ISSN: 2320-5407 Int. J. Adv. Res.

11(04), 1395-1399

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/16802
DOI URL: http://dx.doi.org/10.21474/IJAR01/16802

RESEARCH ARTICLE
RISK FACTORS FOR DEVELOPMENT OF PHACOMORPHIC GLAUCOMA IN MATURE CATARACT
- A HOSPITAL BASED STUDY, JHANSI

Dr. Jitendra Kumar1 and Dr. Archie Gupta2

1. M.S. Ophthalmology, Professor and Head of the Department, Department of Ophthalmology, M.L.B. Medical
College, Jhansi (UP).
2. Junior Resident, Department of Ophthalmology, M.L.B. Medical College, Jhansi (UP).
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Aim:To study the roles of axial length and anterior chamber depth as
Received: 28 February 2023 risk factors for the development of phacomorphic glaucoma in eyes
Final Accepted: 31 March 2023 with mature cataract.
Published: April 2023 Material and Methods: This is a prospective case-control study done
in the year 2023 at Department of Ophthalmology, MLB Medical
Key words:-
Axial Length, Intra Ocular Pressure, College, Jhansi. Phacomorphic glaucoma was diagnosed by Intraocular
Anterior Chamber Depth, Mature Pressure of more than 21 mmHg, intumescent cataract with signs and
Cataract symptoms of phacomorphic glaucoma, axial length and anterior
chamber depth.All patients examined by slit lamp examination .
Results: The Mean Intra ocular pressure of phacomorphic glaucoma
was 49±8 mmHg and of mature cataract was 15±6 mmHg. Vision was
Light perception in phacomorhic glaucoma and Hand movement
observed was mature cataract. The mean axial length was
23.08±0.32mmHg among phacomorphic glaucoma, shorter than mature
cataract, where the mean axial length was 23.71±0.78mm.
Conclusion:Patients with shorter axial lengths are at increased risk for
phacomorphic glaucoma.

Copy Right, IJAR, 2023,. All rights reserved.

……………………………………………………………………………………………………....
Introduction:-
Cataract and glaucoma are leading causes of visual impairment in Asia. In Mongolia, cataract and glaucoma
contribute to 36% and 35% of blindness respectively.[1] As both are diseases of advancing age, they can co-exist
and under certain circumstances, one disease may even lead to the other.Lens induced glaucomas may occur by
different mechanisms. 1.Phacomorphic glaucoma is caused by intumescent lens and it is a type of secondary angle
closure glaucoma, which is most common type . 2.Phacolytic glaucoma is a secondary open glaucoma in which lens
proteins leaked in anterior chamber. 3.Phacotopic glaucoma in which hyper mature cataractous lens may subluxate.

Delay in the extraction of mature cataracts can result in phacomorphic glaucoma, a type of secondary angle closure
caused by the forward displacement of an intumescent (swollen and white) cataract giving rise to pupillary block or
iridocorneal angle closure. In India, phacomorphic glaucoma accounts for 3.9% of all cataract extractions.[2]
Though phacomorphic glaucoma develops in the presence of a mature cataract, not all patients with mature cataract
necessarily go on to develop phacomorphic glaucoma.

Corresponding Author:- Dr. Jitendra Kumar

Address:- M.S. Ophthalmology, Professor and Head of the Department, Department of 1395
Ophthalmology, M.L.B. Medical College, Jhansi (UP).
ISSN: 2320-5407 Int. J. Adv. Res. 11(04), 1395-1399

Various population studies have established advancing age, female gender, shallow anterior chamber depth (ACD),
short axial length (AL) and Chinese ethnicity as risk factors for primary angle-closure suspects, primary angle
closures and primary angle closure glaucomas.[3–9]

Cataract extraction is usually indicated if visual gain is expected after the surgery. However not all patients with
mature cataracts can afford the surgery, especially in developing countries, and for those in the lower social
economic class where they usually seek medical attention from public institutions where they are likely to be put on
a long waiting list.During this period, cataracts may progress from an immature state to a mature cataract and
subsequently develop phacomorphic glaucoma. It is important to identify which of these patients with mature
cataracts are at an increased risk of phacomorphic glaucoma; so priority may be given to them to prevent such
complication.

