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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Cataract Removal Done, Persisting High IOP, Trablecotomy Done. Will I Get Glaucoma Symptoms Again?

Hi all, So long story short in March 2012 I was hit in the right eye with a cricket ball at a decent pace. As a result I had a grade 4 Hyphema. This resulted in cataract . It also damaged the drainage in the eye resulting in elevated IOP. It got up to 68 at the highest recorded point. After a few months on medication the blood was not draining so I had a vitrectomy and cataract removal. I was told that they could not put a new lens in just yet for some reason (Can t remember what the reason was). 2 months after that I still had very high IOP and had a trablectomy. The IOP is now around a comfortable 15-20 on most visits. I am looking at getting a new lens installed in Feb 2013. My questions are; how likely is it that the medication I am given to heal the incision after the lens is installed to also heal the bleb? Am I likely to have to start the pain cycle of Glaucoma symptoms again? Is it really worth getting a lens? I am 29 and am coping perfectly well with no sight in my right eye. I am still not used to decreased depth perception but I would rather this than the pain of high IOP. The high IOP does not seem to have caused TOO much damage to the optic nerve (Slight thinning I think they said) and I have no retinal detachment yet (Although according to the doc I am to expect it to detach at some point in the not too distant future). I am led to believe this type of injury is quite common in cricket, baseball and hockey. Thanks, Pete
Tue, 22 Jan 2013
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Ophthalmologist,  's  Response
Hi Pete,I read your case of trauma with the cricket ball.This is a blunt trauma which had cause hyphaema, traumatic cataract and glaucoma post injury.These are the common complication seen in patients with blunt injury.Since you had grade 4 hyphema and intra ocular pressure(IOP) were high anterior chamber wash should have been done immediately.If you have a dislocated lens and vitreous hemorrhage i.e blood in the vitreous some surgeon wait for the blood to get absorbed and also to have a good view while operating posterior segment.They have taken out your lens and done a vitrectomy to clear the blood.Still some patients after this process suffer from high IOP as they may have ghost cell glaucoma or secondary glaucoma due to damage of the draining area of your eyes.If in such cases IOP is not controlled by medications ,then trabeculectomy is done.Now the good thing is post trabeculectomy your IOP is normal.Now I believe since you are aphakic, with normal IOP,you have three options left if your vision is improving with aphakic glasses.Firist you can uses an aphakic glass of +10 or +11 what ever the correction is and see how much your vision is improving.If its 6/24 and above and comfortable with glass you can use it.But you may suffer from headache , vision disparity and poor cosmesis and may not happy.You can try contact lens which may help you to have some good vision and cosmetically acceptable.Third is Intracolar lens.If you have posterior capsular support you can go for Posterior Capsular IOL and if its not there then sceral fixated IOL.For now I can only tell that, if you don't have any retinal pathology like macular scar post trauma and with aphakic glasses your vision is improving well then you can go for above options or else continue the same...Now since you have one functional eye at present always wear a protective glass...Take care ...and don't be upset.you have a great life ahead...Dr Ajay Shankar kar,Cornea consultant, Sankar Eye Foundation, Visakhapatnam.
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Cataract Removal Done, Persisting High IOP, Trablecotomy Done. Will I Get Glaucoma Symptoms Again?

Hi Pete,I read your case of trauma with the cricket ball.This is a blunt trauma which had cause hyphaema, traumatic cataract and glaucoma post injury.These are the common complication seen in patients with blunt injury.Since you had grade 4 hyphema and intra ocular pressure(IOP) were high anterior chamber wash should have been done immediately.If you have a dislocated lens and vitreous hemorrhage i.e blood in the vitreous some surgeon wait for the blood to get absorbed and also to have a good view while operating posterior segment.They have taken out your lens and done a vitrectomy to clear the blood.Still some patients after this process suffer from high IOP as they may have ghost cell glaucoma or secondary glaucoma due to damage of the draining area of your eyes.If in such cases IOP is not controlled by medications ,then trabeculectomy is done.Now the good thing is post trabeculectomy your IOP is normal.Now I believe since you are aphakic, with normal IOP,you have three options left if your vision is improving with aphakic glasses.Firist you can uses an aphakic glass of +10 or +11 what ever the correction is and see how much your vision is improving.If its 6/24 and above and comfortable with glass you can use it.But you may suffer from headache , vision disparity and poor cosmesis and may not happy.You can try contact lens which may help you to have some good vision and cosmetically acceptable.Third is Intracolar lens.If you have posterior capsular support you can go for Posterior Capsular IOL and if its not there then sceral fixated IOL.For now I can only tell that, if you don t have any retinal pathology like macular scar post trauma and with aphakic glasses your vision is improving well then you can go for above options or else continue the same...Now since you have one functional eye at present always wear a protective glass...Take care ...and don t be upset.you have a great life ahead...Dr Ajay Shankar kar,Cornea consultant, Sankar Eye Foundation, Visakhapatnam.