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]
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]
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.
Prognosis
Prognosis is excellent, with most patients experiencing marked improvement in vision following cataract extraction; however, delayed treatment may cause a poor outcome.
Patients with phacolytic glaucoma (PG) may have a worse prognosis than patients with phacomorphic glaucoma.
In most cases, treatment to lower intraocular pressure can be discontinued after cataract extraction. A minority of patients who have persistent intraocular pressure elevation may need long-term medical therapy or a filtering surgery to control intraocular pressure.
Patient Education
Seek a comprehensive eye examination when progressive vision loss is first noted.
For excellent patient education resources, visit eMedicineHealth's Eye and Vision Center. Also, see eMedicineHealth's patient education articles Glaucoma Overview, Glaucoma FAQs, and Glaucoma Medications.
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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.
