Abstract
Purpose :
To describe the clinical presentation and histopathologic characteristics of phacolytic glaucoma.
Methods :
The database at the Florida Lions Ocular Pathology Laboratory was searched for surgical specimens at the Bascom Palmer Eye Institute under approval of the institutional review board. Patients with a diagnosis of “phacolytic glaucoma” on cytopathology between the years of 1997 and 2022 from the Florida Lions Ocular Pathology laboratory database were included (n=14). Patient demographics, anatomic site, laterality, and clinical features and ocular exam findings were obtained from available medical records. The specimens were reviewed and the clinicopathologic features were evaluated.
Results :
The diagnosis of phacolytic glaucoma was established by light microscopic examination of cytology specimens in 15 eyes (Right=8, Left=6, not specified=1). Between 1997 and 2022, there were 37 cases with a preoperative diagnosis of phacolytic glaucoma submitted for histopathologic analysis (Diagnostic yield=40.5%). From this group of 15 cases, there were 14 patients (Male=9, Female=5). One patient had two samples from the same eye and was regarded as one case. Mean age was 63.6 years (Range: 39-87). Eleven samples were from the anterior chamber and three were obtained from the vitreous. CD68 immunohistochemistry was done in two cases (14.3%). All 14 cases (100%) demonstrated histiocytes with engulfed foamy and/or granular lenticular material. Of the available medical records (13), clinical features and ocular exam findings included: decreased vision [11, (84.6%)], eye pain [7 (53.8%)], anterior chamber inflammation [8 (61.5%)], a dislocated or subluxed crystalline lens [7 (53.8%)], mature cataracts [6 (46.2%)], and elevated intraocular pressure [11 available, (average=45.1)]. Additional clinical histories included: Marfan’s syndrome [2 (average age=46.5 years)], ocular trauma [2 (average age=67)], and previous ocular surgery [1 (40 years)].
Conclusions :
We present a case series (n=14) of phacolytic glaucoma diagnosed by cytopathologic evaluation of vitreous and anterior chamber samples. Common clinical features include sudden onset eye pain, decreased vision, and anterior chamber inflammation in an individual with a white mature cataract and elevated intraocular pressure. Marfan’s syndrome, ocular trauma, and previous ocular surgery may predispose individuals to lens changes and development of phacolytic glaucoma.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.