Aphakic and Pseudophakic glaucoma
Glaucoma in this article refers to conditions that cause increased intraocular pressure (IOP) soon after surgery as well as to those conditions that occur much later. Examples include viscoelastic-associated pressure rise measured in hours to ghost cell glaucoma occurring weeks after surgery.
the pathophysiology is dependent on the mechanism involved and includes the following: distortion of the anterior chamber angle, viscoelastics, inflammation, hemorrhage, pigment dispersion, ghost cell, vitreous in the anterior chamber (AC), pupillary block (pseudophakic/aphakic), malignant glaucoma, and posterior capsulotomy.
Duke-Elder estimated a 12% incidence of postoperative glaucoma in 1969.  However, the landscape of postcataract complications has been altered by the advent of the intraocular lens (IOL) and fine wound-closure techniques. In the modern era, the incidence of glaucoma is dependent on both the methodology and the type of IOL used.
For instance, Cinotti has noted an increased incidence of glaucoma after extracapsular cataract extraction (ECCE) (7.5%) as compared to intracapsular cataract extraction (ICCE) (5.7%). 
Further, Stark has noted that AC IOL (5.5-6.3%) has been associated with an increased incidence of postoperative IOP elevation over iris-fixation (3.9-4.3%) lens and posterior chamber (PC) IOL (1.6-3.5%).  These figures are consistent with those reported by Hoskins, in which he observed 5.5% in AC IOL and 1.6% in PC IOL.  However, congenital cataract surgeries are associated with a higher incidence of glaucoma, and data range from 6.1-24%.
Without good IOP control, glaucoma may result in blindness.
This condition may occur at any age after cataract surgery; however, cataracts are most commonly found in the elderly population.
The prognosis is dependent on the ability to control the IOP.
For excellent patient education resources, visit eMedicineHealth’s Eye and Vision Center. Also, see eMedicineHealth’s patient education articles Glaucoma Overview, Glaucoma FAQs, and Glaucoma Medications.
Duke-Elder S. Disease of the lens and vitreous: glaucoma and hypotony. System of Ophthalmology. 1969. Vol 11: 11.
Cinotti AA, Jacobson JH. Complications following cataract extraction. Am J Ophthalmol. 1953. 36:929.
Stark WJ, Worthen DM, Holladay JT, et al. The FDA report on intraocular lenses. Ophthalmology. 1983 Apr. 90(4):311-17. [Medline].
Hoskins HD Jr. Management of pseudophakic glaucoma. Greve EL, ed. Surgical Management of Coexisting Glaucoma and Cataract. 1987.
Urban B, Bakunowicz-Lazarczyk A. Aphakic glaucoma after congenital cataract surgery with and without intraocular lens implantation. Klin Oczna. 2010. 112(4-6):105-7. [Medline].
Epstein DL, Allingham RR, Schuman JS. Chandler and Grant’s Glaucoma. Baltimore, Md: Williams & Wilkins. 1997.
Shields MB. Textbook of Glaucoma. Baltimore, Md: Williams & Wilkins; 1998.
Kirsch RE, Levine O, Singer JA. Ridge at internal edge of cataract incision. Arch Ophthalmol. 1976 Dec. 94(12):2098-2104. [Medline].
Bömer TG, Lagreze WD, Funk J. Intraocular pressure rise after phacoemulsification with posterior chamber lens implantation: effect of prophylactic medication, wound closure, and surgeon’s experience. Br J Ophthalmol. 1995 Sep. 79(9):809-13. [Medline].
Noureddin BN, Wilson-Holt N, Lavin M, et al. Advanced uncontrolled glaucoma. Nd:YAG cyclophotocoagulation or tube surgery. Ophthalmology. 1992 Mar. 99(3):430-6; discussion 437. [Medline].
