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.
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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.
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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].
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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
Research & References of Phacolytic Glaucoma|A&C Accounting And Tax Services
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