Hemolytic ghost cell glaucoma. Further studies.

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.