There was white cataract with a brownish hue inferiorly. The angleclosure can be caused by lens swelling phacomorphic glaucoma or lens dislocation ectopia lentis. Latin glaucoma, cataract, from greek glaukoma, from glaukos, gray. Vitrectomy for phacolytic glaucoma in a patient with ectopia. Glaucoma quiz 8 djo digital journal of ophthalmology. Over time, the cortical fibers degenerate into liquid protein aggregates. The presentation is a red and painful eye, history of gradual decline of visual acuity reflecting the slow maturation of the cataract, corneal edema. The chemotactic activity of lens proteins may contribute to the pathogenesis of phacolytic glaucoma or the uveitis resulting from retained cortical material after cataract extraction. Glaucoma unila free download as powerpoint presentation. Safety and efficacy of manual small incision cataract surgery. Pdf phacolytic glaucoma and lensinduced uveitis jose. Phacolytic glaucoma is an inflammatory glaucoma caused by the leakage of lens protein through the capsule of a mature or hypermature cataract fig 410.
Phacolytic glaucoma is usually considered a surgical emergency. Phacomorphic glaucoma and lens dislocation involve an angleclosure mechanism while the other forms are secondary open angle glaucomas. If the phacolytic glaucoma is of long duration more than seven days, a combined trabeculectomy may be needed to prevent postoperative iop spikes in eyes with hypermature morgagnian cataracts, one must be especially careful, as the capsule is fragile, the zonules are weak and the view is difficult due to the white, milky cortex. Phacolytic glaucoma and lensinduced uveitis springerlink. A case of phacolytic glaucoma with anterior lens capsule disruption. Increasing awareness of the syndrome of phacolytic glaucoma 1 on the part of ophthalmologists undoubtedly accounts for the decreasing number of eyes.
Medication is initiated prior to urgent lens removal to reduce iop and inflammation. Phacolytic glaucoma is a condition that is characterized by a sudden onset of elevated pressure within the eye, leading to vision loss and pain. The possibility of 2 forms of phacolytic glaucoma was proposed in a recent report. Postoperatively the iop was 22 mmhg or less in all cases. The glaucoma may occur in openangle or angleclosure forms, and there are 4 distinct variants. Treating phacolytic glaucoma american academy of ophthalmology. Phacolytic definition of phacolytic by medical dictionary. In this issue venkatesh and coworkers see page 279 from the aravind eye hospital in pondicherry, india present their results of utilizing a manual sutureless extracapsular cataract surgery msics technique to treat thirty three consecutive cases of phacolytic glaucoma.
A 52yearold man presented with acute, painful loss of vision in left eye. With a mature or hypermature cataract, leakage of high molecular weight lens protein through an intact capsule leads to trabecular meshwork obstruction figure 3. Any of a group of eye diseases characterized by abnormally high intraocular fluid pressure, damage to the optic disk, and gradual loss of vision. Her ocular history was notable for remote cataract surgery in her right eye only. Unlike lens particle glaucoma, which often has lens fragments in the aqueous humor after capsular disruption, phacolytic glaucoma occurs with a grossly intact capsule and absence of lens particles 3. Phacolytic glaucoma pg is the sudden onset of openangle glaucoma caused by a leaking mature or hypermature rarely immature cataract. An examination often reveals a grossly normal anterior chamber angle with accompanying heavy flare.
Lensinduced glaucoma is a secondary glaucoma in which the crystalline lens is involved in the mechanism of intraocular pressure iop increase. Phacomorphic glaucoma was present in 296 patients 72% and phacolytic glaucoma in 115 28%. Phacolytic glaucoma, extracapsular cataract extraction. Phacolytic glaucoma is an acute openangle glaucoma that develops from leakage of lens proteins in an eye with a mature or hypermature cataract. Care of the patient with anterior uveitis clinical. Factors affecting visual outcome in phacolytic glaucoma. The lens may cause phacolytic glaucoma due to a hypermature cataract leading to shedding of proteins which clog up the drainage system or phacomorphic. A 71yearold man was referred to our institute for increased intraocular pressure iop in the right eye. Delayed presentation of plg may make its diagnosis and management difficult and worsen its prognosis. Vitrectomy for phacolytic glaucoma in a patient with. Mavrakanas n, axmann s, issum cv, schutz js, shaarawy t. Download as ppt, pdf, txt or read online from scribd. The openangle glaucoma include glaucoma related to.
