Excessive loss of hyperopia. A presenting sign of juvenile aphakic glaucoma.

We present the cases of four patients in whom juvenile aphakic glaucoma developed. An excessive loss of hyperopia was the initial clinical sign that alerted us to the diagnosis of glaucoma. At the time of diagnosis, the mean refractive error of the six glaucomatous eyes in the four patients was +4.75 diopters (D) (range, -0.25 to +6.75 D). The mean change in refraction from time of cataract extraction to diagnosis of juvenile aphakic glaucoma was 17.00 D (range, 9.25 to 21.00 D). All aphakic patients in the private practice of one of us (B.J.K.) with a spherical equivalent of less than +8.00 D in either eye have glaucoma. The only exception are those patients with a coexisting condition predisposing them to myopia. We have found an excessive loss of hyperopia to be a useful sign in alerting the ophthalmologist to the diagnosis of juvenile aphakic glaucoma.