Late onset lens particle glaucoma as a consequence of spontaneous dislocation of an intraocular lens in pseudoexfoliation syndrome

PURPOSE: To report acute onset lens particle glaucoma associated with pseudoexfoliation-related dislocation of an intraocular lens implant 12 years after cataract surgery. METHODS: Case report. RESULTS: An 80-year-old woman presented with acute onset of left eye pain that was associated with white fleck-like particles circulating in the anterior chamber and an intraocular pressure of 48 mm Hg. The posterior chamber intraocular lens within the capsular bag was positioned more posteriorly to the iris plane than usual, and pseudoexfoliative material was present on the lens capsule and the zonules. Anterior chamber aspirate confirmed the presence of lens cortical fibers. CONCLUSION: Spontaneous dislocation of the posterior chamber intraocular lens in patients with pseudoexfoliation syndrome several years after cataract surgery may liberate lens cortical material, causing lens particle glaucoma.     

个性化方案治疗恶性青光眼的疗效分析

目的:探讨恶性青光眼的个性化治疗方法。方法:回顾分析2016-01/2018-10在我院眼科中心接受治疗的恶性青光眼患者19例19眼的临床资料,观察治疗前后的最佳矫正视力(LogMAR)、眼压、前房深度及并发症。结果:选取的患者中7眼经药物治疗后眼压下降、前房恢复,3眼行YAG激光虹膜周边切除+后囊膜切开+玻璃体前界膜切开,5眼行白内障超乳化+人工晶状体植入+前部玻璃体切除+后囊膜切开术,2眼行前部玻璃体切除+后囊膜切开,1眼行玻璃切除术,1眼在术中发生恶性青光眼患者予以玻璃腔水囊穿刺抽液后完成小梁切除+白内障超声乳化吸出术。术后患眼均眼压下降,前房恢复,部分患者视力提高。眼压由治疗前31.25±5.19mmHg降至治疗后14.43±3.46mmHg (P<0.05),前房轴深由治疗前0.69±0.57mm恢复至治疗后2.64±0.47mm(P<0.05),术前最佳矫正视力为0.71±0.25,术后为0.34±0.19(P<0.05)。除1眼出现低眼压、脉络膜脱离外,其余患者未见明显严重并发症。结论:恶性青光眼发生后需充分评估患者具体情况,根据患者病情采取个性化的治疗方法。     

高眼压青光眼的滤过手术治疗

目的:探讨在高眼压状态下行青光眼滤过手术的方法和技巧,并观察疗效。方法:选取高眼压青光眼患者50例,手术前眼压>40mmHg。行复合式小梁切除(小梁切除+虹膜周切术),提前前房穿刺减压,手术中巩膜瓣下及筋膜下使用MMC(0.2或0.4g/L),较宽的虹膜根切口,根据手术中眼压和前房形成状况选择玻璃体腔穿刺抽液,做巩膜瓣可调整缝线。结果:术后随访3mo,视力提高26例,不变24例。41例眼压<21mmHg;1例术后1wk出现浅前房,再次行前段玻璃体切除、前房成形术;1例行白内障摘出、后囊截开、前房成形术;2例2mo后行睫状体光凝;5例患者术后1mo眼压升高,联合使用1～2种降眼压药物后,眼压控制在21mmHg以下。结论:高眼压状态下行青光眼滤过手术,需要改良、细化手术的部分操作,可以提高手术成功率,挽救残存视力。     

Trabeculectomy with anterior vitrectomy in aphakic and pseudophakic glaucoma

In 15 eyes with uncontrolled aphakic/pseudophakic glaucoma, trabeculectomy with anterior vitrectomy was performed. Mean pre-operative intraocular pressure (IOP) was 38.2 ± 6.7 mmHg and mean post operative IOP was 19.3 ± 5.2 mmHg after follow-up of 11.2 2 months. The anterior chamber maintainer technique during vitrectomy has been employed. Success rate (IOP < 21 mmHg with or without glaucoma medication) was 80 %. Visual acuity remained unchanged in 4 eyes, improved in 5 eyes and worsened in 6 eyes. Post-operative complications included: two eyes with cystoid macular edema, two eyes with choroidal effusion and prolonged hypotony, one eye with self-absorbing vitreus hemorrhage and one eye with some opacification of the corneal graft. In aphakic/pseudophakic glaucoma where vitreus is filling the anterior chamber - a combined trabeculectomy with anterior vitrectomy is indicated for removal of vitreus from the sclerostomy site with better aqueous flow through the sclerostomy and adequate control of IOP.     