Lensinduced glaucoma in the elderly pubmed central pmc. To evaluate the safety, visual outcome and complications of manual small incision cataract surgery msics in the treatment of patients with phacolytic glaucoma. Statement of the problem anterior uveitis is an intraocular inflammation of the uveal structures anterior to the middle of the vitreous cavity. The authors report a case of a 62yearold white female, with bilateral lens dislocation into the vitreous, who presented clinical and pathological features of phacolytic glaucoma in the left eye. Patients with phacolytic glaucoma usually experience a return of good vision and an improvement in iop after surgery. Lens particle glaucoma, in contrast to phacolytic glaucoma, is secondary to a disruption of the lens capsule, which may occur after cataract surgery, penetrating lens injury, or laser posterior capsulotomy. Glaucoma is a group of eye diseases which result in damage to the optic nerve and cause vision loss. Glaucoma today phacolytic glaucoma and homocystinuria. Feb 05, 2014 pauciarticular onset 8590% of jia that have uveitis. Free, official information about 2014 and also 2015 icd9cm diagnosis code 365. Phacolytic glaucoma jama ophthalmology jama network. May 18, 2020 cholesterol crystals in aqueous humor of the eye with phacolytic glaucoma. Phacolytic glaucoma plg is a rare complication of hypermature senile cataract.
Jun 29, 2009 lensrelated glaucoma arises from a variety of pathophysiologic mechanisms. A woman aged 75 years complaining of sleep disturbing pain and inaccurate projection of rays oculus dextrus od was referred to our centre for management of nonresolving microbial keratitis with endophthalmitis. Typically unilateral, the intact lens capsule of a hypermature cataract leaks high molecular. Phacolytic, phacomorphic glaucomas, iol implantation. Thorough irrigation of all lens material should be performed. Jody piltzseymour, tak yee tania tai, in glaucoma second edition, 2015. This acute openangle glaucoma is the result of the leakage of lenticular material from senile hypermature or morgagnian cataract through an intact lens capsule figure 4. Phacolytic glaucoma or lens protein glaucoma was first described in 1900. Patients with phacolytic glaucoma typically have a history of slow vision loss for months or years prior to the acute onset of pain, redness, and sometimes further decrease in vision.
Phacolytic glaucoma mimicking endophthalmitis request pdf. Signs include increased iop associated with corneal edema, cellsflare, occasional iridescent. Rare atypical presentation of phacolytic glaucoma as non. Phacolytic glaucoma is openangle glaucoma induced by leakage of soluble contents into the anterior chamber by a hypermature or mature cataract. Phacolytic glaucoma pg is a form of glaucoma which is caused due to a leaking mature or immature cataract. Phacolytic glaucoma article about phacolytic glaucoma by. Speakers text glaucoma is a leading cause of blindness and visual impairment for americans, affecting as many as 2. Wed like to understand how you use our websites in order to improve them.
The pathogenesis of lensinduced uveitis and phacolytic glaucoma is still not fully understood. Treatment of phacolytic glaucoma with extracapsular. Secondary glaucoma group of disorders in which the raised iop is associated with a primary ocular or systemic disease. Glaucoma group of disorders characterized by a progressive optic neuropathy resulting in characteristic appearance of optic disc and a specific pattern of irreversible visual field defects associated with raised intraocular pressure. There was diffuse corneal edema that cleared after lowering iop with intravenous mannitol. Chemotactic activity of lens proteins and the pathogenesis of. Phacolytic glaucoma definition of phacolytic glaucoma by. The pathology of the outflow system in primary and.
This case report highlights the successful management, by vitrectomy alone, of a case of chronic phacolytic glaucoma secondary to a dislocated hypermature lens in the vitreous of a patient with. The need for tabeculectomy in lens induced glaucoma needs further comparative study. Patients with primary glaucoma, prior ocular hypotensive treatment, and glaucoma due to dislocated lens were excluded from the study. Opens large image view large image view hires image download.
