Evaluation of secondary glaucoma associated with subluxated lens misdiagnosed as acute primary angle-closure glaucoma.

PURPOSE: To evaluate the causes of misdiagnosis in patients with acute angle-closure glaucoma secondary to subluxated lens, and postoperative outcomes.

DESIGN

Retrospective clinical study.

METHODS

Five hundred twenty-six cases of acute angle-closure glaucoma were consecutively recruited from Zhongshan Ophthalmic Center between March 2003 and March 2009. Zonular dialysis, anterior chamber angle, and anterior chamber depth were examined by ultrasound biomicroscopy. Surgical therapy was performed according to the degree of zonular dialysis and angle closure.

RESULTS

Thirty-one eyes (5.89%) with acute angle-closure glaucoma secondary to lens subluxation were misdiagnosed as acute primary angle-closure glaucoma. In these cases, the anterior chamber depth of the affected eyes was significantly shallower than the fellow eyes (1.34±0.45 vs. 2.27±0.44, P<0.05). The best-corrected visual acuity was significantly improved 3 months after surgery, and intraocular pressure was well controlled in all eyes. Mean intraocular pressure was 12.09±4.41 mm Hg without any medication at the final visit.

CONCLUSIONS

The causes of misdiagnosis in patients with acute angle-closure glaucoma secondary to subluxated lens include neglected history and/or signs of ocular trauma. Lens extraction surgery was an effective therapy for these cases.