Diagnostic Challenge of Mixed Lens-Induced Glaucoma After Chronic Traumatic Posterior Lens Dislocation: A Case Report.

Background/

Objectives

Chronic traumatic posterior lens dislocation may cause ocular hypertension through overlapping lens-induced and traumatic mechanisms. We report a delayed presentation with a dislocated hypermature lens, a phacolytic phenotype, an incomplete capsule, and severe pressure elevation persisting after lens removal. Case Presentation: A 47-year-old man presented 5 years after blunt trauma with pain, redness, and blurred vision. Visual acuity was hand motion at 10 cm, and intraocular pressure (IOP) was 44.1 mmHg. Slit-lamp examination showed corneal edema, milky material in a deep anterior chamber, and the cataractous lens behind the iris. Ultrasonography localized the lens but could not assess capsular integrity or angle anatomy. Mixed lens-induced glaucoma with possible phacolytic, lens-particle, and traumatic components was diagnosed. Two days after 25-gauge pars plana vitrectomy and lensectomy, IOP remained 45.3 mmHg despite intensive therapy, prompting trabeculectomy with mitomycin C. At 6 months, IOP was 20.1 mmHg on three agents (qualified success), and vision remained hand motion at 30 cm with persistent corneal edema, aphakia, and suspected optic-nerve damage.

Conclusions

Persistent IOP elevation after the removal of visible lens material suggested established trabecular or traumatic outflow dysfunction. Incomplete characterization of the capsule and angle precluded the assignment of a single mechanism.