Ocular Pathology

Anatomy and pathology of the human eye. Use it to review eye pathology for Ophthalmology Board Review or OKAP.

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Saturday, March 01, 2008


Definition: Glaukomflecken was described clinically as flecks of patchy anterior subcapsular opacities associated with severe elevation of intraocular pressure. Glaukomflecken is also referred to as cataracta disseminata subepithlias, and glaukomatosa acuta).
History: In 1931 Vogt first described cases of disseminated subepithelial lens opacities in patients after an acute attack of glaucoma [1].
Incidence/ Prevalence: The precise incidence is not known.

Etiology: Glaukomflecken results from infarction of anterior lens epithelial cells. Glaukomflecken has been reported frequently after acute angle closure glaucoma. Some suggest that obstruction of outflow with a resulting milieu of toxins results in the necrosis or that pressure exerted from corneal-iris/lens touch may cause the disorder [2].
Clinical Findings: After an episode of acute glaucoma accompanied by severe elevation of intraocular pressure, the lens may develop the irregular patches of anterior subcapsular opacification of glaukomflecken. Hypopyon has been associated, albeit rarely, with glaukomflecken and an acute intraocular pressure rise.[3]

Histopathology: Foci of anterior subcapsular epithelial cell necrosis may be seen with anterior cortical cataract. [4].These changes may be seen after trauma or with lens iris adhesion. In the case shown of severe intraocular pressure after traumatic hyphema arrow 1 points to the erythrocytes in the anterior chamber. Subcapsular epithelium sports either effete nuclei (arrow 2) or apoptotic/necrotic nuclei (arrow 3) in association with globular degeneration of anterior cortical lens fibers (arrow 4).
Treatment: New lens fiber growth continues after the glaukomflecken episode.[5] Of course management of intraocular pressure and appropriate therapeutic maneuvers directed at the underlying disorder as treatment of lens opacity as needed.
1. Vogt A: Lehrbuch und Atlas der Spaltlampenmikroskopie des lebenden Auges. Zweiter Teil: Linse und Zonula. Berlin: Julius Springer; 1931:565.
2. Winstanley J: Iris atrophy in primary glaucoma. Trans Opthalmol Soc UK 1961;81:23-38.

3. Eu Eong KG et al. Int Ophthalmol. 1993;17:127-9.
4. Anderson DR: Pathology of the glaucomas. Br J Opthalmol 1972;56:146-157.

5. Yip et al. Can J. Ophthalmology 2007;42:321-2.

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