Posters

Phacolytic glaucoma: a lot can be salvaged

Poster Details

First Author: S. Saha INDIA

Co Author(s):    A. Mohanta                    

Abstract Details

Purpose:

Phacolytic glaucoma is an acute clinical condition caused by leakage of high molecular weight lens protein from hyper- mature cataracts into the anterior and posterior chambers of the eye which blocks the trabecular meshwork leading to high intraocular pressure and also elicits severe inflammatory reaction. This is an ophthalmic emergency situation, requiring prompt medical and surgical intervention. This study correlates the post-management visual outcome with the clinical presentation, initial medical management given, surgical events and post-operative course.

Setting:

This retrospective study includes 18 patients of phacolytic glaucoma, managed in a tertiary care hospital in West Bengal, India.

Methods:

Immediate medical management was done with topical steroids, cycloplegics, anti-glaucoma medicines and mannitol infusion if not contraindicated. Cataract extraction was performed on the same or following day. Manual Small Incision Cataract Surgery (MSICS) was performed in most cases after preoperative mannitol infusion. Corneal epithelial scraping was done. Initially small anterior capsulorhexis was done. Escape of milky cortex reduced intralentricular pressure. Anterior capsulorhexis was enlarged further before delivering nucleus into anterior chamber. Single piece IOL was implanted in capsular bag in MSICS cases. Post-operatively topical steroids and cycloplegics were administered and patients were followed-up at 2 weeks.

Results:

Most patients reported within 5 days of symptom-onset. At presentation all of them had poor vision with only perception of light (PL). 12 patients had intraocular pressure of ≥30 mmHg. MSICS was performed in 16 patients. Post-operatively at 2 weeks, visual equity was ≥ 6/18 in 9 patients. Corneal oedema in 3 patients and raised intraocular pressure in 2 were responsible for reduced vision in 5 patients. Ocular fundus examination revealed various degrees of optic disc pallor in 12 patients. At 6 weeks, 12 patients had improved visual equity of ≥6/18.

Conclusions:

Early presentation, proper diagnosis, immediate medical followed by surgical intervention were associated with good treatment outcome. Patients with late presentation had severe corneal oedema, weak zonules and optic disc damage. Immediate medical management should be administered in all patients reporting in OPD and surgical intervention should be performed preferably within 24 hours.

Financial Disclosure:

NONE