Hemolytic ghost cell glaucoma. Further studies
D. G. Campbell and E. M. Essigmann
Three variations of ghost cell glaucoma that occur following cataract
extraction are presented. The most common variant occurred when a large,
anterior chamber and vitreous hemorrhage complicated the immediate
postoperative course. Weeks later, as the anterior chamber hemorrhage
cleared, ghost cells that had formed within the vitreous cavity passed
forward into the anterior chamber and obstructed the aqueous outflow
channels. Ultramicroscopy of aqueous specimens confirmed that RBC ghost
were the major aqueous component and were therefore the cause of the
glaucoma, distinguishing this glaucoma from glaucoma due to macrophages and
RBC debris. Scanning and transmission electron microscopy of hemorrhagic
vitreous showed that RBCs disintegrated into ghosts and denatured
extracellular hemoglobin aggregates. The latter, common in the vitreous,
were bound within vitreous strands, accounting for their absence in the
anterior chambers of patients with ghost cell glaucoma. In correlation with
clinical findings, perfusion studies showed that neither fresh RBCs nor
ghosts could pass through an intact anterior hyaloid face.
