Phacolytic Glaucoma Research Articles

Phacolytic Glaucoma Diagnosed by Cytopathology: A Clinicopathologic Case Series

ABSTRACT Purpose The aim of this study was to describe the clinical presentation, histopathologic characteristics, and management of phacolytic glaucoma. Patients and Methods The database at the Florida Lions Ocular Pathology Laboratory was searched for surgical specimens at the Bascom Palmer Eye Institute. Patients with a diagnosis of “phacolytic glaucoma” on cytopathology between the years of 1997 and 2023 were included (n = 15). Patient demographics, anatomic site, laterality, clinical features, and ocular examination findings were obtained from available medical records. Results The diagnosis of phacolytic glaucoma was established by light microscopic examination of cytology specimens in 15 eyes (Right = 8, Left = 6, not specified = 1). Between 1997 and 2023, there were 32 cytopathology cases with a preoperative diagnosis of phacolytic glaucoma. From this group of 15 cases, there were nine males and six females. Mean age was 64.2 years (Range: 39–87). Thirteen samples were from the anterior chamber and two were obtained from the vitreous. All 15 cases (100%) demonstrated histiocytes with engulfed foamy and/or granular presumed lenticular material. CD68 immunohistochemistry was positive within histiocytes in four cases that were stained (100%). Of the available medical records, clinical features, and ocular examination findings included: eye redness, decreased vision, eye pain, anterior chamber inflammation, dislocated or subluxed crystalline lens, cataract, and elevated intraocular pressure (average = 41.3 ± 8.67 mm Hg). Conclusions Phacolytic glaucoma is a rare complication of mature/hypermature cataracts that presents with ocular pain, decreased vision, and anterior chamber inflammation. AC paracentesis with cytopathologic evaluation is a minimally invasive, rapid technique that can aid in the diagnosis and management of this disease.

Case Report of Phacolytic Glaucoma in the Eye Department of Dr. M. Djamil Hospital Padang

A 68-year-old man came to the polyclinic at a type A hospital in West Sumatra with complaints of pain in the right eye since 3 weeks before coming to the hospital. Anamnesis and physical examination were performed on the patient and a diagnosis of phacolytic glaucoma was established. This article aims to report a case of phacolytic glaucoma which is a rare case of secondary open-angle glaucoma.

Fluid accumulation in Berger’s space in a patient with phacolytic glaucoma: A case report

Leakage of the cortical fluid behind the lens through the posterior capsule into the space between the capsule and anterior hyaloid, called as hyaloido-capsular space or Berger’s space, is a rare phenomenon that can occur in phacolytic glaucoma. It is difficult to note the retrolental fluid preoperatively due to anterior chamber flare and white hard cataract and is often first seen intraoperatively. The visual outcome in such patients is suboptimal in immediate postoperative period despite uneventful cataract surgery. We present a case of retrolental fluid accumulation in a patient of phacolytic glaucoma and Morgagnian cataract with good visual gain at 1-month post-cataract extraction with intense steroid therapy. We would like to highlight the importance of conservative management in such cases with no intraoperative intervention for the retrolental fluid.

Clinical Outcome of Manual Small-incision Cataract Surgery in Patients with Phacolytic Glaucoma

Abstract Aim and Objective: To study the clinical outcome of cataract surgery in patients with phacolytic glaucoma. Materials and Methods: This is a hospital based prospective interventional study done on 50 eyes of 50 cases of phacolytic glaucoma conducted over one year. Following initial medical management, patients underwent lens extraction through manual small incision cataract surgery (SICS). Clinical examination, best corrected visual acuity and intraocular pressure were noted preoperatively as well as postoperatively. Result: A total of 50 patients were enrolled in this study with female to male ratio of 1.5:1. The mean age of presentation was 62.48 years. Preoperative vision in the affected eye was only perception of light in all of them and IOP measured at presentation was <30 mm Hg in 11 (22%), 30-40 mm in 17 (34%), 40-50 mm in 14 (28%) and >50 mm in 8 (16%). Thirty patients (60%) had good vision in fellow eye due to pseudophakia. The average duration between the first and second eye surgery was 1-3 years. 94% of our patients were from rural areas. All patients presented within one week of the onset of symptoms. All patients underwent manual small incision cataract surgery with rigid IOL implantation in 35 patients (70%), whereas 15 cases (30%) were left aphakic and planned for secondary IOL at a later date. Intraoperative complications noted were zonular dehiscence in 38%, anterior capsular calcification which led to difficulty in anterior capsulorhexis in 32%, peripheral rhexis runoff in 20%, subluxated lens in 12% and posterior capsular rupture in 14%. BCVA at the end of 1 month was >6/12 in 21 patients (42%), 6/12-6/18 in 14 patients (28%), and <6/18 in 15 patients (30%). Among the 15 patients with vision <6/18, 14 had low vision due to aphakia, and 1 had cystoid macular edema which was treated with systemic and oral steroids and topical non-steroidal anti-inflammatory agents. Conclusion: We concluded that lens-induced glaucoma is a cause of preventable blindness, particularly in elderly patients. Factors such as ignorance, socioeconomic challenges, lack of awareness, absence of an escort, and good vision in the other eye contribute to delayed presentation. Early diagnosis and treatment, along with sequential cataract surgery, are crucial for achieving better visual outcomes and preventing complications like lens-induced glaucoma.