Rękas M, Krix-Jachym K, Żarnowski T. Evaluation of the Effectiveness of Surgical Treatment of Malignant Glaucoma in Pseudophakic Eyes through Partial PPV with Establishment of Communication between the Anterior Chamber and the Vitreous Cavity. J Ophthalmol. 2015. 2015:873124. [Medline].
Madgula IM, Anand N. Long-term follow-up of zonulo-hyaloido-vitrectomy for pseudophakic malignant glaucoma. Indian J Ophthalmol. 2014 Dec. 62 (12):1115-20. [Medline].
Comer RM, Kim P, Cline R, Lyons CJ. Cataract surgery in the first year of life: aphakic glaucoma and visual outcomes. Can J Ophthalmol. 2011 Apr. 46(2):148-52. [Medline].
Bothun ED, Guo Y, Christiansen SP, Summers CG, Anderson JS, Wright MM, et al. Outcome of angle surgery in children with aphakic glaucoma. J AAPOS. 2010 Jun. 14(3):235-9. [Medline].
Takihara Y, Inatani M, Ogata-Iwao M, Kawai M, Inoue T, Iwao K, et al. Trabeculectomy for open-angle glaucoma in phakic eyes vs in pseudophakic eyes after phacoemulsification: a prospective clinical cohort study. JAMA Ophthalmol. 2014 Jan. 132 (1):69-76. [Medline].
Dao JB, Sarkisian SR Jr, Freedman SF. Illuminated Microcatheter-facilitated 360-Degree Trabeculotomy for Refractory Aphakic and Juvenile Open-angle Glaucoma. J Glaucoma. 2014 Sep. 23(7):449-54. [Medline].
Eslami Y, Mohammadi M, Fakhraie G, Zarei R, Moghimi S. Ahmed glaucoma valve implantation with tube insertion through the ciliary sulcus in pseudophakic/aphakic eyes. J Glaucoma. 2014 Feb. 23(2):115-8. [Medline].
Rabkin-Mainer Z, Wolf A, Mathalone N, Malamud A, Buckman G, Edmunds B, et al. Ex-PRESS Miniature Glaucoma Shunt versus Ahmed Glaucoma Valve in the Surgical Treatment of Glaucoma in Pseudophakic Patients. J Glaucoma. 2018 Aug 14. [Medline].
Altintas O, Yuksel N, Karabas VL, Demirci G. Cystoid macular edema associated with latanoprost after uncomplicated cataract surgery. Eur J Ophthalmol. 2005 Jan-Feb. 15(1):158-61. [Medline].
Araie M, Ishi K. Effects of apraclonidine on intraocular pressure and blood-aqueous barrier permeability after phacoemulsification and intraocular lens implantation. Am J Ophthalmol. 1993 Jul 15. 116(1):67-71. [Medline].
Arcieri ES, Santana A, Rocha FN, Guapo GL, Costa VP. Blood-aqueous barrier changes after the use of prostaglandin analogues in patients with pseudophakia and aphakia: a 6-month randomized trial. Arch Ophthalmol. 2005 Feb. 123(2):186-92. [Medline].
Arvind H, George R, Raju P, et al. Glaucoma in aphakia and pseudophakia in the Chennai Glaucoma Study. Br J Ophthalmol. 2005 Jun. 89(6):699-703. [Medline].
Barnes EA, Murdoch IE, Subramaniam S, Cahill A, Kehoe B, Behrend M. Neodymium:yttrium-aluminum-garnet capsulotomy and intraocular pressure in pseudophakic patients with glaucoma. Ophthalmology. 2004 Jul. 111(7):1393-7. [Medline].
Berson FG, Patterson MM, Epstein DL. Obstruction of aqueous outflow by sodium hyaluronate in enucleated human eyes. Am J Ophthalmol. 1983 May. 95(5):668-72. [Medline].
Brown DN. Long-term success of argon laser trabeculoplasty in aphakic and pseudophakic eyes. Invest Ophthalmol Vis Sci. 1992. 33:1159.
