Phacomorphic Glaucoma

A patient with a history of chronic angle closure glaucoma (ACG) referred by local ophthalmologist to ED for evaluation. Patient had previously undergone a laser iridotomy in both eyes and had a history of chronic angle closure glaucoma. The intraocular pressure (IOP) was been controlled with Timolol, Lumigan and brimonidine.

Patient complained about severe headache, eye pain, hazy eye, OD since last day and denied eye trauma, floaters/flashes.

Best-corrected visual acuity is e/4 ft and 20/40 (+10. D OU) and the IOP by Goldmann applanation tonometry is 50 Hg OD. Anterior segment examination revealed corneal edema, a patent iridotomy, shallow anterior chamber depth, and nuclear sclerosis. Also, evidence of corneal edema, intraocular inflammation, and closed angle.

Because of the increased risk of complications during cataract extraction, deepening of the AC with pars vitrectomy was performed. Secondary intraocular lens implantation was performed three weeks later. Cataract surgery was necessary in the contralateral eye.

Phacomorphic glaucoma (PG) is a rare but clinically significant presentation requiring emergent cataract surgery.

After cataract extraction, visual recovery is expected, intraocular pressure usually doesn’t require additional surgeries.

The purpose of this presentation was to familiarize audience with the importance of identify Phacomorphic Glaucoma. We discussed the pathophysiology, clinical findings, imaging test that provided the information needed in order to safely accomplish a curative surgical treatment that preserved our patients' visual acuity.

Presentation Date: 04/27/2023

Issue Date: 05/19/2023