Phacolytic glaucoma

Last updated
Phacolytic glaucoma
Schematic diagram of the human eye.png
Anatomy of the eye
Specialty Ophthalmology
Differential diagnosis Phacomorphic glaucoma

Phacolytic glaucoma (PG) is a form of glaucoma which is caused due to a leaking mature or immature cataract. Inflammatory glaucoma which occurs in phacolysis is a condition which is a result of the leakage of protein within the lens into the capsule of a mature or hyper mature cataract and involves a simple procedure to be cured that is referred to as cataract extraction. [1]

Contents

The main symptoms of glaucoma include pain in the eye, redness and loss of sight, all of which reduce an individual's independence, in turn, reducing quality of life and an individual's ability to fulfill other societal roles (such as driving and reading) as it reduces visual clarity. Phacolysis tends to be more frequently reported in underdeveloped countries because of the lack of resources necessary to treat such as condition.

Signs and symptoms

There are a variety of characteristics which indicate that an individual may have phacolytic glaucoma. Within older people, the lens of the eye may appear to be yellow and lose its transparency (becomes cloudy). Once the protein begins to seep into the lens, permanent damage to the lens may be caused as the precipitate in lens impairs vision.

Another symptom includes the fading of visual clarity. This symptom makes the eye create an image commonly described to appear as though looking through a waterfall. If the lens becomes completely opaque the individual will become blind, even though the photoreceptor cells are completely functional. Other common symptoms include;

The major influencers of this illness include high exposure to the sun and age as this is a rare condition for individuals under the age of 35. [1]

Causes

Cataracts, if left untreated, can develop into a mature state or hyper mature state, and may progressively become leaky thereby excreting proteins. Cataracts are caused by a breakdown of proteins which allows the lens to become cloudy and gradually turn opaque, causing a decrease in vision. Through the leakage of proteins that have a high molecular weight an obstruction of the drainage mechanism of the eye is caused.

Diagnosis

Lens of the eye becomes cloudy once affected by the cataract. Acute Angle Closure-glaucoma.jpg
Lens of the eye becomes cloudy once affected by the cataract.

A variety of procedures can be used to physically diagnose phacolytic glaucoma as there are a variety of other types of glaucoma which may be confused with phacolysis such as acute angle-closure glaucoma (AACG), lens-particle glaucoma, neovascular glaucoma, phacomorphic glaucoma and uveitic glaucoma which can cause confusion in which procedures need to be conducted to revamp vision. [1]

The first type of diagnostic procedure referred to as a ‘slit lamp examination’ of phacolytic glaucoma allows for specific identification of microcystic corneal edema and the presence of macrophages, white material (dotted with patches within the inside capsule of the lens) and intense flare and iridescent or hyper-refringent particles specific to phacolytic glaucoma. [3] The time period which symptoms have been affecting the patient should be obtained as experiencing symptoms for a period longer than 5 days may result in further issues such as glaucomatous disc damage or poorer prognosis. Additionally, previous cataract or trauma surgery which have been conducted must be accounted for so that an accurate diagnosis of current symptoms which could be caused because of these previous experiences. [1]

An ophthalmologic examination is another procedure which must be conducted to effectively diagnose phacolytic glaucoma. This test will indicate high levels of inflammation due to high intraocular pressures within the eyes. Additionally, the presence of calcium oxalate and cholesterol crystals from the degenerating cataract lens is an indication of phacolytic glaucoma but can only be identified by puncturing the cataract. This is specifically used to differentiate between uveitic glaucoma where keratic precipitates are present rather than calcium oxalate. [1] [3]

Target Population

Phacolysis is evident, more commonly, within elderly people as a result of cataracts that have developed over time. There are other factors which contribute to the development of phacolysis in seniors. This is clearly indicated through the increase of intraocular pressure, which usually occurs when anterior flow faces obstruction of the anterior flow to the aqueous humor. Essentially, the eye requires a photosynthetic pigment which allows for light to become chemical energy. Within seniors, this pigment over time splits with the oxygen to thereby generate phacolysis. [4]

Treatment

Medical procedure being conducted to treat Phacolysis. Cataract surgery.jpg
Medical procedure being conducted to treat Phacolysis.