A Study of Visual Rehabilitation and Intraocular Pressure Control in Phacolytic Glaucoma

<i>Purpose</i>: To evaluate the visual recovery and intraocular pressure control after cataract surgery in patients of phacolytic glaucoma. <i>Methods</i>: 23 patients diagnosed clinically as phacolytic glaucoma and included in the study were operated upon using either SICS or Phacoemulsification procedure after lowering of the Intraocular pressure (IOP) and control of ocular inflammation. <i>Results</i>: Post-operatively 21.73% of patients achieved a best corrected visual acuity (BCVA) of 6/60-6/12, 43.82% had a BCVA of 4/60-6/60 and 30.43% achieved a final BCVA between 4/60 to only perception of light. However 86.95% of patients maintained an IOP less than 20 mm Hg, 8.69% had an IOP between 20-23 mm Hg and 4.34% had an IOP between 24-30 mm Hg requiring a Glaucoma filtering surgery. <i>Conclusion</i>: Patients of Phacolytic Glaucoma if present at an early stage can have a good visual recovery and well controlled IOP in the post-operative period.

The Outcome of Manual Small Incision Cataract Surgery (MSICS) Using Ruit’s Technique in Phacomorphic and Phacolytic Glaucoma at Nan Hospital, Thailand

Objective: To evaluate the visual outcome and complications of manual small incision cataract surgery (MSICS) using Ruit’s technique in the treatment of patients with phacomorphic and phacolytic glaucoma. Materials and Methods: The medical records of 150 eyes in 147 patients with phacomorphic and phacolytic glaucoma who underwent MSICS by the Ruit’s technique between January 2009 and May 2022 at Nan Hospital, were retrospectively reviewed. Out of these 150 eyes from the 147 patients, 58 eyes from 58 patients missed the six-week follow-up, and 14 eyes from 14 patients had pre-operative vision impairing pathology. Records were analyzed of the patients with pre-operative, post-operative uncorrected visual acuity (UCVA), intraocular pressure (IOP), operative time, intraoperative difficulties and complications, and post-operative complications and astigmatism in the second and sixth week after surgery for the 78 eyes out of 75 patients. Results: Seventy-eight eyes of 75 patients treated by MSICS using Ruit’s technique with IOL implanted in the posterior chamber demonstrated no significant intraoperative or post-operative complications. The post-operative UCVA at the sixth-week follow-up was 20/70 or better in 76% of the phacomorphic glaucoma group and 64% of the phacolytic glaucoma group. In the sixth week after treatment, the mean post-operative astigmatism of the phacomorphic glaucoma group was –1.4±0.9 D and –1.3±0.7 D for the phacolytic glaucoma group. The mean post-operative IOP in the sixth week after surgery for phacomorphic glaucoma and phacolytic glaucoma were 10.7±3.7 mmHg and 9.8±4.3 mmHg, respectively. Conclusion: Manual small incision cataract surgery (MSICS) using Ruit’s technique is an effective method and excellent at controlling the IOP and achieving good visual acuity with a low rate of complications for patients with phacomorphic and phacolytic glaucoma. Keywords: Ruit’s technique; Manual small incision cataract surgery; Phacomorphic glaucoma; Phacolytic glaucoma

