Outcomes Of A Patient With Phacolytic Glaucoma Managed By Manual Small-Incision Cataract Surgery (Msics)

TO SHOW WEEKLY CLINICAL PHOTOGRAPHS AND EVOLUTION OF A PATIENT WITH PHACOLYTIC GLAUCOMA FROM ADMISSION TO CATARACT SURGERY USING THE SICS (SMALL INCISION CATARACT SURGERY) TECHNIQUE. 

PHACOLYTIC GLAUCOMA IS AN OPHTHALMOLOGICAL EMERGENCY CAUSED BY TRABECULAR MESHWORK BLOCKAGE DUE TO THE LEAKAGE OF HIGH MOLECULAR WEIGHT PROTEINS FROM A HYPERMATURE CATARACT THROUGH AN INTACT CAPSULE. PATIENTS WITH THIS DIAGNOSIS OFTEN COURSE WITH INTENSE INFLAMMATION, ENDOTHELIAL CELL LOSS, ZONULAR WEAKNESS AND A BRUNESCENT CATARACT MAKING THIS DIAGNOSIS A REAL CHALLENGE FOR THE SURGICAL MANAGEMENT.

PATIENT CONCERNS. A 68-YEAR-OLD FEMALE WITH PROGRESSIVE BLURRED VISION IN HER LEFT EYE, PRESENTS WITH 1-DAY HISTORY OF INTENSE OCULAR PAIN. DIAGNOSIS. OPHTHALMOLOGICAL EXAMINATION SHOWED LIGHT PERCEPTION VISION AND INCREASED INTRAOCULAR PRESSURE(IOP)(69mmg), CILIARY INJECTION, SUBEPITHELIAL EDEMA AND ANTERIOR CHAMBER WITH INTENSE FLARE AND HYPERREFLECTIVE PARTICLES THAT PREVENT VISUALIZATION OF IRIS DETAILS. CLINICAL FINDINGS WERE CONSISTENT WITH PHACOLYTIC GLAUCOMA. INTERVENTIONS. TREATMENT WAS INITIATED WITH TOPICAL PREDNISOLONE, A FIXED COMBINATION OF BRIMONIDINE/DORZOLAMIDE/TIMOLOL AND ORAL ACETAZOLAMIDE, RESULTING IN A FAVORABLE REDUCTION OF IOP TO 30mmHg. NEXT WEEK, IOP WAS RECORDED AT 12 mmHg, A CENTRAL RETROENDOTHELIAL WHITISH PLAQUE MEASURING 3.1X2.2mm WITH PRESENCE OF ENDOTHELIAL FOLDS WAS FOUND; THEREFORE, SURGICAL ASPIRATION OF THE PLAQUE WAS DECIDED BEFORE CATARACT SURGERY. TWO WEEKS LATER, THE ENDOTHELIAL FOLDS DISAPPEARED AND SPECULAR MICROSCOPY WAS PERFORMED, SHOWING ENDOTHELIAL COUNT OF 1429CELLS/mm². UPON DILATION, A BRUNESCENT CATARACT WITH 100% RESORBED CORTEX AND NORMAL B-MODE ULTRASOUND WERE OBSERVED. DUE TO THE REDUCED ENDOTHELIAL COUNT, SURGICAL TREATMENT PROCEEDED WITH MANUAL CATARACT EXTRACTION USING A SMALL INCISION (SICS). OUTCOMES. TWO MONTHS LATER, THE PATIENT ACHIEVED VISUAL ACUITY OF 0.2 LOGMAR, IOP 15 MMHG WITHOUT HYPOTENSIVE MEDICATION, INTRAOCULAR LENS INSIDE THE CAPUSLAR BAG AND 40% EXCAVATED OPTIC NERVE WITH SLIGHT PALLOR.

IN PATIENTS WITH DIAGNOSIS OF PHACOLYTIC GLAUCOMA WE SHOULD CONTROL THE ANTERIOR SEGMENT INFLAMMATION AND INTRAOCULAR PRESSURE BEFORE CATARACT SURGERY. IN MOST PATIENTS, OCULAR HYPERTENSION RESOLVES AFTER UNCOMPLICATED CATARACT SURGERY; HOWEVER, IF IT PERSISTS FOR MORE THAN 7-10 DAYS, IT IS REASONABLE TO CONSIDER COMBINED GLAUCOMA SURGERY (TRABECULECTOMY OR TUBE IMPLANT). IN CASES WITH REDUCED ENDOTHELIAL COUNTS AND ZONULAR WEAKNESS, THE SICS TECHNIQUE IS AN EXCELLENT OPTION FOR SURGICAL MANAGEMENT.