The procedure involved in the curing of phacolysis includes the reduction of intraocular pressure (IOP) in the eye followed by cataract extraction surgery. Medical management is commonly used simply to control the inflammation temporarily. The reduction of intraocular pressure can be conducted through the use of a combination of topical and systemic IOP-lowering agents, cycloplegics, aqueous suppressants, hyper-osmotic agents, and anti-inflammatory drugs. [5] Topical steroids also may assist in lowering intraocular pressure and decreasing pain. [3]

Previous to cataract surgery a variety of optometrical tests have to be conducted to comprehensively analyse an individual's eye-sight prior to the surgery. A refraction is also conducted to determine how much nearsightedness, farsightedness and/or astigmatism an individual may have. Additional specific measurements of the eye will be necessary in order to determine the curvature and length of the cornea in order to choose the most effective IOL which will need to be inserted during the surgery. [2]

Cataract surgery has become a very simple process which, with modern-day technology, can be conducted in a local anaesthetic procedure in an average time period of 15 minutes. The aim of cataract surgery is to replace the lens within the eye with an artificial lens to clear vision while removing any residue which could cloud vision. The cataract extraction surgery involves four major steps which includes; local anaesthetic, clearing of eye, intraocular lens is inserted and finally the contact lens to protect the eye which dissolves releasing antibiotics. [2]

Before major advancements in medical technology, cuts had to be manually made to the lens to conduct cataract extraction surgery, however, with the improvements in technology the LASIK procedure is the main procedure used to conduct cataract surgeries. This procedure involves the use of femtosecond lasers which allow for precision cuts to create the corneal flap necessary to clear the cataract which were substituted for use instead of a surgical tool which is generally hand-held by the surgeon to conduct the same incision manually. The corneal incision, the anterior capsulotomy and lens and cataract fragmentation are steps in which can be an alternative. Within this process, lasers strike a titanium-like target that are attached to an irrigation-aspiration probe. [6] It is said that the utilisation of this laser will enable for better precision, accuracy and reproducibility for the corneal incision, the anterior capsulotomy and lens and cataract, therefore ensuring the reduction of risks and enabling for refined visual development of phacolysis and the extraction of cataract. [7]

When completing the surgery the utilisation of laser cataract surgery will allow for a precise incision resulting in a self-sealing process, enabling for the reduction of infection after the surgery. Therefore, as a result of the advancements in which the laser cataract surgery has provided, regarding the removal of the lens, surgeons have been able to complete the procedure in a more efficient manner and thereby ensure an improvement in the outcomes for individuals suffering from phacolysis. [7] Additionally, the laser cataract procedures which are used to cure phacolysis have a success rate of 98% further proving this procedure's effectiveness. [5]

The main issue with this technology is that the process costs about $300,000 to $500,000 [3] and like all surgical procedures there is a degree of risk. Within the cataract removal procedures which take place a variety of complications may occur including;

Rehabilitation

Patient using eyepatch after cataract surgery to reduce the risk of infection. Ophthalmic eyepatch.jpg
Patient using eyepatch after cataract surgery to reduce the risk of infection.

