Lens associated with uveitis and glaucoma

Upon penetration of the lens proteins through an intact or damaged capsule, a strong intraocular inflammatory reaction is triggered into the anterior chamber of the eye or vitreous cavity, as a result of which an outflow of intraocular fluid may occur with the development of an acute increase in intraocular pressure or glaucoma.

The release of lens proteins is usually due to accidental or surgical damage to the capsule or is associated with the progression of cataracts. Conditions in which uveitis and glaucoma associated with the lens develop: phacoantigenic uveitis, phacolithic glaucoma, glaucoma, associated with lens masses and phakomorphic glaucoma. Uveitis and glaucoma can also develop as a complication of intraocular lens implantation.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

Epidemiology of uveitis and glaucoma associated with the lens

The incidence of glaucoma in various forms of uveitis associated with the lens is unknown, despite the good knowledge of this state. And one study presents data on patients suffering from phacoanaliphytic uveitis (phacoantigenic uveitis), in which glaucoma was detected in 17% of cases.

[13], [14], [15], [16], [17], [18], [19], [20]

The causes of uveitis and glaucoma associated with the lens

Usually, glaucoma associated with the lens, there is a violation of the outflow of intraocular fluid at the level of the trabecular network. When phacoantigenic uveite modified lens proteins cause the development of a granulomatous inflammatory process, as a result of which the formation of a blue and a blockage of the trabecular network can occur. When phacolitic glaucoma occurs, the trabecular network is obstructed by lens proteins and macrophages filled with proteins, and in glaucoma associated with lens masses, fragments of cortical masses damage the trabecular lens network. In phacomorphic glaucoma, unlike other types of glaucoma associated with the lens, when the angle of the anterior chamber is open, the swelling of the lens leads to the development of the pupillary block or the displacement of the iris anteriorly, which leads to the formation of a slit anterior chamber and acute closure of the angle. In artiphakia, intraocular inflammation may be associated with previous uveitis, delayed onset of postoperative endophthalmitis, or with irritation of the vascular envelope with the intraocular lens. The development of glaucoma occurs due to damage to the trabecular network, the formation of synechiae on the intraocular lens with the development of the pupillary block or peripheral sinus anterior and closing the angle of the anterior chamber.

Symptoms of uveitis and glaucoma associated with the lens

Phacoantigenic uveitis, phaco-anaphylactic uveitis, or phaco-anaphylactic endophthalmitis, develops as a result of the release of lens proteins upon rupture of its capsule. The disease develops a few days or weeks after traumatic or surgical damage to the lens. When examining the patient, redness and soreness of the eyeball is revealed. Rarely with phacoantigenic uveitis develop sympathetic ophthalmia and inflammation of the second eye.

Phacolitic glaucoma usually develops in elderly patients with mature or overripe cataracts as a result of leakage of lens proteins through an intact but permeable capsule. Phacolitic glaucoma is usually manifested in the sudden appearance of pain and reddening of the visually impaired eye, on which cataracts were previously observed.

Glaucoma associated with the lens masses (phacotoxic uveitis) develops with any damage leading to the ingress of cortical lens masses into the anterior chamber. Usually, increased intraocular pressure develops a few days or weeks after the injury.

In case of phakomorphic glaucoma, the capsule does not usually damage, and the eye does not show a pronounced inflammatory process. With a low visual acuity, cataracts cause pain and redness associated with the closure of the anterior chamber angle.

Uveitis-glaucoma-hyphaemia syndrome is a common cause of postoperative inflammation and glaucoma in patients who underwent implantation of the rigid anterolateral intraocular lenses of the first generation. The development of the syndrome is associated with an incorrect choice of lens size or manufacturing defects in the lens material, which leads to mechanical irritation of the anterior chamber structures. In chronic or severe postoperative inflammation, developed in patients who underwent posterior chamber implantation of the intraocular lens, artifactic inflammatory glaucoma may develop.

Course of the disease

The clinical course of glaucoma associated with the lens is relatively short because of the high efficiency of surgical methods.

Diagnosis of uveitis and glaucoma associated with the lens

Ophthalmological examination

When external examination of patients suffering from glaucoma associated with the lens, and acute uveitis, conjunctival and ciliary injection of the eyeball is detected. There may be signs of damage to the eyeball. With a marked increase in intraocular pressure, edema of the cornea is noted. The anterior chamber fluid usually opalesces, contains inflammatory cells, and granulomatous and non-granulomatous precipitates are detected on the cornea. In the intraocular fluid and in the angle of the anterior chamber there may be a white flaky substance and fragments of the cortical masses of the lens. The angle of the anterior chamber can be open, narrow and closed. Often observed peripheral anterior and posterior synechia. When phacoantigenic uveitis and glaucoma associated with lens masses, usually show signs of damage to the lens capsule or loose lens masses. When phacolithic or phakomorphic glaucoma is detected, respectively, an overripe or swelling cataract, and with artifacial inflammatory glaucoma - an intraocular lens. When examining the posterior segment of the eye, inflammatory cells and opacities of the vitreous humor, lens mass in the vitreous cavity and other signs of damage to the eyeball can be detected.

Differential diagnostics

Fakoantigennuyu and associated with the masses of the lens glaucoma, first of all, should be differentiated from post-traumatic and postoperative endophthalmitis. In phacomorphic glaucoma, other reasons for closing the anterior chamber angle should be avoided.

Laboratory research

The diagnosis of uveitis and glaucoma associated with the lens is based on clinical data, there is no need for laboratory methods of investigation. Histological examination of the lens of patients suffering from phacoantigenic uveitis reveals a zonal granulomatous inflammation localized at the site of the lens damage.

[21], [22], [23], [24], [25]

Treatment of uveitis and glaucoma associated with the lens

Radical treatment of uveitis and glaucoma associated with the lens is the extraction of cataracts or the removal of the lens masses or intraocular lens. Before surgery, the inflammatory process should be stopped with the help of local glucocorticoids and normalize intraocular pressure with antiglaucoma drugs. With phacomorphic glaucoma, if it is not possible to extract the cataract or if it is necessary to postpone the operation, laser iridotomy should be performed after a drug reduction in intraocular pressure.