Posters

Rare and challenging cataract operation on a patient with phacomorphic glaucoma

Poster Details

First Author: C.Papandreou UK

Co Author(s): M. Khan                    

Abstract Details

Purpose:

To emphasise the challenges of performing conventional phacoemulsification operation on a lens induced glaucoma patient.

Setting:

Urgent Eye Clinic, Lister Hospital, East and North Hertfordshire NHS Trust, UK

Methods:

We report a rare case of challenging conventional cataract operation on a patient with phacomorphic glaucoma. An 83 year old male patient was referred by the optician to the Urgent Eye Clinic with presence of an asymmetric mature lens, counting fingers visual acuity, angle closure, and intraocular pressure of 52 in the affected eye which led to the diagnosis of phacomorphic glaucoma. Mydriatics, corticosteroids, and aqueous suppressants successfully ameliorated the patient’s intraocular pressure to 19. The following day patient underwent peripheral iridotomies and a week later he was scheduled for conventional phacoemulsification operation.

Results:

Right pupil was partially dilated and minimally reactive without an afferent pupillary defect. The patient had a Maluygin ring inserted to manage atrophic small pupil, he had shallow anterior chamber. During the operation, it was revealed that the patient had zonular dehiscence, phacodonesis was noted as well, hence capsular tension ring was used before the removal of the lens, bag was intact and intraocular lens was inserted in the bag. One week following the cataract operation, intraocular pressure was 15, visual acuity was 6/12, patient very satisfied with the outcome of the procedure. No post operative complications were reported.

Conclusions:

To underline the role of cataract surgery in the phacomorphic glaucoma patient, in terms of the effect on intraocular pressure, to point out the challenges it can present intraoperatively. This case was rare given that zonular dehiscence is often managed with intracapsular extraction with aphacia and secondary lens implantation, furthermore it is common practice to perform extracapsular or even intracapsular cataract extraction with trabeculectomy for the management of lens induced glaucoma, however we managed to perform conventional phacoemulsification operation with intraocular lens implantation in the bag successfully and uneventfully.

Financial Disclosure:

None