[Ciliolenticular block as a late complication in pseudophakia].
A ciliolenticular block is characterized by a rise in IOP and a shallow anterior chamber. This problem is known as a complication after fistulating surgery and has well called malignant glaucoma. It can also occur after cataract surgery with implantation of a posterior chamber lens. When a ciliolenticular block occurs, it is extremely important to avoid any therapeutic delay and to manage it correctly. Otherwise there would be a risk of irreversible damage of the iridocorneal angle and the optic nerve.


METHODS
During the last 12 years we performed 32,000 cataract operations. Ciliolenticular block occurred in eight patients. Six patients were operated on in our hospital. The predisposing factors, clinical course, and therapeutic consequences were analyzed.


RESULTS
Ciliolenticular block occurred only in women, 66-90 years of age. All but one patient had chronic glaucoma with a narrow iridocorneal angle before they underwent cataract surgery. Three patients had had fistulating surgery before. The axial length of the globe was equal to or less than 22.5 mm. Three patients had a marked rise in IOP (up to 40 to 50 mmHg) and an extremely shallow anterior chamber on admission. The remaining patients had a moderate rise in IOP (up to 40 to 50 mmHg) and an extremely shallow anterior chamber on admission. The remaining patients had a moderate rise in IOP (up to 30 mmHg) and a shallow anterior chamber. The interval between cataract surgery and the occurrence of ciliolenticular block was between 4 weeks and 11 months. Nd:YAG laser iridotomy with photodisruption of the peripheral and central posterior capsule was successful in one case only. The remaining patients had to undergo pars-plana vitrectomy to achieve long-term control of anterior chamber pathology and IOP.


CONCLUSIONS
The early stage of ciliolenticular block has to be recognized and managed immediately to prevent a dramatic progression of this complication with an excessive rise in IOP and a completely shallow anterior chamber. In addition to the well-known conservative therapy, Nd:YAG-laser iridotomy with photodisruption of the capsule can be performed initially. In most cases only vitrectomy can achieve normal aqueous circulation.
Wollensak
J
J
Augenklinik, Klinikum Rudolf Virchow, Freien Universität Berlin.
Pham
D T
DT
Anders
N
N
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007498:Iris / Q000601:surgery; D053685:Laser Therapy; D007910:Lenses, Intraocular; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014821:Vitrectomy
Ziliolentikulärer Block als Spätkomplikation bei Pseudophakie.