Lens induced glaucoma – Clinical profile and prognosis in tertiary care centre

Conditions in which cataractous lens and abnormalities of lens leads to elevated intra ocular pressure have been termed as Lens induced glaucoma (LIG). Objective of our study was to know the clinical profile of patients, describe management and visual outcome in lens induced glaucoma. Hospital based prospective study conducted on 40 patients of LIG from November 2016 to October 2018 attending the outpatient department of Ophthalmology at Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute. After taking informed consent, detail history, detailed examination, IOP by Applanation tonometry, Gonioscopy, examination of posterior segment, patients diagnosed as lens induced glaucoma admitted and managed with medical and surgical treatment. Post operative day 1 visual acuity and IOP recorded and followed up on day 8 and 6 weeks for above. Data analyzed with descriptive statistics and chi square test. In our study mean age of presentation in phacomorphic glaucoma is 67.25 ± 6.58 years and phacolytic glaucoma mean age was 64.10years ± 9.78. Female to male ratio being 1.8 : 1. Phacomorphic glaucoma was found in 57% and phacolytic glaucoma in 43%. Mean IOP at presentation was 42.6mmHg ±5.36. Most of them underwent SICS + PCIOL (52.5%). Study showed that most of them had better visual acuity at the end of 6 weeks. Final IOP was 15.8 mmHg± 1.78.Our study demonstrated that lens induced glaucoma is still a challenging complication of cataract which can be prevented by early treatment of cataract. SICS is still gold standard that effectively controls IOP and gives better visual outcome.

A Rare Presentation of Intraocular Lens Opacification as Phacolytic Glaucoma

A Rare Presentation of Intraocular Lens Opacification as Phacolytic Glaucoma

Ultrasound biomicroscopy-assisted diagnosis of phacolytic glaucoma in an eye with no anterior chamber view

Ultrasound biomicroscopy-assisted diagnosis of phacolytic glaucoma in an eye with no anterior chamber view

Commentary: Impact of manual small-incision cataract surgery on outreach and training curriculum across the world.

Commentary: Impact of manual small-incision cataract surgery on outreach and training curriculum across the world.

Snowflake Vitreous Opacities in Phacolytic Glaucoma

A 66-year-old man, diagnosed with phacolytic glaucoma, had visual acuity (VA) of light perception, iridescent opacities in the anterior chamber (AC), dense cataract (A), and elevated intraocular pressure in the right eye. One week after cataract surgery, his VA was hand motion. Iridescent crystals were noted behind the intact posterior capsule in the vitreous. (B) Fundus examination showed "snowflake" opacities in the vitreous, obscuring the details of the retina. (C) Twelve weeks later, VA improved to 20/50 and the opacities in the vitreous were noted to have decreased. (D) These "snowflake" vitreous opacities are probably cholesterol crystals similar to those found in the AC, which leak through the intact posterior capsule in phacolytic glaucoma. It is a self-limiting entity, not requiring any intervention (Magnified version of Figure A-D is available online at www.aaojournal.org).

Phacolytic glaucoma at a glance

The objectives of this study were to report a case of phacolytic glaucoma with a lens-particle pseudohypopyon. This study was case report and literature review. A 66-year-old man with no comorbidities presented with gradual painless loss of vision in his left eye over 10 years. Ocular examination revealed visual acuity of 20/40 and light perception, for the right and left eye, respectively. The left eye slit-lamp examination disclosed extensive cornea guttae without edema or bullae, white fluffy material deposits on pupillary margin, poor mydriasis, hypermature cataract with intact lens capsule, and a mobile white cone-shaped deposit in the anterior chamber representing a lens-particle pseudohypopyon. Intraocular pressure was 32 mmHg. A B-scan ultrasonography was performed and showed increased anterior-posterior longitude due to posterior staphyloma and a large excavation of the optic nerve head. Corneal endothelial cell density was low, 880 cells/mm2. At this point, phacolytic glaucoma due to a hypermature cataract was diagnosed. Hypermature cataracts are commonly seen in developing countries and phacolytic glaucoma is a complication of a long-standing cataract.

AN INTERVENTIONAL STUDY ON LENS INDUCE GLAUCOMA, ITS COMPLICATION, MANAGEMENT AND OUTCOME AT A TERTIARY EYE CARE INSTITUTE

Purpose: To know the causes and modes of presentation to evolve better techniques and methodology of management of LIG. Further, to study complications preoperatively and postoperatively, also their effect on visual outcome nally. Method: It is an interventional study comprises 60 patients visiting our hospital, over a period of 12 months. Patients diagnosed as LIG are subjected to a detailed evaluation of their clinical condition, IOP, and visual acuity and are admitted for surgery (SICS with PCIOLimplant) They are further followed up for 45 days postoperatively to evaluate their BCVA and IOP. Results: It is observed, 58% of LIG cases were found to be with phacomorphic glaucoma, 38% were phacolytic glaucoma the rest were with lens particle glaucoma and subluxation or dislocation 2% each. The most affected age group was 66-76 years (40%). Poor vision (6/60 or less) was obtained in about 40% of cases who delayed their visit to the hospital for a very long time with high IOP >41mmHg. Preoperative IOP was very high(41mmHg) and above in 54% of cases, moderately high(31-40mmHg) in about 40% of cases, and only, 6% of patients were found to have IOP<30mmHg. Conclusion: Our study indicated that the 56-75years age group was most affected. The most important symptom which brought them to the hospital was pain followed by a gross diminution of vision. The cause of loss of vision was more with people who reported to the hospital too late and with sustained increased IOPfor a longer duration