There are several medications which need to be consumed in order to treat phacolytic glaucoma. The medicines induced ensure the management of glaucoma and reduce inflammation. [3] These medications consist of: Aqueous suppressants, anti-inflammatory drugs, hyper-osmotic agents, cycloplegics, anti-glaucoma medications. Medical therapy, however, is only a temporary treatment until cataract surgery can take place. [2]

The use of an eyepatch for a certain amount of time, as well as a contact lens to protect the eye which dissolves releasing antibiotics, must be incorporated in the rehabilitation process to reduce the risk of infection of the eye and to allow for an effective healing process. Additionally, the patient must consistently visit the specialist in order to ensure a successful removal of phacolytic glaucoma. There may be a need for medical therapies which treat arising issues for the eye such as inflammation. [8] These medical therapy procedures for phacolysis consist of controlling the intraocular pressure which may include the use of topical steroids in order to decrease inflammation in the eye, and mydriatics in order to prevent the formation of synechiae. [3]

Medication

It is found that with most cases, of phacolytic glaucoma post surgery patients are not exposed to many further obstacles in the healing process which therefore avoids the need for medication. Although, it is mostly encouraged that patients take antiglaucoma medication in order to deter the possibility of glaucoma and inflammation implicating the eye. One of these medications include eye drops which contain prostaglandin analogs. Prostaglandin analogs aim to lower intraocular pressure which thereby avoids inflammation to ensure an efficient healing process after cataract removal. Carbonic anhydrase inhibitors (CAI) in the form of pills, disables the production of the sodium pump in the aqueous humor and thereby decreases inflammation to, in turn, lower intraocular pressure.

Astigmatism condition. Astigmatism.jpg
Astigmatism condition.

The only major obstacle which could affect the healing process after the surgery necessary to treat phacolytic glaucoma would be an infection to the eye. The ophthalmologists' conducting the surgery must aim to reduce the amount of microbes which are present on the ocular surface and avoid intracocular contamination during the procedure. These tasks can be conducted through the use of intracameral and topical antibiotics. [9] Intracameral antibiotics are usually injections which are put into the eye or ocular surface to rid of microbes. Topical antibiotics come in the form of tablets which can be consumed through the mouth to treat bacterial infection. The use of either or both are left to the surgeon and their personal opinion on the possibility of bacterial infection.

Astigmatism correction

Astigmatism involves a deficiency in the optical capacity of the eye whereby the angle of light passing through the eye deviates and becomes distorted visuals due to the light rays, avoiding a common focus. Astigmatisms are the result of the cornea forming more in the shape of a curve in comparison to other meridians. Therefore, in order to reduce this, minor incisions must be taken in place of the cornea which, as previously mentioned, is forming in the shape of a curve, which will flatten the turn to a little extent, thereby allowing the cornea to be rounder and uniform. [7] By performing astigmatism in order to correct the removal of cataract the requirement of prescription glasses and reading glasses post cataract extraction is avoided and ensures better vision for patients. Astigmatism rates increase dramatically from 14.3% in the under 15-year-old age group to 67.2% in the age group of over 65-years old. [10] Since astigmatism affects the population of people over 65-years old which are more likely to suffer from phacolytic glaucoma it is an effective procedure which can take place during the cataract surgery used to correct phacolytic glaucoma and improve the quality of life of sufferers.

Epidemiology

The youngest patient found to be diagnosed with Phacolytic Glaucoma was 35 years of age, [2] which thereby highlights its significant prevalence in senior patients. Moreover, Phacolytic Glaucoma is more likely seen in underdeveloped countries as a result of the lack of access to ophthalmologic care. When being faced with Phacolytic Glaucoma most cases ameliorate when the cataract is extracted thereby enhancing vision. On the other hand, this disease is less prevalent in developed countries such as Australia and the United States, due to a greater access to health care and earlier cataract surgery.

Related Research Articles

<span class="mw-page-title-main">Glaucoma</span> Group of eye diseases

Glaucoma is a group of eye diseases that lead to damage of the optic nerve, which transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of sight" because the loss of vision usually occurs slowly over a long period of time. A major risk factor for glaucoma is increased pressure within the eye, known as intraocular pressure (IOP). It is associated with old age, a family history of glaucoma, and certain medical conditions or medications. The word glaucoma comes from the Ancient Greek word γλαυκός, meaning 'gleaming, blue-green, gray'.

