Occult phacomorphic glaucoma - a new clinical entity

1 Clinical Hospital of Ophthalmologic Emergencies, Piata Alexandru Lahovari 1, Bucharest, Romania 2 ”Carol Davila” University of Medicine and Pharmacy, Bulenardul Eroii Sanitari 8, 050474 Bucharest, Roamania 3 Clinical Emergency Hospital ClujNapoca, Clinicilor Street 3-5, 400006, Cluj-napoca, Romania 4 "Iuliu Hateganu" University of Medicine and Pharmacy, Victor Babes Street 8, 400012 Cluj-Napoca, Romania *Corresponding Author’s E-mail: [email protected] Phacomorphic glaucoma is known as a secondary angle closure glaucoma caused by special forms of advanced cataract, usually associated with an increase in lens volume, called intumescent cataract. We present a series of 11 cases that associated increased sagittal diameter in a transparent lens, which induced the condition. A clear lens in a relatively young patient (fourth-fifth decade of life) can obscure its involvement in the disease mechanism. Patients presented after a poor response to peripheral laser iridotomy with high intraocular pressure (IOP), glaucomatous optic neuropathy, a clear lens and mild refractive changes. All patients were investigated thoroughly including biometry and ultrabiomicroscopy (UBM) with anterior chamber depth and lens measurements. After establishing the importance of the lens in the pathogenesis of this disease we performed phacoemulsification with a positive outcome in all cases, confirming once again our theory. We considered this new entity occult phacomorphic glaucoma in order to differentiate it from the one associated to advanced cataract and to highlight the fact that there are no lens induced myopia or transparence changes. Lens involvement is obscured by its transparency and can be documented by UBM.