Phacolytic Glaucoma

Phacolytic Glaucoma

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Phacolytic glaucoma (PG) is the sudden onset of open-angle glaucoma caused by a leaking mature or hypermature (rarely immature) cataract. It is cured by cataract extraction. [1, 2, 3]

In contrast to some forms of lens-induced glaucomas (eg, lens particle glaucoma, phacoanaphylactic glaucoma), phacolytic glaucoma occurs in cataractous lenses with intact lens capsules. The available evidence implicates direct obstruction of outflow pathways by lens protein released from microscopic defects in the lens capsule that is intact clinically. The high molecular weight proteins found in cataractous lenses produce outflow obstruction in experimental perfusion studies similar to that found in phacolytic glaucoma. [4, 5, 6] Although a macrophagic response is typically present, macrophages are believed to be a natural response to lens protein in the anterior chamber rather than the cause of the outflow obstruction.

The possibility of 2 forms of phacolytic glaucoma was proposed in a recent report: (1) a more acute presentation caused by rapid leakage of lens proteins that occlude the trabecular meshwork and (2) a more gradual presentation with macrophages resulting from an immunologic response to lens proteins in the anterior chamber. [7]

United States

Phacolytic glaucoma is infrequent in developed countries, such as the United States, because of greater access to health care and earlier cataract surgery.

International

Phacolytic glaucoma occurs more frequently in underdeveloped countries.

Most cases resolve after cataract extraction with excellent improvement in vision.

No racial predilection exists.

No sexual predilection exists.

Phacolytic glaucoma typically occurs in older adults. The youngest patient reported was age 35 years.

Kanski JJ. Lens-related glaucoma. Clinical Ophthalmology. 5th ed. 2003. 239.

Richter C. Lens-induced open angle glaucoma: phacolytic glaucoma (lens protein glaucoma). Ritch R, Shields MB, Krupin T, eds. The Glaucomas. 2nd ed. St Louis: Mosby; 1996. 1023-1026.

Stamper R, Lieberman M, Drake M. Secondary open-angle glaucoma: phacolytic glaucoma. Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas. 7th ed. St Louis, Mo: Mosby; 1999. 324-326.

Kim IT, Jung BY, Shim JY. Cholesterol crystals in aqueous humor of the eye with phacolytic glaucoma. J Korean Ophthalmol Soc. 2000 Sept. 41(9):2003-7.

Mavrakanas N, Axmann S, Issum CV, Schutz JS, Shaarawy T. Phacolytic Glaucoma: Are There 2 Forms?. J Glaucoma. 2011 Mar 16. [Medline].

Khandelwal R. Ocular snow storm: an unusual presentation of phacolytic glaucoma. BMJ Case Rep. 2012. 2012:[Medline].

Mavrakanas N, Axmann S, Issum CV, Schutz JS, Shaarawy T. Phacolytic glaucoma: are there 2 forms?. J Glaucoma. 2012 Apr-May. 21(4):248-9. [Medline].

Pradhan D, Hennig A, Kumar J. A prospective study of 413 cases of lens-induced glaucoma in Nepal. Indian J Ophthalmol. 2001. Jun;49(2):103-7. [Medline].

Mandal AK, Gothwal VK. Intraocular pressure control and visual outcome in patients with phacolytic glaucoma managed by extracapsular cataract extraction with or without posterior chamber intraocular lens implantation. Ophthalmic Surg Lasers. 1998 Nov. 29(11):880-9. [Medline].

Allingham RR, Damji KD, Freedman S. Glaucomas associated with disorders of the lens: phacolytic (lens protein) glaucoma. Shields Textbook of Glaucoma. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2005: 262-3.

Chu ER, Durkin SR, Keembiyage RD, Nathan F, Raymond G. Nineteen-year delayed-onset phacolytic uveitis following dislocation of the crystalline lens. Can J Ophthalmol. 2009 Feb. 44(1):112. [Medline].

Gadia R, Sihota R, Dada T, Gupta V. Current profile of secondary glaucomas. Indian J Ophthalmol. 2008 Jul-Aug. 56(4):285-9. [Medline].

Sihota R, Kumar S, Gupta V, Dada T, Kashyap S, Insan R, et al. Early predictors of traumatic glaucoma after closed globe injury: trabecular pigmentation, widened angle recess, and higher baseline intraocular pressure. Arch Ophthalmol. 2008 Jul. 126(7):921-6. [Medline].

Alliman KJ, Smiddy WE, Banta J, Qureshi Y, Miller DM, Schiffman JC. Ocular trauma and visual outcome secondary to paintball projectiles. Am J Ophthalmol. 2009 Feb. 147(2):239-242.e1. [Medline].

Yoo WS, Kim BJ, Chung IY, Seo SW, Yoo JM, Kim SJ. A case of phacolytic glaucoma with anterior lens capsule disruption identified by scanning electron microscopy. BMC Ophthalmol. 2014. 14:133. [Medline].

Braganza A, Thomas R, George T. Management of phacolytic glaucoma: experience of 135 cases. Indian J Ophthalmol. 1998 Sep. 46(3):139-43. [Medline].

Chen TC. Lens-induced glaucomas: surgical techniques and complications. Middle East J Ophthalmol. 2004 May. 12(1):40-52.

Venkatesh R, Tan CS, Kumar TT, Ravindran RD. Safety and efficacy of manual small incision cataract surgery for phacolytic glaucoma. Br J Ophthalmol. 2007 Mar. 91(3):279-81. [Medline]. [Full Text].

Alm A, Grierson I, Shields MB. Side effects associated with prostaglandin analog therapy. Surv Ophthalmol. 2008 Nov. 53 Suppl1:S93-105. [Medline].

Kayoung Yi, MD, PhD Associate Professor, Department of Ophthalmology, Hallym University, Kangnam Sacred Heart Hospital, Korea

Kayoung Yi, MD, PhD is a member of the following medical societies: Korean Medical Association, Korean Ophthalmological Society, Korean Board of Ophthalmology

Disclosure: Nothing to disclose.

Teresa C Chen, MD, FACS Associate Professor, Department of Ophthalmology, Harvard Medical School; Director of Clinical Affairs, Glaucoma Service, Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Teresa C Chen, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Women in Ophthalmology, Inc

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Inci Irak Dersu, MD, MPH Associate Professor of Clinical Ophthalmology, State University of New York Downstate College of Medicine; Attending Physician, SUNY Downstate Medical Center, Kings County Hospital, and VA Harbor Health Care System

Inci Irak Dersu, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Richard W Allinson, MD Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Phacolytic Glaucoma

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