Malignes Glaukom nach stumpfem Bulbustrauma

PURPOSE: Ciliary block glaucoma most commonly occurs after intraocular surgery. We report a case of malignant glaucoma following blunt trauma of the eye with no previous surgery or laser. PATIENT: A 54-year-old female suffered from acute elevation of intraocular pressure on her right eye after blunt trauma 2 months earlier. As a variety of topical and systemic antiglaucomatous drugs and the presence of a patent iridotomy could not control intraocular pressure (IOP) and the anterior chamber remained flattened, ciliary block glaucoma was diagnosed. Subsequent surgical treatment included pars plana vitrectomy (PPV), phacoemulsification with implantation of an intraocular lens, a second PPV with trabeculectomy and mitomycin-C, eccentric YAG-laser capsulotomy, and a third PPV with zonulo-iridectomy and endolaser-induced zonular shrinkage. After this variety of surgical approaches, a stable and deep anterior chamber could be achieved with an average IOP of 10 mmHg. CONCLUSIONS: Ciliary block glaucoma may occur after blunt trauma of the eye even without a history of intraocular surgery or laser. In addition, our case demonstrates the uncertainty of surgical success in affected patients.     

25G前段玻璃体切除术治疗极浅前房青光眼合并白内障的疗效和安全性

目的：观察巩膜瓣下25G前段玻璃体切除术在超声乳化联合小梁切除术治疗极浅前房青光眼合并白内障中的安全性及有效性。

方法：回顾性分析18例18眼青光眼合并白内障患者(8例男性,10例女性),其中11眼为原发性急性闭角型青光眼,7眼为晶状体半脱位继发青光眼。所有患者经保守治疗后眼压不能控制,均接受白内障超声乳化并人工晶状体植入术、小梁切除术及巩膜瓣下前段玻璃体切除术。主要观察指标为最佳矫正视力、前房深度、眼压、裂隙灯显微镜、降眼压药物、眼底及并发症情况。

结果：患者平均眼轴为21.5±0.6 mm,平均年龄为62.3±7.9岁。术前平均前房深度0.78±0.43 mm,术后1wk平均前房深度2.89±0.41 mm(P<0.001)。术后1wk平均眼压16.72±6.28 mmHg,较术前平均眼压43.28±9.38 mmHg显著下降(P<0.001)。均未发生如眼内炎、视网膜脱离、脉络膜上腔出血、角膜内皮失代偿、恶性青光眼等并发症。

结论：巩膜瓣下25G前段玻璃体切除术在超声乳化联合小梁切除术治疗极浅前房青光眼合并白内障是安全有效的。

     

Weill-Marchesani syndrome. Late athalamia following antiglaucomatous surgery

PURPOSE/METHOD: A case of a patient with Weill-Marchesani syndrome who developed a secondary glaucoma due to synechiae in both eyes is described. As intraocular pressure (IOP) could not be controlled with medical treatment in the left eye (LE), the patient underwent glaucoma filtering surgery. IOP was controlled and no complications occurred. However, 15 months later, athalamia stage 1 was diagnosed in the LE, without any alterations in the posterior pole. To solve this complication, a vitrectomy with lens extraction and intraocular lens implantation in the LE was performed. Currently, IOP is 12 mmHg and the anterior chamber remains deep. RESULTS/CONCLUSIONS: The association of vitrectomy and lens surgery in those cases where there is a predisposition to forward movement of the lens, might reduce intra and postoperative complications.     

25G+微创玻璃体手术治疗人工晶状体植入术后恶性青光眼

目的：观察应用25G+微创玻璃体手术治疗人工晶状体植入术后恶性青光眼的临床效果。

方法：回顾性分析2013-01/2016-07在我科就诊的人工晶状体植入术后恶性青光眼确诊患者18例18眼。术前患眼视力手动～0.5,患眼眼压18.3～56.8(平均35.21±10.43)mmHg,眼轴长度19.60～22.46(平均20.63±0.48)mm,中央前房深度0.98～1.86(平均1.31±0.22)mm。所有患者均接受25G+经睫状体扁平部前部玻璃体切除联合后囊膜切开手术治疗。观察治疗前后患者视力、眼压、前房深度、前房炎症反应及并发症等情况。

