Retrospective case series on the long-term visual and intraocular pressure outcomes of phacomorphic glaucoma

Abstract

To analyse the long-term visual acuity (VA) and intraocular pressure (IOP) outcomes in phacomorphic glaucoma. A retrospective analysis of 100 consecutive, acute phacomorphic glaucoma cases from January 2000 to April 2009 was conducted at The Caritas Medical Centre in Hong Kong. All cases underwent cataract extraction after IOP control with medication and/or laser. During a 3.1±2.6-year follow-up, the mean visual improvement was 1.1±0.9 LogMAR units with improvements in 81.7% of cases. A shorter duration from symptoms to cataract extraction resulted in greater visual improvement (r(2)=0.1, P=0.001). In all, 80.5% of the cases had IOP≤21 mm Hg without any glaucoma treatment; 19.5% required 1.6±0.7 glaucoma eye drops; and 3.7% required additional laser iridotomy or trabeculectomy for IOP control at 1.8±2.3 years. The vertical cup-disc ratio (VCDR) of the index eye was 0.6±0.3. Gonioscopy revealed an averaged Shaffer grading of 3.0±1.0 and 99±90 degrees of peripheral anterior synechiae (PAS). The Humphrey automated perimetry mean deviation was 5.2±2.7 and the pattern standard deviation was -15.9±10. Over 80% of phacomorphic patients had long-term visual improvements and normalization of IOP after cataract extraction. A shorter attack seemed to offer better VA. Post-operatively, most have open angles with some degree of PAS formation, and glaucomatous optic neuropathy is evident from enlarged VCDRs and visual field defects. At least 2 years of follow-up is useful to detect a 20% glaucoma progression possibly requiring additional glaucoma treatments.