Vitrectomy for phacolytic glaucoma in a patient with homocystinuria

• Published in: American journal of ophthalmology Vol. 128; no. 6; pp. 762 - 763
• Main Authors: Smith, Guy T, Vakalis, Athanasios N, Brittain, G.Paul, Casswell, Anthony G
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-12-1999; Elsevier
• Subjects: Adult; Biological and medical sciences; Female; Glaucoma - etiology; Glaucoma - surgery; Homocystinuria - complications; Humans; Intraocular Pressure; Lens Subluxation - complications; Lens Subluxation - diagnostic imaging; Lens Subluxation - surgery; Medical sciences; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Ultrasonography; Visual Acuity; Vitrectomy; Human; Trabeculectomy; Nervous system diseases; Metabolic diseases; Enzymopathy; Cerebral disorder; Genetic disease; Case study; Eye; Eye disease; Homocystinuria; Association; Treatment; Combined surgery; Glaucoma (eye); Surgery; Central nervous system disease; Female; Vitrectomy; Technique; Aminoacid disorder
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/S0002-9394(99)00257-3

PURPOSE:
To determine the successful treatment of unilateral phacolytic glaucoma by vitrectomy and trabeculectomy in a patient with homocystinuria whose lens had dislocated into the vitreous at least 15 years earlier.
METHODS:
In a 32-year-old woman with homocystinuria, bilateral dislocation of the lens into the vitreous, and phacolytic glaucoma in her left eye a three-port pars plana vitrectomy was performed with the patient under general anesthesia. The lens was removed and a trabeculectomy fashioned. Special precautions for general anesthesia included preoperative aspirin and compression stockings for thromboembolic prophylaxis and intraoperative dextrose infusion, 5%, to maintain intravascular volume and prevent hypoglycemia.
RESULTS:
The intraocular pressure and uveitis resolved postoperatively with improvement in the visual acuity and intraocular pressure, which returned to normal without further treatment.
CONCLUSIONS:
Phacolytic glaucoma is best resolved by removal of the exciting lens material. Pars plana vitrectomy with the patient under general anesthesia can be carried out safely despite the risks traditionally associated with homocystinuria.