Unintentional lens injury in glaucoma surgery.

In 1891, Priestly Smith wrote that in glaucoma surgery, "the lens is occasionally wounded, unsuspected by the operator," and described serious consequences. In 1953 Christensen and McLean found histologic evidence of perforation of the lens capsule in many eyes which had been enucleated after unsuccessful glaucoma surgery. Twelve additional enucleated eyes with lens perforations plus clinical consultations indicate that unintentional surgical injuries to the lens still are occurring during iridectomies, filtrations, and trabeculectomies and usually are unsuspected by the surgeon. This injury should be considered when a lens opacity becomes manifest within a few days or weeks after surgery. In addition to failure of the operation, the consequences vary from limited cataract formation to complete opacification and subluxation of the lens. The lens injury also may cause a severe phacogenic uveitis which requires early lens extraction to avoid extensive intraocular fibroplasia. Clinical features and histopathology are presented with illustrative cases. The prevention and management of unintentional lens injury are discussed.