University of Iowa Health Care

Ophthalmology and Visual Sciences

Iowa Glaucoma Curriculum

Supplementary Material

Chapter 27

Case from
Phacolytic Glaucoma: 65-year-old male presented with acute onset of pain and redness in his right eye (OD), which had long-standing light perception vision after an explosive injury resulted in a penetrating shrapnel wound and large macular scar 

Phacolytic cases from

Phacolytic Glaucoma: This patient presented with one week of pain in the right eye. She had known that she had a cataract in that eye for many years but had never gotten around to having cataract surgery. The left eye had had an intracapsular cataract extraction ten to twenty years previously. At presentation her visual acuity was light perception and her intraocular pressure was 32 mmHg.

Hypermature Lens - slit lamp only: This 94 year old patient has a disciform scar in the right eye. He has had vision reduced to the level of light perception for 8 years at the time this video was taken. The right lens shows a hypermature cataract with loss of cortical substance and wrinkling of the anterior capsule. This is what a lens looks like when most of the cortex is gone. This patient never had a phacolytic reaction.

Phacomorphic cases from
Phacomorphic Glaucoma: 81 year-old woman with chronic angle closure glaucoma. She had undergone laser iridotomies 15 years previously. Her axial aye length is 20 mm and her lens is 5.1 mm thick.

Narrow Angle from Phacomorphic Glaucoma (slit lamp only): This 50 year old man has retinopathy of prematurity. He developed this dense nuclear sclerotic cataract and was diagnosed with phacomorphic glaucoma. His lens at the time of this video was 6.1 mm in thickness and his anterior chamber centrally was 1.0 mm.

Phacomorphic Glaucoma: This 66-year-old woman had an intraocular pressure to 70 mmHg in her left eye. After undergoing laser iridotomy she was found to have persistently narrow angles. Her eyes were found to be quite short (22 mm) and her lens is very thick (5.3 mm).

Ectopia lentis cases from

Ectopia Lentis (slit lamp only): This patient was first seen at age 13 with ectopia lentis. The left eye lost vision at age 16 due to a retinal detachment. The right eye developed elevated intraocular pressure at age 34.

Lens in Vitreous: 57 year-old woman with presumed Marfan’ syndrome. Her other eye had ectopia lentis and developed phacolytic glaucoma. This eye has a lens in the vitreous that is well tolerated. She wears aphakic correction.

Ectopia Lentis & Pseudoexfoliation: This woman presented at age 83. She was known to have pseudoexfoliation with poor control of her intraocular pressures in both eyes despite maximum tolerated medical therapy. At the time of presentation she had 20/100 vision OD and 20/250 vision OS. Her intraocular pressures were 27 mmHg OD and 52 mmHg OS. She underwent an intracapsular cataract extraction with trabeculectomy OS and had a good visual and intraocular pressure outcome. Note: This clip is presented both under ectopia lentis and pseudoexfoliation.

Ectopia Lentis et Pupillae (slit lamp only): This 37-year old has woman has ectopia lentis et pupillae. She has undergone pars plana vitrectomy and lensectomy approximately 6 years before this examination. One can see that the pupils are displaced up and out. The lenses were displaced down and in.

Traumatic ectopia lentis (slit lamp only): After blunt trauma, this patient has a subluxed lens. He also has asteroid hyalosis, which makes for an interesting slit lamp picture.

Ectopia Lentis: This patient was struck in the eye with a spring from an garage door.

Exfoliation Syndrome with Ectopic Intraocular Lens (slit lamp only)

Spherophakia case from
Spherophakia: This young woman at age 26 developed acute angle closure glaucoma in the right eye. She is highly myopic (-11 diopters). She underwent laser iridotomy in both eyes and ultimately required a trabeculectomy the right eye. Her axial eye lengths were 22.21 mm OD and 21.77 mm OS.