Phacomorphic Glaucoma

Phacomorphic Glaucoma

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Phacomorphic glaucoma is the term used for secondary angle-closure glaucoma due to lens intumescence. The increase in lens thickness from an advanced cataract, a rapidly intumescent lens, or a traumatic cataract can lead to pupillary block and angle closure.

Phacomorphic glaucoma is shown in the image below.

In an eye with advanced cataract formation, the lens is swollen or intumescent. Progressive reduction occurs in the iridocorneal angle. In such eyes, pupillary block glaucoma is caused by changes in the size of the lens and the position of the anterior lens surface. Angle closure may be secondary to an enhanced pupillary block mechanism, or it may be due to forward displacement of the lens-iris diaphragm.

International

Although no formal epidemiologic statistics are available, angle closure from hypermature cataracts is more common in countries where cataracts are common and surgery is not readily available.

Phacomorphic glaucoma can occur in any race.

Phacomorphic glaucoma occurs equally in men and women.

Generally, phacomorphic glaucoma is observed in older patients with senile cataracts, but it can occur in younger patients after a traumatic cataract or a rapidly developing intumescent cataract.

For excellent patient education resources, visit eMedicineHealth’s Eye and Vision Center. Also, see eMedicineHealth’s patient education articles Glaucoma OverviewGlaucoma FAQs, and Glaucoma Medications.

Tham CC, Lai JS, Poon AS, Chan JC, Lam SW, Chua JK, et al. Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study. Eye (Lond). 2005 Jul. 19(7):778-83. [Medline].

Leung CK, Chan WM, Ko CY, Chui SI, Woo J, Tsang MK, et al. Visualization of anterior chamber angle dynamics using optical coherence tomography. Ophthalmology. 2005 Jun. 112(6):980-4. [Medline].

Lee JW, Lai JS, Yick DW, Tse RK. Retrospective case series on the long-term visual and intraocular pressure outcomes of phacomorphic glaucoma. Eye (Lond). 2010 Nov. 24(11):1675-80. [Medline].

Dada T, Kumar S, Gadia R, Aggarwal A, Gupta V, Sihota R. Sutureless single-port transconjunctival pars plana limited vitrectomy combined with phacoemulsification for management of phacomorphic glaucoma. J Cataract Refract Surg. 2007 Jun. 33(6):951-4. [Medline].

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McKibbin M, Gupta A, Atkins AD. Cataract extraction and intraocular lens implantation in eyes with phacomorphic or phacolytic glaucoma. J Cataract Refract Surg. 1996 Jun. 22(5):633-6. [Medline].

Rao SK, Padmanabhan P. Capsulorhexis in white cataracts. J Cataract Refract Surg. 2000 Apr. 26(4):477-8. [Medline].

Ritch R, Shields MB, Krupin T. The Glaucomas. 1996. Vol 2:

Shields MB. Textbook of Glaucoma. 1998.

Vander JF, Gault JA. Ophthalmology Secrets. 1998.

Harpreet Gill, MD Staff Physician, Henry Ford Ophthalmology

Harpreet Gill, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Mark S Juzych, MD, MHSA Chief, Department of Ophthalmology, Harper Hospital; Associate Chair and Program Director, Associate Professor, Department of Ophthalmology, Kresge Eye Institute, Wayne State University School of Medicine

Mark S Juzych, MD, MHSA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, Association for Research in Vision and Ophthalmology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Anju Goyal, MD Assistant Professor of Ophthalmology, Director for Medical Student Clinical Education, Ophthalmology, Kresge Eye Institute, Wayne State University School of Medicine

Anju Goyal, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology

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.

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

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.

Phacomorphic Glaucoma

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