结果：术后随访6～12(平均9)mo。末次随访：患者最佳矫正视力0.2～0.8,与术前视力比较差异有统计学意义(P<0.01); 眼压12.3～19.8(平均16.05±2.46)mmHg,与术前眼压比较差异有统计学意义(t=7.59,P<0.01); 前房深度1.89～3.49(平均2.42±0.47)mm,与术前前房深度比较,差异有统计学意义(t=9.07,P<0.01); 术后早期1眼术后眼压为8mmHg,经抗炎治疗恢复正常,末次眼压为15mmHg; 所有患者无角膜内皮细胞失代偿、人工晶状体夹持、眼内出血、感染、眼压失控等严重并发症发生。

结论：25G+微创玻璃体手术可安全有效地治疗白内障术后恶性青光眼。     

优化恶性青光眼治疗方法

目的：：探讨恶性青光眼治疗方法的选择。方法：设计回顾性病例分析,回顾分析2012-05/2013-05在我院眼科中心接受治疗的21例恶性青光眼患者的临床资料,21例21眼恶性青光眼患者,发生于小梁切除术后16眼(76%),青光眼引流钉术后3眼(14%),青光眼引流阀术后2眼(10%)。主要指标矫正视力、眼压、前房深度及并发症。结果：患者13眼经药物治疗后眼压下降前房恢复,4眼行玻璃体水囊抽吸+前房成形术,2眼行白内障超声乳化+人工晶状体植入术,2眼(白内障术后)行前部玻璃体切除+后囊膜切开,术后均眼压下降恢复前房。眼压由治疗前29.81±4.98 mmHg 降至治疗后12.71±3.77 mmHg ( P=0.00),前房轴深由治疗前0.41±0.34 mm 升至治疗后2.13±0.54mm(P=0.00),术前矫正视力0.19±0.17,术后矫正视力0.20±0.16(P=0.36)。除1眼行玻璃体水囊抽吸后少量玻璃体出血,给予药物治疗后玻璃体出血吸收,余所有患者在治疗过程中及治疗后均未见明显眼部或全身不良反应。结论：及早发现恶性青光眼,采用循序渐进的方法治疗恶性青光眼效果明显,能够降低眼压,恢复前房。     

超声乳化白内障吸出为主的睫状环阻滞性青光眼手术治疗模式探讨

目的探讨超声乳化白内障吸出为主的睫状环阻滞性青光眼治疗模式的可行性。设计回顾性病例系列。研究对象北京同仁医院青光眼滤过术后药物治疗无效合并有白内障的睫状环阻滞性青光眼患者12例12眼。方法对所有患眼优先行透明角膜切口超声乳化白内障吸出联合折叠式人工晶状体（IOL）植入术,必要时联合术中抽玻璃体水囊及房角分离术;无效者再行Nd：YAG激光晶状体后囊膜及玻璃体前界膜切开或前部玻璃体切割术。除常规检查外,手术前及手术后2周行超声生物显微镜检查。术后平均随访（15．8±5．2）个月。主要指标眼压、中央前房深度及视力变化。结果12眼中术前平均中央前房深度（0．38±0．17）mm,平均眼压（31．50±3．50）mmHg。5／12眼经单纯超声乳化白内障吸出折叠式IOL植入术联合房角分离术;5／12眼又联合Nd：YAG激光晶状体后囊膜及玻璃体前界膜切开术;2／12眼又联合前部玻璃体切割术。术后2周平均中央前房深度（2.31±0．37）mm;末次随访时平均眼压（14．60±4．80）mmHg;视力提高或不变。结论本文小样本的资料显示,药物治疗无效的睫状环阻滞性青光眼病例先行白内障超声乳化吸出术,无效者依次行Nd：YAG激光晶状体囊膜、玻璃体前界膜切开及前部玻璃体切割术的治疗模式是可行的。（眼科,2012,21：43-46）     

