Phacomorphic Glaucoma: Evolving Management Strategies

Phacomorphic glaucoma is defined as secondary angle-closure glaucoma due to an increase in lens thickness and is characterized by a sudden rise in IOP which can compromise the function of the optic nerve and may lead to irreversible visual loss if not treated in time. This increase in lens thickness can be due to an advanced cataract, a rapidly intumescent lens, or a traumatic cataract, eventually leading to pupillary block and angle closure. Phacomorphic glaucoma is peculiar to developing countries like India, (constitutes 3.91% of all cataract operations done) where the incidence of cataract far exceeds the total number of surgeries.1-5 In developing countries, due to an unequal distribution of eye care facilities and economic constraints, many patients with age related cataracts are not able to get cataract surgery in time and present with phacomorphic glaucoma. In the European races, there is a gradual shrinkage of lens with development of cataract and thereby a progressive deepening of the anterior chamber occurs. Although no formal epidemiological data exists comparing the geographical and racial predilections, cataracts in Indians seem to show sudden hydration and intumescence rather commonly.