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UNDERSTANDING PHACOLYTIC GLAUCOMA

Pathophysiology:

  • Phacolytic glaucoma results from inflammatory processes initiated by the leakage of lens material through a mature cataract capsule.

  • Altered lens protein and inflammatory cells obstruct the trabecular meshwork, precipitating glaucoma.
     

Diagnosis:

  • Recognize phacolytic glaucoma by symptoms of eye pain, photophobia, and severe conjunctival hyperemia, particularly in older individuals with pre-existing vision problems.

  • Diagnosis involves observing prominent cell or particle accumulation in the anterior chamber, a flare reaction without keratic precipitates, corneal edema, elevated intraocular pressure, and evidence of a mature cataract.

  • Pseudohypopyon may also be present, characterized by lens protein deposits layering in the inferior angle.

  • Gonioscopy typically reveals an open anterior chamber angle.
     

Management:

  • Initiate treatment with topical cycloplegia, steroids, and aqueous suppressants to alleviate inflammation and reduce intraocular pressure.

  • The primary goal is to reduce inflammation and intraocular pressure promptly.

  • Definitive treatment involves cataract extraction to address the underlying cause of phacolytic glaucoma.

Pearls:

  • Recognizing the unique clinical presentation of phacolytic glaucoma is essential for accurate diagnosis and timely intervention.

  • Effective management strategies focus on reducing inflammation and intraocular pressure to prevent optic nerve damage and preserve vision.

  • Cataract extraction offers definitive treatment and addresses the underlying cause of phacolytic glaucoma, improving outcomes and patient satisfaction.

References

1. Macovei, M. L., Canache, M., & Neagoe, M. Phacolytic glaucoma – case report. Romanian Journal of Ophthalmology, 65(2), 191-195. https://doi.org/10.22336/rjo.2021.38

2. Sharanabasamma, M., & Vaibhav, K. Management and Visual Outcome in Patients of Lens-induced Glaucomas at a Tertiary Eye Care Hospital in South India. Journal of Current Glaucoma Practice, 10(2), 68-75. https://doi.org/10.5005/jp-journals-10008-1204

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