Intravitreal sodium hyaluronate and secondary glaucoma after complicated phacoemulsification

We report 4 cases that presented with intractable glaucoma after complicated phacoemulsification during which sodium hyaluronate 1.0% (Healon) was used to tamponade a central posterior capsule rupture. The postoperative intraocular pressure (IOP) was uncontrolled on maximal medical therapy. In 2 patients, the IOP took 8 to 10 weeks to resolve and simultaneous ultrasound B-scans showed the presence of clear globules in the anterior and midvitreous that became smaller with conservative therapy. An early pars plana vitrectomy in 2 cases immediately controlled the IOP. The presence of globules presumed to be sodium hyaluronate in the vitreous cavity of the patients while the IOP was elevated suggests a causal relationship with the refractory secondary glaucoma.