EyeWorld India December 2019 Issue

EWAP DECEMBER 2019 59 GLAUCOMA A case presentation on phacomorphic glaucoma, shown as an e-poster at the 23rdWinter Meeting of the European Society of Cataract and Refractive Surgeons, highlighted the damaging effect this entity can have on intraocular pressure. According to Charikleia Papandreou, MD, lens induced glaucoma may not only cause a huge, acute rise in IOP but it can pose challenges intraoperatively. “ We presented this case to emphasize the challenges of performing a conventional «>ViÕÃwV>Ì «iÀ>Ì in a lens-induced glaucoma patient,” she said. “ Our take- home message is to underline the role of cataract surgery in the phacomorphic glaucoma patient in terms of the effect on IOP and to point out the challenges it can present intraoperatively.” Phacomorphic glaucoma (lens swelling) is the term used for secondary angle closure glaucoma due to lens intumescence. The increase in lens thickness can be caused by a rapidly developing senile cataract, a quickly intumescent lens, or a traumatic cataract, which can further lead to pupillary block and angle closure and needs to be handled carefully and quickly. Case study Dr. Papandreou’s case involved an 83-year-old male patient who was referred by his optician due to the presence of an asymmetric mature lens in his without the existence of an afferent pupillary defect, and there was a shallow, right-sided anterior chamber. The patient underwent left-sided cataract surgery ÜÌ«>ViÕÃwV>Ì° À° Papandreou stained the anterior capsule with trypan blue under an air bubble to protect the endothelium and facilitate the capsulorhexis. She inserted a Malyugin ring to create more space for surgery due to the atrophic small pupil of the left eye. The surgeon noted zonular dehiscence and phacodonesis during the surgery, and then decided to insert a capsular tension ring prior to lens removal. The capsular bag remained intact and the IOL was inserted into the bag. Postoperative outcomes One week following cataract surgery, IOP was 15 mmHg in the patient’s left eye, remaining within normal limits without further interventions. Visual acuity in this eye was 6/12 and the patient was very Ã>ÌÃwi` ÜÌÌi ÕÌVi of the procedure. No other postoperative complications were reported. Phacomorphic glaucoma can be accompanied by acute pain, blurred vision, rainbow-colored halos around lights, and even nausea and vomiting. As in Dr. Papandreou’s patient, this entity frequently causes decreased vision before the onset of an acute episode related to cataract. Signs associated with phacomorphic glaucoma Phacomorphic glaucoma and cataract surgery by Stefanie Petrou Binder, MD EyeWorld Contributing Writer Contact information Papandreou: papandreoucharikleia@yahoo.gr This article originally appeared in the October 2019 issue of EyeWorld . It has DGGP UNKIJVN[ OQFKƂGF CPF CRRGCTU here with permission from the ASCRS Ophthalmic Services Corp. left eye. The patient had left- sided visual acuity of counting w}iÀÃ >` À}ÌÃ`i` ÛÃ v 6/12. Dr. Papandreou observed narrow anterior chamber angles bilaterally and high intraocular pressures of 52 mmHg in the affected, left eye, which led to the diagnosis of phacomorphic glaucoma. IOP was 22 mmHg in the patient’s right eye. Dr. Papandreou’s management of this case vVÕÃi` wÀÃÌ Ài`ÕV} the very high IOP to prevent further damage to the optic nerve, especially in the affected eye, and to prevent synechia formation. The patient was immediately administered mydriatics, corticosteroids, and aqueous suppressants, which addressed the acute nature of the angle closure and successfully lowered the patient’s IOP to 19 mmHg in his left eye and 13 mmHg in his right eye. The following day, the patient underwent peripheral iridotomies and he was scheduled for conventional «>ViÕÃwV>Ì ÃÕÀ}iÀÞ within the week. The pupil of the patient’s right eye was partially dilated and minimally reactive, Secondary angle-closure glaucoma can be caused by lens intumescence. Source: Pekka Virtanen, MD continued on page 62