Pseudophakic glaucoma and intraocular lens subluxation

Purpose. To evaluate the results of glaucoma surgery with Xenoplast drainage and fixation of IOL/capsula bag complex in patients with subluxation and luxation of this complex and secondary pseudophakic glaucoma.

Materials and methods. 35 patients (35 eyes) aged 60 to 92 with secondary pseudophakic previously unoperated glaucoma, pseudophakia, zonula weakness and IOL dislocation or decentration were observed. The patients underwent phacoemulsification 6 to 12 years prior to the follow-up. In all cases IOP exceeded 28 mm Hg under 4–5 hypotensive medications a day. All patients had glaucoma surgery nonpenetrating deep sclerectomy with Xenoplast drainage implantation in the intrascleral space with simultaneous IOL/capsula bag suturing to the sclera. Anterior vitrectomy was performed if proved necessary.

Results. In early post-op period, 94% of cases showed moderate hypertension of 26 to 28 mm Hg, but 2 cases showed 40 mm Hg one day after the operation. During the first month all patients received hypotensive medication: 2–3 instillations of carbonic anhydrase inhibitors. IOP normalized by the 8th week after operation. 1 to 2 months after surgery, all patients received IAG laser goniopuncture. Vision acuity was improving for 8 weeks and reached 0.1–0.8. The observation period varied between 6 months and 4 years.

Conclusions. Non-penetrating deep sclerotomy with Xenoplast implantation combined with IOL/capsula bag complex fixation to the sclera in cases of pseudophakic noncompensated glaucoma normalizes IOP in the long-term post-op period.

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