Abstract
AimPhacomorphic glaucoma (PG) is a rare but clinically significant presentation requiring emergent cataract surgery. We chose to investigate whether the expected refractive error based on the intraocular lens (IOL) calculations differed from the expected refractive outcome post-surgery.Materials & MethodsA retrospective analysis of patients with PG between 2009 to 2018 who underwent cataract surgery and had postoperative refraction was included. Information collected included presenting and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP) pre and postoperatively, and the presence of corneal edema. Predicted spherical equivalence (SphEq) data was collected from IOL calculations, and postoperative SphEq was calculated from postoperative manifest refraction.ResultsTwenty patients with PG who underwent cataract surgery were identified; of these, 10 patients and 10 eyes who underwent manifest refraction postop were included. Mean BCVA at presentation was 20/544 [Logarithm of Minimal Angle of Resolution (LogMAR) 1.44], and mean pre-op IOP was elevated at 24.6 ± 14.2 mmHg. Mean BCVA measured at one month post-op improved to 20/192 (LogMAR 0.983). Mean IOP decreased to 19 ± 8.8 mmHg at one month post-op. The mean difference between the predicted and actual refractive error, as calculated by SphEq was 0.088 (p=0.570).ConclusionThe study shows an improvement in visual acuity and IOP post-cataract surgery in patients with PG, as would be expected. The study also demonstrates that patients ended up with a slightly more myopic refractive error than expected postoperatively, and illustrates the clinical variability in postoperative refractive outcomes from a large standard deviation. This is a new and clinically important finding, although not statistically significant, that has not been previously published.
Highlights
Glaucoma is the second leading cause of blindness worldwide and has many forms [1]
Predicted spherical equivalence (SphEq) data was collected from intraocular lens (IOL) calculations, and postoperative SphEq was calculated from postoperative manifest refraction
Mean bestcorrected visual acuity (BCVA) at presentation was 20/544 [Logarithm of Minimal Angle of Resolution (LogMAR) 1.44], and mean pre-op intraocular pressure (IOP) was elevated at 24.6 ± 14.2 mmHg
Summary
Glaucoma is the second leading cause of blindness worldwide and has many forms [1]. In adults between the ages of 40 and 80, the prevalence of glaucoma is as high as 3.54% [2]. Phacomorphic glaucoma is a rare but clinically significant subtype of secondary angle-closure glaucoma that occurs due to a hyper mature cataract [3]. The enlarged lens of the hyper mature cataract displaces the iris forward and into apposition with the conventional and uveoscleral aqueous drainage pathways, creating a secondary angle-closure [1]. Pupillary block is a well-known secondary effect of lens intumescence, and can further limit aqueous outflow [3]. The result is a rapidly increased intraocular pressure (IOP) and, closed or narrowangle glaucoma [4,5,6]. Increased IOP has the potential to induce vision loss secondary to damage of the optic nerve [4,6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