<span class="mw-page-title-main">Cataract</span> Clouding of the lens inside the eye, causing poor vision

A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision of the eye. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colours, blurry or double vision, halos around light, trouble with bright lights, and difficulty seeing at night. This may result in trouble driving, reading, or recognizing faces. Poor vision caused by cataracts may also result in an increased risk of falling and depression. Cataracts cause 51% of all cases of blindness and 33% of visual impairment worldwide.

<span class="mw-page-title-main">Farsightedness</span> Eye condition in which light is focused behind instead of on the retina

Far-sightedness, also known as long-sightedness, hypermetropia, and hyperopia, is a condition of the eye where distant objects are seen clearly but near objects appear blurred. This blur is due to incoming light being focused behind, instead of on, the retina due to insufficient accommodation by the lens. Minor hypermetropia in young patients is usually corrected by their accommodation, without any defects in vision. But, due to this accommodative effort for distant vision, people may complain of eye strain during prolonged reading. If the hypermetropia is high, there will be defective vision for both distance and near. People may also experience accommodative dysfunction, binocular dysfunction, amblyopia, and strabismus. Newborns are almost invariably hypermetropic, but it gradually decreases as the newborn gets older.

<span class="mw-page-title-main">LASIK</span> Corrective ophthalmological surgery

LASIK or Lasik, commonly referred to as laser eye surgery or laser vision correction, is a type of refractive surgery for the correction of myopia, hyperopia, and astigmatism. LASIK surgery is performed by an ophthalmologist who uses a femtosecond laser or a microkeratome to create a corneal flap to expose the stroma and then an excimer laser to reshape the cornea in order to improve visual acuity.

<span class="mw-page-title-main">Eye surgery</span> Surgery performed on the eye or its adnexa

Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.

<span class="mw-page-title-main">Radial keratotomy</span> Refractive surgical procedure to correct myopia (nearsightedness

Radial keratotomy (RK) is a refractive surgical procedure to correct myopia (nearsightedness). It was developed in 1974 by Svyatoslav Fyodorov, a Russian ophthalmologist. It has been largely supplanted by newer, more accurate operations, such as photorefractive keratectomy, LASIK, Epi-LASIK and the phakic intraocular lens.

<span class="mw-page-title-main">Refractive surgery</span> Surgery to treat common vision disorders

Refractive surgery is an optional eye surgery used to improve the refractive state of the eye and decrease or eliminate dependency on glasses or contact lenses. This can include various methods of surgical remodeling of the cornea (keratomileusis), lens implantation or lens replacement. The most common methods today use excimer lasers to reshape the curvature of the cornea. Refractive eye surgeries are used to treat common vision disorders such as myopia, hyperopia, presbyopia and astigmatism.

<span class="mw-page-title-main">Phacoemulsification</span> Method of cataract surgery

Phacoemulsification is a cataract surgery method in which the internal lens of the eye which has developed a cataract is emulsified with the tip of an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the volume of the anterior chamber during the procedure. This procedure minimises the incision size and reduces the recovery time and risk of surgery induced astigmatism.

<span class="mw-page-title-main">Intraocular lens</span> Lens implanted in the eye to treat cataracts or myopia

An Intraocular lens (IOL) is a lens implanted in the eye usually as part of a treatment for cataracts or for correcting other vision problems such as short sightedness and long sightedness; a form of refractive surgery. If the natural lens is left in the eye, the IOL is known as phakic, otherwise it is a pseudophakic lens. Both kinds of IOLs are designed to provide the same light-focusing function as the natural crystalline lens. This can be an alternative to LASIK, but LASIK is not an alternative to an IOL for treatment of cataracts.

<span class="mw-page-title-main">Phakic intraocular lens</span> Lens implanted in eye in addition to the natural lens

A phakic intraocular lens (PIOL) is an intraocular lens that is implanted surgically into the eye to correct refractive errors without removing the natural lens. Intraocular lenses that are implanted into eyes after the eye's natural lens has been removed during cataract surgery are known as pseudophakic.