恶性青光眼的临床特点与防治方法

目的探讨恶性青光眼的临床特点与防治方法。方法回顾分析12例（13只眼）恶性青光眼的临床资料及治疗方法。本组病例角膜直径9．5—11mm,平均10．8mm。眼轴长17．8～22．5mm,平均21．9mm,发生于慢性闭角型青光眼小梁切除术后11只眼,占84．6％。6只眼行药物治疗,其中2只眼联合YAG激光治疗;5只眼行晶状体摘除联合人工晶状体植入、后囊截开、前部玻璃体切除术;2只眼行晶状体摘除联合人工晶状体植入、小粱切除术,再次经睫状体平部行前部玻璃体切除、晶状体后囊膜部分切除术。结果出院时患者眼压在10-15mm Hg,中央及周边前房形成。随访观察10个月至5年,平均20个月,前房稳定,眼压15—21mm Hg,平均18．7mm Hg。结论恶性青光眼好发于小角膜、短眼轴的慢性闭角型青光眼小梁切除术后,药物治疗、无晶状体眼联合Y-AG激光治疗可以控制部分恶性青光眼,晶状体摘除联合人工晶状体植入、后囊截开、前部玻璃体切除手术可以治愈药物不能控制的恶性青光眼。     

晶状体全脱位所致青光眼的手术治疗

目的评价玻璃体切除联合晶状体超声粉碎及小梁切除术治疗晶状体全脱位所致青光眼的疗效。方法共收治9例（9眼）外伤性晶状体全脱位所致青光眼病例，这砦病例都具有以下共同特点：晶状体全脱位于玻璃体腔；瞳孔散大，前房消失；眼压在40mmHg以上（1mmHg=0．133kPa），而且药物治疗无效。术中先用玻璃体切除器切除玻璃体后，再用晶状体超声粉碎器将晶状体吸引至玻璃体腔中央行晶状体超声粉碎术，术毕作常规小粱切除术。结果术后视力提高到眼前数指者2眼，0．1～0．3者3眼，0．3以上者4眼，术后眼压15—20mmHg者5眼，2l，24mmHg者4眼，经滴降眼压滴眼液后，眼压降至20mmHg以下。结论玻璃体切除联合品状体超声粉碎及小梁切除术治疗晶状休全脱位所致青光眼，具有眼内组织损伤小，术后散光轻及并发症少等优点。     

多联手术治疗晶状体悬韧带松弛继发急性闭角型青光眼

目的　探讨多联手术治疗晶状体悬韧带松弛继发急性闭角型青光眼的临床疗效。方法　回顾性病例研究。２０１２年３月至２０１４年５月在河北省眼科医院白内障科就诊的晶状体悬韧带松弛继发急性闭角型青光眼患者２３例（２３眼）,采用微切口囊袋内预劈核超声乳化联合张力环植入、前部玻璃体切割和房角分离术进行治疗。术后随访观察最佳矫正视力、眼压、前房深度以及前囊收缩情况、后囊膜混浊程度、人工晶状体的居中性。结果　术后３个月最佳矫正视力＞０．６～１．０者８眼,＞０．３～０．６者１２眼,０．１～０．３者３眼。术后３个月最佳矫正视力较术前增加,差异有统计学意义（ｔ＝３６．２２５,Ｐ＜０．０１）。所有患者术后１ｄ眼压均下降至正常,为１０．３～１６．５（１４．２±１．９）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）,与术前相比差异有统计学意义（ｔ＝２７．９０２,Ｐ＜０．０１）。术后随访３个月,未见眼压明显波动。术中未出现灌注液迷流综合征,术后未发生恶性青光眼。术后３个月所有患者人工晶状体居中性良好,未出现囊袋收缩、后发性白内障等并发症。结论　采用多联手术治疗晶状体悬韧带松弛继发急性闭角型青光眼可以取得满意的疗效。     

Surgical management of crystalline lens dislocation into the anterior chamber with corneal touch and secondary glaucoma

We present a 53-year-old man with a crystalline lens that spontaneously dislocated anteriorly with corneal touch and secondary glaucoma. A dry anterior vitrectomy and partial intercapsular lensectomy were performed using a limbal approach to control intraocular pressure (IOP) and decrease the lens volume. The lens capsule was gently separated from the corneal endothelium with viscoelastic material, after which a bimanual lensectomy was performed with a vitrectomy probe and a phacoemulsification microflow tip. The risk for expulsive choroidal hemorrhage, which can occur during large-incision, open-chamber surgery; a sudden IOP decrease; and significant damage to the corneal endothelium were avoided with this technique. After secondary intraocular lens scleral fixation, the final visual acuity was 20/25.     