Phacolytic glaucoma: a rare glaucoma case

A 70-year-old male with no known medical history presented to our hospital with severe pain in his left eye for one week. The best-corrected visual acuity was light perception. Slit-lamp examination of the left eye revealed diffuse corneal edema with major inflammation of the anterior segment. We can see some lens matter in the anterior chamber associated with an advanced white cataract. The intraocular pressure was 70 mmHg by applanation tonometry. Slit-lamp examination of the right eye was unremarkable. Phacolytic glaucoma is caused by an inflammatory process caused by the leakage of lens material through the capsule of a mature cataract. Local and general steroids and hypotonic treatments were given to reduce anterior chamber inflammation and intraocular pressure. The patient underwent extracapsular cataract extraction with intraocular lens implantation. Two weeks later, the best corrected visual acuity was 5/10 with normal ocular pressure and a quiet anterior chamber.

IOL scaffolding technique in Hypermature/ Morgagnian cataract in Manual Small Incision Cataract Surgery.

To describe surgical technique of IOL scaffolding in hypermature / Morgagnian cataract in manual small incision cataract surgery.Setting: charitable section of the hospital through direct availed services at free /subsidised cost. Interventional study. This study included 38 eyes of 38 patients operated at charitable section of the hospital through direct availed services at free /subsidised cost. IOL scaffolding in manual small incision cataract surgery was executed in 38 patients out of which 25 patients were diagnosed as hypermature cataract, pseudoexfoliation syndrome with mature cataract in 5 patients, 5 patients had phacolytic glaucoma and 3 patients had lens induced uveitis. This technique was successful in 35 out of 38 patients and was not successful in three patients in whom traditional SICS was performed in 2 patients and retro haptic iris fixation in one patient. We describe a technique which uses IOL as a scaffold in hypermature cataract in MSICS that provides a stable barrier by stretching the capsular bag in order to prevent the crumpling of the bag or whole bag removal following nucleus delivery.

Visual Outcome after Cataract Surgery in Phacolytic Glaucoma

A prospective study was conducted between March 2021 and February 2022 in the National Institute of Ophthalmology & Hospital, Dhaka, Bangladesh involving 30 patients who underwent cataract surgery for phacolytic glaucoma. The aim of this study was to see the postoperative visual outcome of cataract surgery in patients with phacolytic glaucoma. Visual acuity and development of any postoperative complications were recorded. The mean age of the patients was 60.7 years. Female to male ratio was 1.3:1. Most of the patients (67%) presented after 1 week of symptoms. On the first visit, mean preoperative intraocular pressure (IOP) was 37.5 mm of Hg. Following surgery, 93.33% had an intraocular pressure less than 21 mm Hg at discharge. Visual acuity (VA) as perception of light (PL) was found doubtful in 2 (6.67%), while PL was positive in 17 (56.66%) and HM <3/60 was in 11 (36.66%) preoperatively. At discharge, 73.33% achieved VA 6/24 or better, 5 (16.67%) had less than 6/24 and 3 (10%) less than 3/60. Cataract surgery is effective to restore visual acuity and lowering the intraocular pressure (IOP) in patients with phacolytic glaucoma.
 CBMJ 2022 July: vol. 11 no. 02 P: 120-124

Outcomes of manual small incision cataract surgery in hypermature/morgagnian cataract.

To evaluate the visual outcome and complication rate of manual small incision cataract surgery (MSICS) in hypermature morgagnian cataract (HMC). Aravind Eye Hospital, Pondicherry, India. Retrospective, single center study. Case records of patients diagnosed with HMC and who underwent MSICS from January to December 2019 were retrospectively collected. Data were analyzed for demographic details, preoperative risk factors, intraoperative/postoperative complications, and visual outcome at 1-month follow-up. 105 patients were included in the study. Preoperative risk factors like dense pseudoexfoliation were seen in 6 patients (5.7%), phacolytic glaucoma in 7 patients (6.7%), lens induced uveitis in 5 (4.7%), and phacodonesis in 30 patients (28.5%). Overall intraoperative complication rate was 14.3%, which included posterior capsular rent (n = 4), zonular dialysis (n = 7), and whole bag removal (n = 4). Due to poor posterior capsular bag support, 7 patients (6.6%) did not receive intraocular lens implantation in primary surgery. Both the intraoperative and postoperative complication rate were high in those with risk factors, and this difference was statistically significant ( P < .001 and .0005, respectively). On the first postoperative day, 70 patients (66.7%) had a corrected distance visual acuity (CDVA) better than 20/40, and at 1 month, 98 patients (93.3%) had a CDVA of 20/60 or better of which 89.5% had CDVA of ≥20/40. MSICS for hypermature cataract is relatively safe and yields adequate visual outcome. Preoperative risk factors, in addition to hypermaturity, increase the complication rate.

