Pacomorphic Glaucoma Case Study

INTRODUCTION
Phacomorphic glaucoma is defined as secondary angle-closure glaucoma due to an increase in lens thickness and is characterized by a sudden rise in IOP which can compromise the function of the optic nerve and may lead to irreversible visual loss if not treated in time. This increase in lens thickness can be due to an advanced cataract, a rapidly intumescent lens, or a traumatic cataract, eventually leading to pupillary block and angle closure. Phacomorphic glaucoma is peculiar to developing countries like India, (constitutes 3.91% of all cataract operations done) where the incidence of cataract far exceeds the total number of surgeries.1-5
Phacomorphic glaucoma is recognized by the complaints of pain and redness in an eye which

However, both of these parameters are variable and not entirely objective especially when phacomorphic angle closure often affects an elderly population where dementia and neglect are common 11. In addition, studies in acute primary angle closure (APAC) have shown that more than half of the patients with a single attack can have no visual field defects 19. On the other hand, retinal nerve fiber layer measurements can detect early GON as its damage often precedes visual field

Furthermore, the results produced at 6 months in 6 patients post attack failed to demonstrate any significant difference between the phacomorphic and contralateral eye but there was already significant RNFL thinning detected on OCT.
Lee et al faced the same problem, the mean deviation (MD) in there study was −5.8 ± 3.7 decibels (db) and the PSD was 4.2 ± 3.0 db. There was no significant difference in the PSD between the attack (4.2 ± 3.0 db) and contralateral eye (3.1 ± 1.1 db) (p = 0.7). There was also no significant correlation between the RNFL thickness on OCT and the PSD on VF (p = 0.2)29.
Hence our study demonstrated that there is progressive RNFL thinning going on despite of removal of cause of raised IOP (cataract). The effect was seen some where between 3 months and 6 months post attack in superior and inferior