Ghost Cell Glaucoma
A patient with history of T2DM and HTN presented to an emergency department with 2 days of eye pain. The patient endorsed a history of CEIOL in both eyes several years prior and recent history of vitreous hemorrhage for which he had been receiving intravitreal injections. Upon presentation, the patient found to have elevated intraocular pressure (IOP) and tan-colored cells throughout the anterior chamber and the inferior angle. Exam was notably without evidence of inflammatory cells or neovascularization of the iris or angle. Given history and exam findings, as well as absence of findings to suggest an alternative etiology, a diagnosis of Ghost Cell Glaucoma was made without additional diagnostic procedures. The elevated IOP was managed with topical IOP-lowering medications, with response sufficient enough to defer paracentesis. Ghost Cell Glaucoma is a potential complication following vitreous hemorrhage. It is characterized by the migration of dehemoglobinzed erythrocytes from the vitreous into the anterior chamber. The dehemoglobinized erythrocytes cause a mechanical obstruction of the trabecular meshwork, are more effective at obstructing trabecular meshwork outflow, and thus contribute to elevated IOP. The presentation is quite variable and the management depends on initial response to medical therapy. Definitive treatment involves addressing the ghost cell reservoir with vitrectomy.
Presentation Date: 09/12/2024
Issue Date: 10/15/2024
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