APHAKIC GLAUCOMA

In a successive cataract series of 874 eyes which underwent operation for senile cataract by microsurgery, and had no preoperative diagnosis of glaucoma, 16 (1.8%) were found to have aphakic glaucoma after a follow‐up period ranging from 10 months to 6 years. Of these cases 44% (7 eyes) had pupillary block, 37% (6 eyes) canal block, and 19% (3 eyes) angle block without primary pupillary block, whereas no eye showed ciliary block. The cause of pupillary block in the present series appears to have been the use of iridotomy instead of iridectomy (in 6 of the 7 cases). In 5 of the 7 cases with pupillary block, the manifest aphakic pupillary block had been preceded by increasing vitreous herniation into the pupil, without rupture of the hyaloid membrane. This situation, designated relative aphakic pupillary block, is assumed to precede in most cases the manifest aphakic pupillary block and is therefore of diagnostic importance, unlike stationary vitreous hernia. In the group with canal block, the mean preoperative ocular tension had been higher than in the other groups. When considering also the normal postoperative gonioscopy, this makes us interpret these cases as latent simple glaucoma (canal block) rendered manifest by the cataract operation. This small series does not afford any indication to assume that a corneal cataract incision involves less risk than a corneo‐scleral incision of injuring Schlemm's canal. Treatment was predominantly surgical in the group of pupillary block, predominantly medical in the others.