Carter BC, Plager DA, Neely DE, Sprunger DT, Sondhi N, Roberts GJ. Endoscopic diode laser cyclophotocoagulation in the management of aphakic and pseudophakic glaucoma in children. J AAPOS. 2007 Feb. 11(1):34-40. [Medline].
Ellingson FT. The uveitis-glaucoma-hyphema syndrome associated with the Mark VIII anterior chamber lens implant. J Am Intraocul Implant Soc. 1978 Apr. 4(2):50-3. [Medline].
Fontana H, Nouri-Mahdavi K, Caprioli J. Trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma: outcomes and risk factors for failure. Am J Ophthalmol. 2006 Apr. 141(4):652-9. [Medline].
Harrison SE, Soll DB, Shayegan M, Clinch T. A new and effective protective agent for intraocular lens insertion. Ophthalmology. 1982 Nov. 89(11):1254-60. [Medline].
Lee LC, Pasquale LR. Surgical management of glaucoma in pseudophakic patients. Semin Ophthalmol. 2002 Sep-Dec. 17(3-4):131-7. [Medline].
Lima FE, Magacho L, Carvalho DM, Susanna R Jr, Avila MP. A prospective, comparative study between endoscopic cyclophotocoagulation and the Ahmed drainage implant in refractory glaucoma. J Glaucoma. 2004 Jun. 13(3):233-7. [Medline].
Michael I, Walton DS, Levenberg S. Infantile Aphakic Glaucoma: A Proposed Etiologic Role of IL-4 and VEGF. J Pediatr Ophthalmol Strabismus. 2011 Mar-Apr. 48(2):98-107. [Medline].
Minckler DS, Heuer DK, Hasty B, Baerveldt G, Cutting RC, Barlow WE. Clinical experience with the single-plate Molteno implant in complicated glaucomas. Ophthalmology. 1988 Sep. 95(9):1181-8. [Medline].
Rockwood EJ, Parrish RK 2nd, Heuer DK, et al. Glaucoma filtering surgery with 5-fluorouracil. Ophthalmology. 1987 Sep. 94(9):1071-8. [Medline].
Ruiz RS, Rhem MN, Prager TC. Effects of carbachol and acetylcholine on intraocular pressure after cataract extraction. Am J Ophthalmol. 1989 Jan 15. 107(1):7-10. [Medline].
Ruiz RS, Wilson CA, Musgrove KH, Prager TC. Management of increased intraocular pressure after cataract extraction. Am J Ophthalmol. 1987 Apr 15. 103(4):487-91. [Medline].
Shingleton BJ, Alfano C, O’Donoghue MW, Rivera J. Efficacy of glaucoma filtration surgery in pseudophakic patients with or without conjunctival scarring. J Cataract Refract Surg. 2004 Dec. 30(12):2504-9. [Medline].
Simon JW, O’Malley MR, Gandham SB, Ghaiy R, Zobal-Ratner J, Simmons ST. Central corneal thickness and glaucoma in aphakic and pseudophakic children. J AAPOS. 2005 Aug. 9(4):326-9. [Medline].
Simsek T, Mutluay AH, Elgin U, Gursel R, Batman A. Glaucoma and increased central corneal thickness in aphakic and pseudophakic patients after congenital cataract surgery. Br J Ophthalmol. 2006 Sep. 90(9):1103-6. [Medline].
Valmaggia C, de Smet M. Endoscopic laser coagulation of the ciliary processes in patients with severe chronic glaucoma. Klin Monatsbl Augenheilkd. 2004 May. 221(5):343-6. [Medline].
Robert H Graham, MD Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
Disclosure: Partner received salary from Medscape/WebMD for employment.
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
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.
Bradford Shingleton, MD Assistant Clinical Professor of Ophthalmology, Harvard Medical School; consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary
Disclosure: Nothing to disclose.
The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthors, Sai Gandham, MD, and DooHo Brian Kim, BA, to the development and writing of this article.
Aphakic and Pseudophakic Glaucoma
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