Aphakic glaucoma: a never-ending story?
- A V Levin, Department of Ophthalmology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; alex.levin{at}sickkids.ca
Aphakic glaucoma has plagued those who provide ophthalmic care to children ever since paediatric cataract surgery became a reality. It is the second most common cause of paediatric glaucoma,1 and all children who have cataract surgery remain at risk for life. Its pathophysiology is largely not understood, and there appears to be little if any end in sight on the near horizon. There are many theories as to its causation.
BAROTRAUMA TO THE IMMATURE ANGLE
In support of this theory is the higher frequency of aphakic glaucoma in children who have their surgery at younger ages. Arguing against this theory is the seemingly equal rate of aphakic glaucoma following pars plana lensectomy.
STRUCTURAL CHANGES TO THE ANGLE DRAINAGE COMPLEX
Certainly this makes sense in the “soft” paediatric eye and may be supported by a possible lower incidence of glaucoma in pseudophakic eyes, although the latter factor requires many more years of study, and the incidence of glaucoma in pseudophakia seems to rise as the years pass: a rise far above the initial cautious expectations.2
GONIODYSGENESIS
Some eyes with aphakic glaucoma do have an angle appearance on gonioscopy very reminiscent of the angle in congenital/infantile glaucoma. Such eyes may even respond to goniotomy. This …
