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   Table of Contents      
CASE REPORT
Year : 1985  |  Volume : 33  |  Issue : 1  |  Page : 53-55

Ghost cell glaucoma


Deptt. of Ophthalmology, Christian Medical College Vellore, India

Correspondence Address:
Ravi Thomas
Department of Ophthalmology Christian Medical College, Vellore
India
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Source of Support: None, Conflict of Interest: None


PMID: 4077207

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How to cite this article:
Thomas R, Alexander T A, Joseph P, Sajeev G. Ghost cell glaucoma. Indian J Ophthalmol 1985;33:53-5

How to cite this URL:
Thomas R, Alexander T A, Joseph P, Sajeev G. Ghost cell glaucoma. Indian J Ophthalmol [serial online] 1985 [cited 2019 Aug 26];33:53-5. Available from: http://www.ijo.in/text.asp?1985/33/1/53/27334

Blood products in the vitreous can give rise to secondary glaucomas. Earlier reports ascribed this glaucoma to red blood cell debris. and macrophages which had engulfed these products. Noting the similarity to phacolytic glaucoma, this condition was named haemo­lytic glaucoma[1],[2],[3],[4].

Campbell and Grant described a secondary glaucoma associated with vitreous haemorr­hage which they thought was caused primarily by degenerated erythrocytes[5],[6],[7]. They named this condition Ghost cell glaucoma and described it as a transient secondary glaucoma resulting from obstruction of the trabecular meshwork by degenerated erythro­cytes-Ghost cells. The ghost cells develop within the vitreous cavity following haemar­rhoges of varying aetiology.

We describe two cases of Ghost cell glau­coma following blunt trauma in phakic eyes.


  Case reports Top


Case Report 1 : Mr. R. a 35 years old man presented to us with a history of pain in the left eye. He had sustained blunt trauma to the left eye with immediate loss of vision, one month before he attended the hospital.

On examination the vision in the right eye was 6/6, JI and in the left eye was percep­tion of light with an inaccurate projection.

The examination of the right eye was within normal limits. Examination of left eye revealed mild ciliary congestion. The anterior chamber showed a 2+ flare and tan coloured cells about 5-10/H.P.F. The iris and lens were normal. The pupil was semi dilated and reacting sluggishly to light. The applanation tension was 48 mmHg. Khaki coloured cells and old blood could be seen in the vitreous. On indirect ophthalmoscopy, the disc was hazily visible and appeared normal. No other fundus details could be made out. Gonioscopy showed no angle recession. A provisional diagnosis of Ghost cell glaucoma was made and the patient was put on Diamox, oral glycerol and Timolol. On this regime, the tension decreased to 10 mmHg within one week. Two weeks later the tension was again 46 mmHg with tare 3+ and khaki coloured cells in anterior chamber 10-15/ H.P.F. A diagnostic and therapeutic paracentesis was done. About 0.6 ml of fluid was obtained on paracentesis and the anterior chamber was irrigated with Hartman's Ringer lactate solution. Under the phase contrast microscope, the aspirate showed red blood cells about 6 microns in diameter with Heinz bodies-Ghost cells [Figure - 1].

The diagnosis of ghost cell glaucoma was confirmed and it was decided to maintain the patient on medical treatment. The tension after paracentesis and irrigation was 12 mm­Hg (applanation). The patient was discharged on medical treatment, and did not come for further follow-up.

Case Report 2 : Mr. E., aged 45 years, presented to us with a history of blunt injury in the right eye, sustained ten hours earlier. He had severe ocular pain and diminished vision. On examination his vision in the right eye was hand movements with an accurate projection of rays and in the left eye, 6/9 and J1. His right 'eke showed mild ciliary con­gestion, a hazy cornea and hyphaema. The pupil was semi dilated and not reacting to light. The applanation tension was 16 mmHg. Slit lamp and ophthalmoscopic examination showed vitreous haemorrhage of the right eye and therefore fundus could not be visualised. The left eye was within normal limits.

The patient was admitted and started on systemic Prednisolone and topical betametha­sone drops. The following day the hyphaema cleared up but the tension started rising in the right eye (38 mmHg applanation). He was treated with I. V. Mannitol, Diamox, glyce­rol and Epitrate. Inspite of these medications his tension remained high (42 mmHg applana­tion). Slit lamp examination showed right eye flare 2 + and khaki coloured cells in the anterior chamber. A provisional diagnosis of ghost cell glaucoma was made.