In a nonrandomised interventional case series, 33 consecutive patients with phacolytic glaucoma underwent cataract extraction by msics, with staining of the anterior capsule by trypan blue. The differential diagnoses for phacolytic glaucoma are acute angle closure glaucoma, open angle glaucoma with uveitis, neovascular glaucoma, and glaucoma secondary to trauma. Magnified version of fig ab is available online at. This study was conducted to evaluate the visual outcome of phacolytic glaucoma, a common cause. Mar 14, 2003 vitrectomy for phacolytic glaucoma in a patient with ectopia lentis et pupillae. He had light perception vision and intraocular pressure iop of 56 mmhg. May 18, 2020 the possibility of 2 forms of phacolytic glaucoma was proposed in a recent report. The lens may cause phacolytic glaucoma due to a hypermature cataract leading to shedding of proteins which. A 70yearold woman presented with a history of 3 to 5 days of decreased visual acuity with associated pain and pressure in her left eye.
Mar 18, 2011 phacolytic glaucoma is a secondary openangle glaucoma that occurs with advanced cataract formation. Phacolytic glaucoma occurs more frequently in underdeveloped countries. Article information, pdf download for phacolytic glaucoma. As the lens ages, its protein composition becomes altered, with an increased concentration of highmolecularweight lens protein. Phacolytic glaucoma is infrequent in developed countries, such as the united states, because of greater access to health care and earlier cataract surgery. Phacolytic glaucoma is characterized by a rise in iop in the setting of a hyper mature cortical cataract with an open iridocorneal angle. Nov 19, 2014 phacolytic glaucoma is induced by lens protein or macrophages that have leaked through a macroscopically intact anterior lens capsule. The current study was undertaken to determine the efficacy of extracapsular cataract extraction ecce as a definitive treatment for phacolytic glaucoma. Chemotactic activity of lens proteins and the pathogenesis.
Keep vision in your future 4 speakers guide slide 3. A trabeculectomy was added to standard cataract surgery if symptoms endured for more than seven days, or if preoperative control of intraocular pressure iop with maximal medical treatment was inadequate. A nearly forgotten entity deepika dhingra, suman grover, gargi kapatia, surinder s pandav, and sushmita kaushik european journal of ophthalmology 0 10. This study concludes that a better visual outcome in phacolytic glaucoma depends.
Most cases resolve after cataract extraction with excellent improvement in vision. Out of these 1560% patients had phacomorphic and 1040% had phacolytic glaucoma respectively. Pdf on may 1, 2019, natasha gautam seth and others published phacolytic glaucoma find, read and cite all the. Ecce with placement of a posterior chamber intraocular lens pc iol. A case of phacolytic glaucoma with anterior lens capsule. This study concludes that a better visual outcome in. Treatment of phacolytic glaucoma with extracapsular cataract. Request pdf on mar 28, 2020, manu sharma and others published phacolytic glaucoma mimicking endophthalmitis find, read and cite all the research you need on researchgate. Openangle glaucoma develops slowly over time and there is no pain. To report a case of phacolytic glaucoma with rupture of anterior.
Inflammatory glaucoma which occurs in phacolysis is a condition which is a result of the leakage of protein within the lens into the capsule of a mature or hyper mature cataract and involves a simple procedure to be cured that is referred to as cataract extraction. Phacolytic glaucoma typically occurs in older adults. Safety and efficacy of manual small incision cataract. Most studies show that at least half of all persons with glaucoma do not know. We retrospectively analyzed 5 eyes with phacolytic glaucoma. One study from nepal diagnosed phacolytic glaucoma in 0. We report an unusual case where the dislocated cataractous lens firmly adherent to the corneal endothelium evoked a cellular reaction similar to phacolytic glaucoma but clinically appeared like a deep corneal abscess. Lensinduced glaucoma may occur as either secondary angleclosure or openangle glaucoma. The anterior chamber was deep with presence of flocculent lens matter inferiorly fig a and b.