 months after the implantation of a second intraocular lens (IOL). The second IOL (single-piece acrylic IOL, AcrySof SN60WF) was implanted in the sulcus (Figures 1 and 2). He had atopic dermatitis and the eye had undergone simultaneous surgical procedures for retinal detachment and phacoemulsification 15 years before implantation of the second IOL. No increase in IOP occurred between the combined surgery for retinal detachment and phacoemulsification and implantation of the second IOL. The angle of his right eye displayed extremely thick pigmentation (Figure 3, inset). In a histological examination of the trabeculectomy specimen, a strong accumulation of pigment-laden trabecular cells was observed in the cribriform meshwork (Figure 3), which has not been previously reported [1-3]. This finding suggested that mechanical rubbing of the IOL against the iris pigment epithelium led to the liberation of a large number of melanin granules from the pigment epithelium to the trabecular outflow pathway, which resulted in excess phagocytic activity in the trabecular cells of the uveal and corneoscleral meshwork, and hence, the accumulation of undigested pigment granules in the cribriform meshwork. The absence of both trabecular lamellae fusion and Schlemm’s canal occlusion (Figure 4), which have both been described in previous reports [2,3] of longstanding pigmentary glaucoma, indicated that his glaucoma had occurred very recently. In addition, remnants of the lens cortex in the peripheral part of the lens capsule (Figure 1) and constriction of the anterior lens capsule may have caused the narrow space of the posterior chamber for the lens haptics and optics, resulting in the close proximity of the edge of the IOL optics to the iris pigment epithelium (arrow in Figure 2). This could have led to extensive mechanical rubbing of the IOL against the iris pigment epithelium. It has been highlighted in a previous report [4], single-piece acrylic IOL in the sulcus placement has a high risk of pigment dispersion syndrome. Therefore, it should be noted that a single-piece acrylic IOL should not be used for sulcus placement, eyes with a narrow space in the posterior chamber may carry a high risk of secondary pigmentary glaucoma after sulcus placement for secondary IOL implantation, and prompt IOL extraction is necessary to avoid irreversible changes in the trabecular outflow pathway such as fusion of the trabecular lamellae or the occlusion of Schlemm’s canal [2,3].
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