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First Author: A.Rueda-Villa MEXICO
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To describe the postoperative outcomes of a patient with phacolytic glaucoma treated with manual small incision cataract surgery.
A 67-year-old man presented to our institution with sudden decrease in visual acuity as well as severe pain, redness, photophobia, tearing, and corneal opacity in the left eye for 3 days. He underwent cataract extraction surgery with an iol implant in the right eye 20 years ago but had no history of importance for the present condition.
The patients best-corrected visual acuity in the right eye was 20/70 and in the left eye was light perception. His IOP was 16 mm Hg in the right eye and 56 mm Hg in the left eye. Slit-lamp examination revealed an IOL in the right eye and the left eye with conjunctival hyperemia, ciliary reaction, corneal edema, intense flare with iridescent particles in the anterior chamber, and hipermature cataract.
We diagnosed him with phacolytic glaucoma and started topical treatment with prednisolone, tropicamide with phenylephrine, and ocular antihypertensive treatment with timolol, dorzolamide, and brinzolamide. He also was prescribed acetazolamide orally. Ultrabiomicroscopy revealed deposits of particles, possibly lens material at the angle. B-scan showed an echo-free vitreous, posterior vitreous detachment and normal optic nerve head cupping. One week later we did a manual small incision cataract surgery with IOL implant. Postoperatively topical gatifloxacin and tapering dose of prendnisolone were started. The smear and culture of aqueous humor were negative for any organism. Histopathologic examination revealed the lens surrounded by inflammatory cells and multinucleated giant cells engulfing the lenticular fibre. One month postoperatively his vision was 20/20, IOP of 16 mm Hg and normal optic nerve head cupping in both eyes.
The incidence of phacolytic glaucoma is decreasing due to the awareness and availability of cataract surgery. It is cause by an obstruction of trabecular meshwork by lens proteins or protein-laden macrophages. There was presence of lens particles in the ultrabiomicroscopy and of inflammation, histiocytic response, and giant cells seen around the lens material in the histopathologic examination thus confirming the ongoing phacolytic process. Extraction of the lens with the manual small incision cataract surgery led to recovery of symptoms and vision gain of 20/20.