Phacolytic Glaucoma in an Adult with Stickler Syndrome

Phacolytic Glaucoma in an Adult with Stickler Syndrome

A Comparison of Clinical Profile and Treatment Outcomes of Phacomorphic and Phacolytic Glaucoma in a Tertiary Eye Care Hospital of India

Abstract Objective: To compare the clinical features, and treatment outcomes of phacomorphic glaucoma (PMG) versus phacolytic glaucoma (PLG) in a tertiary care eye hospital in India. Methods: A retrospective review of electronic medical record data of all patients operated for phacolytic and PMGs, between March 2013 and March 2020, was performed. Patients with a history of trauma pre-existing glaucoma or who were blind at presentation were excluded. Patients’ demographic data, clinical features, visual and surgical outcomes were analyzed. Results: There were 78 and 86 eyes with a mean age of 69.0 and 70.3 years for PMG and PLG, respectively. Time from onset of symptoms to presentation in the clinic was longer in PMG group of patients (30.7 ± 53.2 days) compared to the PLG group (15 ± 17.5 days). Visual acuities and/or intraocular pressures (IOPs) at presentation were comparable in the two groups. Corneal decompensation or scarring was 3.8% in PMG versus 2.8% in PLG. About 24.4% patients in PMG group were initially misdiagnosed and treated as either primary open angle or closed angle glaucoma, whereas there was no misdiagnosis in the PLG group. Small incisional cataract surgery (SICS) with posterior chamber intraocular lens implantation was performed in 65.4% of phacomorphic and 68.6% of phacolytic groups. Combined cataract and trabeculectomy were carried out in 8.9% of phacomorphic and 4.6% of phacolytic. Vitrectomy was required in 17.9% in phacomorphic and 12.8% in PLG, statistically significant improvement in overall mean logMAR visual acuity improved from 1.5 to 1.4, and IOP reduced by 53% by postoperative 1 week. Conclusion: Both PMG and PLG respond favorably to standard SICS, irrespective of their duration of symptoms. The final visual acuity gain and control of IOPs were comparable in the two groups.

Outcomes and favourable prognostic factors in patients of phacomorphic and phacolytic glaucoma managed by manual small-incision cataract surgery: A retrospective study.

Purpose:To evaluate the outcomes and identify favorable prognostic factors in patients of phacomorphic (PMG) and phacolytic glaucoma (PLG) managed by manual small-incision cataract surgery (MSICS).Methods:The medical records of patients with PMG/PLG who had undergone MSICS in a tertiary eye hospital between September 2014 and August 2018 were retrospectively reviewed. Regression analyses were conducted to identify the predictors associated with intraoperative or postoperative complications and a favorable final outcome at 1 month, namely, a best-corrected visual acuity (BCVA) of 6/18 or better and an intraocular pressure (IOP) of <21 mm Hg. P < 0.05 was considered statistically significant.Results:The records of 209 patients with PMG and 279 patients with PLG were eligible for the review. The mean preoperative IOP for PMG and PLG were 43.15 ± 12.9 and 40.05 ± 12.0 mm Hg, respectively (P = 0.006). A younger age (<60 years) was associated with a lower risk of severe postoperative inflammation in both PMG and PLG [OR = 0.45 (0.21–0.99); P = 0.047 and OR = 0.44 (0.23–0.83); P = 0.011, respectively]. There was no significant difference in the final mean logMAR BCVA (P = 0.21) and IOP (P = 0.36) in the two groups. The likelihood of a final IOP of <21 mm Hg was significant for symptoms less than a week [OR = 3.52 (1.2–10.2); P = 0.02] in PMG and for absence of vitreous disturbance [OR = 35.0 (3.8–325.7); P = 0.002] in PLG. A BCVA of 6/18 or better was strongly associated with symptoms for less than a week [OR = 1.58 (1.0–2.4); P = 0.043] and absence of vitreous disturbance [OR = 23.53 (5.1–108.0); P < 0.001]Conclusion:Early diagnosis and management can translate to good outcomes in PMG and PLG.