Phacomorphic glaucoma can occur in both eyes with shallow or deep anterior chambers as the pathology is the
intumescent cataract rather than the angle configuration like in primary angle closures. This study investigated the
roles of axial length and anterior chamber depth as risk factors for the development of phacomorphic glaucoma in
eyes with mature cataract.

Method and Material:-

This was a prospective case-control study done in the year 2023 at Department of Ophthalmology, MLB Medical
college, Jhansi.It was done from oct 2022 to feb23.It was performed under the Helsinki Declaration of 1975, as
revised in 2000. The necessary permission from the Ethical and Research Committee was obtained for the study.

60 patients were evaluated to do this study and were divided into two groups:
Group 1 - 30 patients were with phacomorphic glaucoma, considered as cases.
Group 2 - 30 patients were with mature cataracts but without phacomorphic glaucoma, considered as controls.
Controls were selected such that age and sex matches with cases.

Phacomorphic glaucoma was diagnosed by Intraocular Pressure of more than 21 mmHg, intumescent cataract with
symptoms such as unilateral transient blurring of vision, colored halos around light, headache, brow ache and eye
ache on the affected side, self termination of attack due to physiological miosis and signs as demonstration of
shallow anterior chamber open angle as identified by slit lamp examination. Those patients presented to OPD with
features of phacomorphic glaucoma were considered as cases.

A Mature cataract is defined as the stage where there is a complete opacification of lens i.e., whole of the cortex is
involved. Lens become pearly white in color. Such a cataract is also labeled as 'ripe cataract’.

Inclusion criteria
All patients between the age group 50-80 years who presented to the OPD of MLB medical College Jhansi with the
complaint of dimunition of vision and on examination were found to have either mature cataract or phacomorphic
glaucoma.

Exclusion criteria
1.Patients outside the age group of 50-80 years .
2.Patients with other retinal disorders.
3.Patients with recent intraocular surgery .
4.Patients with the history of trauma.
5.Mentally or physically unfit patients.

Details regarding all the studied population such as age, sex, socioeconomic status were noted. Cases and controls
affected eyes were examined by measuring Intraocular Pressure, axial length, anterior chamber depth, Best corrected
visual acuity (BCVA). Intra ocular Pressure (IOP) was measured using Goldman Applanation Tonometry, BCVA
was assessed by using Snellen chart and Both Axial length and anterior chamber depth was measured using contact
A-scan ultrasonography.

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Statistical Analysis
All analyses were performed using statistical software Graph pad. Differences of means were analyzed using the t-
test and paired t-test where appropriate and forward stepwise binary logistic regression was implemented for
analysis of the variables: axial length and anterior chamber depth in association with the development of
phacomorphic glaucoma. The critical value of significance was set at P< 0.05 for all tests. All means were expressed
as mean ± standard deviation.

Results:-
In this prospective study, 30 cases and 30 controls were considered with phacomorphic glaucoma and mature
cataract without phacomorphic glaucoma respectively. All the studied population were selected in the age group of
50-80 years. Cases and Control groups were considered such that M:F ratio was 1:1. The mean age of Group 1 was
67±6.2 and Group 2 was 66.4±5.5(Table-1). On BCVA assessment using Snellen chart shown poorer visual acuity
among phacomorphic glaucoma (Group 1) when compared to mature cataract (Group 2), It was Light perception
among Group 1 and Hand movement was observed in Group 2. Axial length and Anterior Chamber Depth were
lesser in Phacomorphic Glaucoma when compared to Mature cataract (Table-2). There was statistical significance in
the axial lengths between group 1 and 2. There was no statistical significant difference of Anterior chamber depth
between phacomorphic glaucoma and mature cataract.