A diagnostic and therapeutic paracentesis was done. 0.5 ml. of aqueous was aspirated and sent for haematological examination which confirmed the diagnoses.

Following paracentesis the tension came back to normal. The post paracentesis vision was as 6/18 in the right and 6/9 in the left eye and tension in both eyes was 18 mmHg.


  Discussion Top


Ophthalmologists have long known that blood and blood products in the form of hyphaema following trauma can raise the intraocular pressure.

More recently a secondary glaucoma was described due to degenerated blood products that originated in the vitreous. This glaucoma was attributed to macrophages distended with red cell debris blocking the trabecular mesh­work. By contrast, ghost cell glaucoma is caused by degenerated erythrocytes or ghost cells obstructing the trabecular meshwork[5],[6]. Our cases had the typical clinical presentation of a ghost cell glaucoma following trauma. The eyes were minimally congested but had a tension of 48 mmHg. There were no keratic precipitates. The anterior chamber and vitreous had khaki coloured cells. The vitreous showed evidence of old vitreous haemorrhage. On paracentesis 0.6cc and 0.5 cc of aqueous could be aspirated. The tension was brought under control after­ irrigating the anterior chamber.

Our cases are unusual because ghost cell glaucoma is rare in the presence of the lens and an intact hyaloid face. We have to pos­tulate that the trauma caused a minute rupture in the anterior hyaloid. This is borne out by the fact that we could aspirate much more aqueous than the normal 0.25 c.c. volume of the anterior chamber in both cases indicating a free communication with the vitreous cavity.

It is important to recognize this entry as a cause of glaucoma associated with vitreous haemorrhage, as drastic steps are generally not required in its management. If the tension remains abnormally high despite medical treatment and repeated paracentesis, vitrecto­my is required[8],[9]. Ghost cell glaucoma should be differentiated from neovascular glaucoma, hemosiderotic glaucoma and uveitis. It is debatable if haemolytic glaucoma forms a separate entity and if it does, its occurrence is very rare.


  Summary Top


Two male patients presented to us after sustaining trauma in the eye with vitreous haemorrhage and raised intraocular pressure. Ghost cell glaucoma was diagnosed clinically and confirmed by paracentesis. This entity should be suspected in all cases of increased intraocular pressure associated with vitreous haemorrhage as it is usually transient, responds to medical treatment and repeated paracen­tesis, and surgery, if required, takes the form of vitrectomy and not a filtering procedure.[10]

 
  References Top

1.
Fenton, R. H., and Zimmerman, L. E., 1963, Arch. Ophthalmol, 70: 236.  Back to cited text no. 1
    
2.
Fenton, R. H., and Hunter, W. S., 1965, Surv. Ophthalmol, 10 : 255.  Back to cited text no. 2
    
3.
Phelphs, C. D., and Watzke R. C., 1975, Amer. J. Ophthalmol. 80 : 688.  Back to cited text no. 3
    
4.
Hunter, W. S , 1969, Trans Am. Acad. Ophthal­mol. Otolaryngal. 73 : 96  Back to cited text no. 4
    
5.
Campbell, D. G., and Grant, W. M., 1975, A. R. V. O. April, 1975.  Back to cited text no. 5
    
6.
Campboll, D. G., Simmons, R. J. and Grant W. M., 1976, Amer J. Ophthalmol. 81, 431.  Back to cited text no. 6
    
7.
Campbell, D. G., and Essigman, E. N., 1979, Arch. Ophthalmol, 97: 2141.  Back to cited text no. 7
    
8.
Michels, R. G., Machemer, R. and Mueller­Jensen, K., 1974.Ophthalmic Surg. 5(4) : 13.  Back to cited text no. 8
    
9.
Bruckdr, A. J , Michels, R. G., Green, W. R.. 1978. Ann. Ophthalmol. 10: 1427.  Back to cited text no. 9
    
10.
Campbell, D. G, 1981, Ophthalmology, 88:1511.  Back to cited text no. 10
    


    Figures

  [Figure - 1], [Figure - 2]



 

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