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Tetsuo Joshita, Nobushige Tanaka, Takayo Watanabe, Makoto Inoue, Toshiyuki Nagamoto; Clinical Course Of Phacomorphic Glaucoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5708.
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To report the clinical course of phacomorphic glaucoma and to find the factors affecting visual outcome.
The medical records of 16 eyes of 15 patients (7 men and 8 women, mean age of 69 years ranged from 28 to 89 years) underwent cataract extraction for phacomorphic glaucoma in Kyorin Eye Center from 2001 to 2009 were retrospectively reviewed. The clinical course and factors affecting visual outcome were analyzed.
8 out of nine eyes with a history of ocular trauma, 3 out of six eyes with mature cataract, and 1 out of three eyes with pseudoexfoliation had dehiscence of Zinn zonule. Surgical intervention was performed immediately in two eyes. The other 14 eyes were initially treated by medication to lower intraocular pressure (IOP). 9 eyes (60 %), but not 5 eyes (40 %), responded well to the medication and planed surgery was given when needed. Early surgical intervention was performed in non-responders except one who rejected receiving operation. Either phacoemulsification and aspiration (PEA) (8 eyes) or intracapsular cataract extraction (ICCE) (8 eyes) was conducted. In the PEA group in-the-bag implantation of intraocular lens (IOL) were successfully curried out in 6 eyes and in the ICCE group scleral IOL suture were curried out in 5 eyes. Simultaneous trabeculotomy was required in one eye in the ICCE group. Postoperative mean IOP was 13.1 mmHg (ranged from 4 to 26 mm Hg) and only one eye had IOP over 20 mmHg. Mean logMAR visual acuity (VA) was improved from 1.72 to 0.65 by proper surgical intervention and medication as well. Postoperative mean logMAR VA in responder group and non-responder group were 0.60 and 0.92 and that in PEA group and ICCE group were 0.56 and 0.74, respectively. No statistical significant difference was found among the group. The causes of poor visual outcome (more than 1) were optic nerve atrophy (3 eyes), neovascular glaucoma (1 eye), and persistent corneal edema (1 eye).
Dehiscence of Zinn zonule of which ocular trauma was the major cause was frequently observed in eyes with phacomorphic glaucoma. Immediate surgical intervention when medication failed to control IOP did lead to the acceptable result. Although simple operation appears to be less invasive to the eye, type of surgery did not cause any difference in postoperative visual outcome.
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