Ciliochoroidal effusion after remission of lens-induced glaucoma detected by ultrasound biomicroscopy

PURPOSE: To report the results of ultrasound biomicroscopy(UBM) cases of ciliochoroidal effusion after a lens-induced glaucoma attack. CASES: Case 1 was an 83-year-old female. She had shallow anterior chamber with expanded cataract with exfoliation in her right eye. Intraocular pressure(IOP) of the right eye was 64 mmHg. On the next day, IOP was reduced to 16 mmHg by conservative therapy. UBM showed circumference ciliochoroidal effusion in the right eye. On the 5th day, IOP increased to 38 mmHg. UBM was repeated and showed the disappearance of ciliochoroidal effusion. On the 9th day, phacoemulsification was done to treat the lens induced glaucoma attack. Two weeks after operation, IOP of the right eye was 6 mmHg and UBM showed ciliochoroidal effusion. Case 2 was an 85-year-old female. She had been diagnosed by an ophthalmologist as having an attack of lens-induced glaucoma in her left eye. IOP was 46 mmHg. When she was referred to us, IOP was decreased to 24 mmHg and ciliochoroidal effusion was observed in her left eye by UBM. CONCLUSION: We report two cases of ciliochoroidal effusion associated with lens-induced glaucoma attack. UBM is useful to observe changes in the ciliary body after lens-induced glaucoma attack.     

迟缓型恶性青光眼的特点及治疗方法的选择

目的:探讨迟缓型恶性青光眼的特点及治疗方法的选择。方法:观察12例(14眼)迟缓型恶性青光眼出现的时间、眼压、前房深度及处置方法的选择。结果:术后出现恶性青光眼的时间1～8(平均3.1)mo;前浅房程度:Ⅱ°:7眼,Ⅲ°:7眼;眼压:28～46(平均34.6)mmHg。3眼经药物治疗后恢复前房;其余分别选择手术治疗;2眼行玻璃体水囊抽吸+前房成形术;2眼行玻璃体水囊抽吸+前房成形+Phaco+后囊截开术;3眼行前部玻璃体部分切除+Phaco+后囊截开术;4眼行前部玻璃体部分切除+Phaco+后囊截开+IOL术;术后均恢复前房。术后眼压14～23(平均18.3)mmHg。结论:慢性炎症刺激引起的瞳孔后粘连是迟缓型恶性青光眼发生的主要原因。前部玻璃体部分切除+Phaco+后囊截开+IOL术是迟缓型恶性青光眼最有效的治疗方法。     

超声乳化联合人工晶状体植入治疗急性闭角型青光眼

目的：探讨术前或术中辅助降压后超声乳化白内障吸除人工晶状体植入术治疗急性闭角型青光眼急性发作期的效果。

方法：收治87例92眼急性闭角型青光眼患者,入院时眼压均在45.0mmHg以上,术前通过全身及局部使用最大剂量降眼压药物处理,眼压能降至25.0mmHg以下者于降压后2～3d内行白内障超声乳化吸除人工晶状体植入手术(60眼),如眼压依然高于30.0mmHg且前房深度尚可者,术前先行前房穿刺降压并于降压后1～2d内行白内障超声乳化白内障摘除联合人工晶状体植入并前房角分离术(25眼),如药物降压后眼压仍高于35.0mmHg且前房较浅,则手术时行玻璃体腔穿刺抽取部分玻璃体腔液后再前房穿刺实现降眼压后行白内障超声乳化白内障摘除联合人工晶状体植入并前房角分离术(7眼)。对术前检查和术后6mo随访检查结果进行比较分析,包括眼压、视力、手术并发症及中央前房深度和前房角宽度等。

结果：随访6mo～2a,全部病例在随访期间眼压均可控制在20.0mmHg以下,其中有2眼在6mo时需20g/L卡替洛尔滴眼液点眼。术前视力均低于0.3,术后视力：<0.1者5眼,0.1～0.3者22眼,<0.3～0.5者50眼,>0.5者15眼。前房及房角：术后前房均明显加深,房角全部开放者8眼,开放大于270度者23眼,开放≥180度者56眼,开放<180度者5眼。术后并发症：60眼出现较明显的前房反应,其中有16眼出现前房纤维素性渗出。

