Diagnostic Considerations
In addition to the above diagnoses, another lens-induced glaucoma, phacoanaphylactic glaucoma, may be confused with phacolytic glaucoma (PG). Phacoanaphylactic glaucoma is a delayed-onset granulomatous reaction to retained lens material, such as that occurring after disruption of the lens capsule from trauma or because of incomplete removal of lens material during cataract extraction (including gross loss of lens fragments into the vitreous cavity during cataract extraction). Pain, if it occurs at all, is often slow in onset and is associated with signs of granulomatous uveitis (eg, keratic precipitates) in contrast to the acute, severe pain that is typical of PG, which shows no signs of chronic inflammation.
Traumatic glaucomas, including angle-recession glaucoma and ghost cell glaucoma, also may be confused with PG. [12, 13, 14] A careful history and examination of the anterior chamber angle may reveal evidence of prior trauma. A history of long-standing vitreous hemorrhage should raise suspicion of ghost cell glaucoma.
Finally, in apparently aphakic eyes, the posterior segment must be inspected carefully for a dislocated lens that, when hypermature, may begin to leak and cause PG even when a cataract is not readily visible.
Differential Diagnoses
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Microscopy of the aspirate at the time of cataract extraction shows clumped, notched rectangular platelike crystals from the aqueous of a patient with phacolytic glaucoma (X160). Reproduced from J Korean Ophthalmol Soc 2000 Sep;41(9): Copyright © 2000, Korean Ophthalmological Society. All rights reserved.
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Microscopy of the aspirate at the time of cataract extraction of a patient with phacolytic glaucoma shows round, regular cells with foamy cytoplasm consistent with macrophages (*). A leukocyte (white arrow) and an erythrocyte (black arrow) also are seen (X160). Reproduced from J Korean Ophthalmol Soc 2000 Sep;41(9): Copyright © 2000, Korean Ophthalmological Society. All rights reserved.
