Vitrectomy for phacolytic glaucoma in a patient with homocystinuria

PURPOSE: To determine the successful treatment of uni lateral phacolytic gl aucoma by vitrectomy and trabeculectomy in a patient with homocystinuria wh ose lens had dislocated into the vitreous at least 15 years earlier. METHODS: In a 32-year-old woman with homocystinuria, bilateral dislocation of the lens into the vitreous, and phacolytic glaucoma in her left eye a th ree-port pars plana vitrectomy was performed with the patient under general anesthesia. The lens was removed and a trabeculectomy fashioned. Special p recautions for general anesthesia included preoperative aspirin and compres sion stockings for thromboembolic prophylaxis and intraoperative dextrose i nfusion, 5%, to maintain intravascular volume and prevent hypoglycemia, RESULTS: The intraocular pressure and uveitis resolved postoperatively with improvement in the visual acuity and intraocular pressure, which returned to normal without further treatment. CONCLUSIONS: Phacolytic glaucoma is best resolved by removal of the excitin g lens material. Pars plana vitrectomy with the patient under general anest hesia can be carried out safely despite the risks traditionally associated with homocystinuria. (C) 1999 by Elsevier Science Inc. All rights reserved.