结论：超声乳化白内障吸除人工晶状体植入术对于急性发作的急性闭角型青光眼有良好的疗效,能及时控制眼压并挽救患者的视功能。前房穿刺或玻璃体穿刺是术前眼压控制不良者有效降眼压手段,有利于提高手术的安全性。     

眼外伤玻璃体术后青光眼应用睫状体光凝联合前房穿刺治疗观察

目的 探讨经巩膜睫状体光凝联合前房穿刺术治疗眼外伤玻璃体切除术后难治性青光眼的效果.方法 回顾复杂性眼外伤玻璃体手术后难治性青光眼41例(41只眼),采用经巩膜睫状体光凝联合前房穿刺术治疗,术后随访3-12个月.结果 41只眼中,手术前眼压是(43.14±12.37)mmHg,术后最后一次随访眼压为(19.76±7.06)mmHg,手术后眼压明显下降,(t=6.5742,P＜0.001).5只眼视力略有提高,33只眼无变化,3只眼视力下降.术后1只眼眼球萎缩.结论 经巩膜睫状体光凝联合前房穿刺术是治疗眼外伤玻璃体手术后难治性青光眼一种安全有效的方法.

Abstract：

Objective To evaluate the clinical effects of transscleral diode laser cyclophotocoagulation and paracentesis of anterior chamber for traumatic refractory glaucoma following vitrectomy.Methods Forty-one cases (41 eyes) with traumatic refractory glaucoma following vitrectomy were received the transscleral diode laser cyclophotocoagulation and paracentesis of antenor chamber, the patients were followed three to twelve months. Results The intraocular pressure (IOP) were (43.14±12.37) mmHg before treatment. IOP were (19.76±7.06) mmHg in the last following-up. IOP was significantly decreased by this surgery (P <0.001). The visual acuity in following-up, 5 eyes was unproved, 33 stable and 3 eyes decreased. One eye was atrophiabulbi. Conclusions Transscleral diode laser cyclophotocoagulation and paracentesis of anterior chamber is a safe and effective treatment for traumatic refractory glaucoma following vitrectomy.     

外伤性晶状体脱位合并青光眼手术的疗效分析

目的：回顾性评价晶状体摘除联合玻璃体切割术用于外伤性晶状体脱位合并继发性青光眼的手术疗效。
　　方法：对31例31眼因钝挫伤导致晶状体脱位,合并继发性青光眼患者分别行晶状体摘除联合前部玻璃体切割术,小梁切除术及人工晶状体植入术。随访术后1wk;1,3mo术眼眼压、视力。
　　结果：患者31眼全部成功摘除晶状体联合前部玻璃体切割术,其中联合小梁切除术6眼,植入前房型人工晶状体9眼,后房缝线固定晶状体15眼。一期植入16眼,二期植入8眼。术后31眼眼压全部控制正常。有23眼术后矫正视力0.3以上。
　　结论：晶状体摘除联合玻璃体切割术是治疗晶状体脱位合并继发性青光眼的有效手段,但应根据患者情况选择人工晶状体植入类型及联合小梁切除术,以控制眼压,恢复视功能。     

Correlation of capsular pseudoexfoliation material and iridocorneal angle pigment with the severity of pseudoexfoliation glaucoma

PURPOSE: To evaluate the correlation between the amount of pseudoexfoliation (PXF) material on the anterior lens capsule, pigment in the iridocorneal angle, presenting intraocular pressure (IOP) and severity of glaucoma in patients with PXF glaucoma/syndrome. PATIENTS AND METHODS: Anterior lens capsule PXF material and iridocorneal pigment of 98 untreated patients with PXF syndrome/glaucoma were graded from photographs and correlated with untreated IOP and indices of glaucoma severity (cup to disc ratio, and visual field mean deviation, and pattern standard deviation). RESULTS: There was a positive statistically significant correlation between the iridocorneal angle pigmentation and IOP (P=0.047, R2=0.2), but not the indices of glaucoma severity (P>0.13). There was no significant correlation between the anterior lens capsule PXF material and IOP or the indices of glaucoma severity (P>0.42). The grade of angle pigmentation, but not lens PXF, in eyes with IOP >21 mm Hg was significantly higher than in eyes with IOP < or =21 mm Hg (P=0.04). CONCLUSIONS: In patients with PXF syndrome/glaucoma, gonioscopically identified iridocorneal angle pigmentation correlates more strongly with presenting IOP than the amount of PXF material on the anterior lens capsule.