Phacolytic Glaucoma

Updated: Apr 06, 2015
  • Author: Kayoung Yi, MD, PhD; Chief Editor: Hampton Roy, Sr, MD  more...
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Overview

Background

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]

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Pathophysiology

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]

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Epidemiology

Frequency

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.

Mortality/Morbidity

Most cases resolve after cataract extraction with excellent improvement in vision.

Race

No racial predilection exists.

Sex

No sexual predilection exists.

Age

Phacolytic glaucoma typically occurs in older adults. The youngest patient reported was age 35 years.

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