GHOST CELL GLAUCOMA

Guest author

SANA JAMEEL

Ajmal Khan Tibbiya College

Aligarh

India 

Introduction

Ghost cell glaucoma was first described by Campbell in 1976 as=

“A transient, secondary open angle glaucoma in which the trabecular meshwork is obstructed by degenerated red blood cells known as ghost cells”.

Etiology

Ghost cell glaucoma occurs=

As a consequence of vitreous hemorrhage caused by trauma, retinal disorders such as diabetic retinopathy or in cases of intraocular tumors such as retinoblastoma. A case of Ghost cell Glaucoma has been reported following a snake bite.

Pathophysiology

Ghost cells may develop from any remaining red blood cells approximately two weeks (7-20 days) following vitreous hemorrhage.

The erythrocytes become spherical, less pliable and partially lose their intracellular hemoglobin, causing them to appear tan-colored. These are now called “Ghost cells”.

The denatured hemoglobin left in the cytoplasm binds to the internal surface of the cell membrane, forming granules termed as “Heinz bodies”.

Ghost cells once formed, remain in the vitreous cavity for months.

These vitreous ghost cells can gain access to the anterior chamber through a disrupted anterior hyaloid face, which can occur from previous surgery (e.g. capsulotomy), following trauma or spontaneously.

Ghost cells are generally 4-7 microns in size and less pliable than normal RBCs. Thus, they remain longer in the anterior chamber causing the obstruction of the trabecular meshwork and markedly increase intra-ocular pressure (IOP) ultimately developing into a secondary glaucoma.

Diagnosis

The diagnosis of Ghost cell glaucoma is largely clinical. An antecedent history of previous vitreous hemorrhage can occasionally be elicited.

IOP can be markedly high, resulting in corneal edema and pain.

On biomicroscopic examination, the anterior chamber is found to have small tan-colored cells. These may layer the lower anterior chamber imparting a candy-striped appearance.

The cellular reaction appears out of proportion to the aqueous flare or conjunctival injection.

Gonioscopically the angle appears open and normal, except for the layer of ghost cells in the lower quadrant of the trabecular meshwork.

In suspicious cases an aqueous aspirate can be taken and ghost cells observed on microscopic examination.

Differential diagnosis

Hemolytic and hemosiderotic glaucomas.

Uveitic glaucoma.

Endophthalmitis.

Neovascular glaucoma.

Management

IOP reduction is the goal of treatment for ghost-cell glaucoma.

Ghost cell glaucoma is not a permanent condition but may take months until the degenerated cells are completely removed from the anterior chamber and vitreous.

Medical therapy=

Aqueous suppressants are the first line approach. In case the IOP is uncontrolled with topical medications IV Mannitol can be used.

Surgery=

If medical management fails, irrigation of the anterior chamber may be necessary to clear blood and ghost cells.

Posterior vitrectomy is required in cases of persistent vitreous hemorrhage.

Complications

Uncontrolled IOP may lead to permanent optic nerve damage following development of glaucomatous optic neuropathy.