<span class="mw-page-title-main">Cataract surgery</span> Removal of opacified lens from the eye

Cataract surgery, also called lens replacement surgery, is the removal of the natural lens of the eye that has developed a cataract, an opaque or cloudy area. The eye's natural lens is usually replaced with an artificial intraocular lens (IOL) implant.

Polycoria is a pathological condition of the eye characterized by more than one pupillary opening in the iris. It may be congenital or result from a disease affecting the iris. It results in decreased function of the iris and pupil, affecting the physical eye and visualization.

ReLExSmall incision lenticule extraction (SMILE), second generation of ReLEx Femtosecond lenticule extraction (FLEx), is a form of laser based refractive eye surgery developed by Carl Zeiss Meditec used to correct myopia, and cure astigmatism. Although similar to LASIK laser surgery, the intrastromal procedure uses a single femtosecond laser referenced to the corneal surface to cleave a thin lenticule from the corneal stroma for manual extraction.

The Trabectome is a surgical device that can be used for ab interno trabeculotomy, a minimally invasive glaucoma surgery for the surgical management of adult, juvenile, and infantile glaucoma. The trabecular meshwork is a major site of resistance to aqueous humor outflow. As angle surgeries such as Trabectome follow the physiologic outflow pathway, the risk of complications is significantly lower than filtering surgeries. Hypotony with damage to the macula, can occur with pressures below 5 mmHg, for instance, after traditional trabeculectomy, because of the episcleral venous pressure limit. The Trabectome handpiece is inserted into the anterior chamber, its tip positioned into Schlemm's canal, and advanced to the left and to the right. Different from cautery, the tip generates plasma to molecularize the trabecular meshwork and remove it drag-free and with minimal thermal effect. Active irrigation of the trabectome surgery system helps to keep the anterior chamber formed during the procedure and precludes the need for ophthalmic viscoelastic devices. Viscoelastic devices tend to trap debris or gas bubbles and diminish visualization. The Trabectome decreases the intra-ocular pressure typically to a mid-teen range and reduces the patient's requirement to take glaucoma eye drops and glaucoma medications. The theoretically lowest pressure that can be achieved is equal to 8 mmHg in the episcleral veins. This procedure is performed through a small incision and can be done on an outpatient basis.

Micro-invasive glaucoma surgery (MIGS) is the latest advance in surgical treatment for glaucoma, which aims to reduce intraocular pressure by either increasing outflow of aqueous humor or reducing its production. MIGS comprises a group of surgical procedures which share common features. MIGS procedures involve a minimally invasive approach, often with small cuts or micro-incisions through the cornea that causes the least amount of trauma to surrounding scleral and conjunctival tissues. The techniques minimize tissue scarring, allowing for the possibility of traditional glaucoma procedures such as trabeculectomy or glaucoma valve implantation to be performed in the future if needed.

Uveitis–glaucoma–hyphaema (UGH) syndrome, also known as Ellingson syndrome, is a complication of cataract surgery, caused by intraocular lens subluxation or dislocation. The chafing of mispositioned intraocular lens over iris, ciliary body or iridocorneal angle cause elevated intraocular pressure (IOP) anterior uveitis and hyphema. It is most commonly caused by anterior chamber IOLs and sulcus IOLs but, the condition can be seen with any type of IOL, including posterior chamber lenses and cosmetic iris implants.

<span class="mw-page-title-main">Phacomorphic glaucoma</span> Disorder of the human eye

Phacomorphic glaucoma is an eye disease that can occur due to a neglected advanced cataract. In this, the mature cataractous lens cause secondary angle closure glaucoma. The presence of an asymmetric mature cataractous lens, shallow or closed anterior chamber angle, raised intraocular pressure (IOP) and other typical signs and symptoms of angle-closure glaucoma in the eye may lead to a diagnosis of phacomorphic glaucoma. Cataract surgery after initial IOP control with medication is the only treatment.

