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Purpose: To evaluate the outcomes and identify favorable prognostic factors in patients of phacomorphic (PMG) and phacolytic glaucoma (PLG) managed by manual small?incision cataract surgery (MSICS). Methods: The medical records of patients with PMG/PLG who had undergone MSICS in a tertiary eye hospital between September 2014 and August 2018 were retrospectively reviewed. Regression analyses were conducted to identify the predictors associated with intraoperative or postoperative complications and a favorable final outcome at 1 month, namely, a best?corrected visual acuity (BCVA) of 6/18 or better and an intraocular pressure (IOP) of <21 mm Hg. P < 0.05 was considered statistically significant. Results: The records of 209 patients with PMG and 279 patients with PLG were eligible for the review. The mean preoperative IOP for PMG and PLG were 43.15 � 12.9 and 40.05 � 12.0 mm Hg, respectively (P = 0.006). A younger age (<60 years) was associated with a lower risk of severe postoperative inflammation in both PMG and PLG [OR = 0.45 (0.21�99); P = 0.047 and OR = 0.44 (0.23�83); P = 0.011, respectively]. There was no significant difference in the final mean logMAR BCVA (P = 0.21) and IOP (P = 0.36) in the two groups. The likelihood of a final IOP of <21 mm Hg was significant for symptoms less than a week [OR = 3.52 (1.2�.2); P = 0.02] in PMG and for absence of vitreous disturbance [OR = 35.0 (3.8�5.7); P = 0.002] in PLG. A BCVA of 6/18 or better was strongly associated with symptoms for less than a week [OR = 1.58 (1.0�4); P = 0.043] and absence of vitreous disturbance [OR = 23.53 (5.1�8.0); P < 0.001]. Conclusion: Early diagnosis and management can translate to good outcomes in PMG and PLG.
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@#AIM:To investigate the risk factors of high intraocular pressure after cataract surgery for phacolytic glaucoma(PLG). <p>METHODS: The clinical data of 148 PLG patients(148 eyes)who underwent cataract surgery were analyzed retrospectively. According to the occurrence of postoperative high intraocular pressure, the patients were divided into non-high intraocular pressure group and high intraocular pressure group. Logistic regression analysis was used to evaluate the risk factors of high intraocular pressure after cataract surgery in PLG patients. Nomogram model was constructed, whose predictive ability was evaluated by receiver operating characteristic curve(ROC). <p>RESULTS: There was no significant difference in age, gender, BMI, cataract lens nucleus grade, combined with hypertension, and surgical methods between two groups(<i>P</i>>0.05); the proportion of diabetes, high myopia, preoperative uveitis, preoperative ocular trauma and intraoperative complications in high intraocular pressure group were higher than those of non-high intraocular pressure group, with the difference was statistically significant(<i>P</i><0.05). Logistic regression analysis showed that diabetes, high myopia, preoperative uveitis, preoperative ocular trauma and intraoperative complications were independent influencing factors for high intraocular pressure after cataract surgery in PLG patients. The nomogram model constructed in this study had good fitting effect, and the area under the ROC curve was 0.906(0.890-0.921), indicating that it had strong predictive ability. <p>CONCLUSION: PLG patients with intraoperative complications, preoperative uveitis, ocular trauma, diabetes and high myopia had higher risk of high intraocular pressure after cataract surgery. Clinical doctors should pay more attention to these patients in order to improve the treatment prognosis.
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Iridescent cholesterol crystals in the anterior chamber are unusual finding. Although the clinical picture of phacolytic glaucoma is well recognized, the nature of the iridescent or hyperrefringent crystals is not well understood. A 70 years old womon presented with the acute onset of monocular pain and redness. The examination revealed a high intraocular pressure (42 mmHg), conjunctival hyperemia, and diffuse corneal edema. The heavy flare and pseudohypopyon were seen in the anterior chamber associated with iridescent or hyperrefringent particles. The anterior chamber aspirate obtained at operation was subsequently examined by wet field microscopy. Wet field microscopy showed that macrophages identified histologically in the aspirate corresponded to regular round cells about two to three times the size of an leukocyte. And, notched rectangular platelike crystals were typical morphologically of cholesterol, varied in size, and contacted each other. We found cholesterol crystals in aqueous humor of the eye with phacolytic glaucoma.