Table 1:-
CHARACTERISTICS GROUP 1 GROUP 2
AGE 67±6.2 66.4±5.5

SEX
Male 31 31
Female 29 29
INTRAOCULAR PRESSURE 49±8 15±6

Table 2:-
Features Group1 GROUP2 p-value significance
Axial length 23.08±0.32 23.71±0.78 0.0008 statistically
significant
Axial chamber depth 2.35±0.81 2.70±0.83 0.1789 not significant

Discussion:-
Phacomorphic glaucoma is a type of lens induced glaucoma,where its pathophysiology is secondary angle closure
glaucoma that may occur as result of hyper mature cataract formation. Gifford has recommended before cataracts
changes to hypermature, early extraction of lens is needed.[10]

Risk factors responsible for phacomorphic Glaucoma are age above 60 years[11,12] female gender[12,13] Axial
length <23.7 mm[14], narrow anterior chamber.In the present study the mean age of Group 1 was 67±6.2 and Group
2 was 66.4±5.5. Low Socioeconomic group people are predominantly affected by Phacomorphic glaucoma.[15] The
Mean Intra ocular pressure of Phacomorphic glaucoma was 49±8 mmHg and of mature cataract was 15±6 mmHg in
this study. Diagnosis of glaucoma mainly by IOP measurement above 21 mmHg[12], whereas average of presenting
is above 40 mmHg. Gonioscopy is a good diagnostic method for the diagnosis of Phacomorphic glaucoma, but it
should not be used in the presence of corneal edema from the acute IOP elevation.Lee JW et al[11] observed that the
mean IOP among Phacomorphic glaucoma was 49.5±11.8 mmHg and among control eyes were 16.7±1.7 mmHg.
On BCVA assessment using Snellen chart shown poorer visual acuity among Phacomorphic glaucoma (Group 1)
when compared to mature cataract (Group 2). It was Light perception among Phacomorphic glaucoma patients and
Hand movement was observed in mature cataracts without phacomorphic glaucoma as per this study. Visual acuity
among Phacomorphic glaucoma in this study is similar to Lee JW et al[11] documented as there is poor vision
between acute attack and dense cataract, averaging light perception only. In this study Axial length and Anterior
Chamber Depth were lesser in Phacomorphic Glaucoma when compared to Mature cataract. Axial length was
statistically significant in between group 1 and 2. There was no statistical significance in Anterior chamber depth
between phacomorphic glaucoma and mature cataract. Lee SJ et al[16] reported that anterior chamber depth is less
than 2mm. In contrast to the study Tomey KF et al[17] documented that Either shallow or deep anterior chamber

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cause phacomorphic glaucoma. Short axial length in relation to primary angle closure glaucoma, like short axial
length decreases while the risk of primary angle closure gets doubled.[17] It is supported by many
studies.[18,11]Main treatment of Phacomorphic glaucoma is by extraction of cataractous lens. Treatment is the main
goal to reduce the IOP, which in turn eliminates the symptoms related to Glaucoma. Surgical treatment may delay in
such conditions where there is an acute attack presenting with corneal edema and High IOP. In such conditions need
to stabilize the eye by medical treatment, later can go with removal of cataractous lens. Medical treatment includes
Beta blockers, alpha -agonists and carbonic anhydrase inhibitors. Argon Laser Peripheral Iridoplasty also can be
used to reduce IOP, has few side effects than oral or intravenous acetazolamide and hyperosmotics.[18] Before
cataract extraction , there is a need to reduce the IOP by using Intravenous mannitol.[20,12]

Conclusion:-
Phacomorphic glaucoma usually results in elderly age, short axial length or shallow anterior chamber. Raise in
Intraocular Pressure is the one responsible for symptoms. Axial length measurement is a easy predictor for
diagnosing phacomorphic glaucoma. In the setting of limited healthcare resources in an area where phacomorphic
glaucoma is prevalent, patients with axial length shorter than their population mean may be considered to receive
earlier elective cataract extraction to prevent phacomorphic glaucoma.

References:-
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[3].Teikari J, Raivio I, Nurminen M. Incidence of acute glaucoma in Finland from 1973 to 1982. Graefes Arch Clin
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