Manual small incision cataract surgery (MSICS) is an evolution of extracapsular cataract extraction (ECCE); the lens is removed from the eye through a self-sealing scleral tunnel wound. A well-constructed scleral tunnel is held closed by internal pressure, is watertight, and does not require suturing. The wound is relatively smaller than that in ECCE but is still markedly larger than a phacoemulsification wound. Comparative trials of MSICS against phaco in dense cataracts have found no statistically significant difference in outcomes but MSICS had shorter operating times and significantly lower costs. MSICS has become the method of choice in the developing world because it provides high-quality outcomes with less surgically induced astigmatism than ECCE, no suture-related problems, quick rehabilitation, and fewer post-operative visits. MSICS is easy and fast to learn for the surgeon, cost effective, simple, and applicable to almost all types of cataract.

Clear lens extraction, also known as refractive lensectomy, custom lens replacement or refractive lens exchange is a surgical procedure in which clear lens of the human eye is removed. Unlike cataract surgery, where cloudy lens is removed to treat cataract, clear lens extraction is done to surgically correct refractive errors such as high myopia. It can also be done in hyperopic or presbyopic patients who wish to have a multifocal IOL implanted to avoid wearing glasses. It is also used as a treatment for diseases such as angle closure glaucoma.

<span class="mw-page-title-main">History of cataract surgery</span> Development of the procedure for removing an opacified lens from the eye

Cataract surgery has a long history in Europe, Asia, and Africa. It is one of the most common and successful surgical procedures in worldwide use, thanks to improvements in techniques for cataract removal and developments in intraocular lens (IOL) replacement technology, in implantation techniques, and in IOL design, construction, and selection. Surgical techniques that have contributed to this success include microsurgery, viscoelastics, and phacoemulsification.

References

  1. 1 2 3 4 5 "Phacolytic glaucoma". www.aao.org. Retrieved 2018-10-19.
  2. 1 2 3 4 5 Yi, Kayoung (2020-05-18). "Phacolytic Glaucoma: Background, Pathophysiology, Epidemiology". Medscape Reference. Retrieved 2024-08-08.
  3. 1 2 3 4 5 6 "Could cataract-dissolving drops replace cataract surgery someday?". All About Vision. Retrieved 2018-10-19.
  4. ↑ Papaconstantinou D, Georgalas I, Kourtis N, Krassas A, Diagourtas A, Koutsandrea C, Georgopoulos G (2009). "Lens-induced glaucoma in the elderly". Clinical Interventions in Aging . 4: 331–6. doi: 10.2147/cia.s6485 . PMC   2722872 . PMID   19696897.
  5. 1 2 "What Are the Risks of Cataract Surgery? - VisionAware". www.visionaware.org. Retrieved 2018-10-19.
  6. ↑ Dodick JM, Lally JM, Sperber LT (February 1993). "Lasers in cataract surgery". Current Opinion in Ophthalmology. 4 (1): 107–9. doi:10.1097/00055735-199302000-00017. PMID   10148300. S2CID   37575045.
  7. 1 2 3 "Laser Cataract Surgery". All About Vision. Retrieved 2018-11-01.
  8. ↑ "Treating Phacolytic Glaucoma". American Academy of Ophthalmology. 2004-07-01. Retrieved 2018-10-19.
  9. ↑ "Antibiotics in Cataract Surgery". CRSToday. Retrieved 2018-11-01.
  10. ↑ Hashemi H, Rezvan F, Yekta AA, Hashemi M, Norouzirad R, Khabazkhoob M (April 2014). "The prevalence of astigmatism and its determinants in a rural population of Iran: the "Nooravaran Salamat" mobile eye clinic experience". Middle East African Journal of Ophthalmology. 21 (2): 175–81. doi: 10.4103/0974-9233.129772 . PMC   4005184 . PMID   24791111.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.