Intraocular pressure control and visual outcome in patients with phacolytic glaucoma managed by extracapsular cataract extraction with or without posterior chamber intraocular lens implantation.

BACKGROUND AND OBJECTIVE: To evaluate long-term intraocular pressure (IOP) control and visual outcome of patients with phacolytic glaucoma.

PATIENTS AND METHODS: Forty-five consecutive eyes of 45 patients with phacolytic glaucoma operated on between January 1990 and December 1995 and who had completed at least 1 year of follow-up were included in the study. Of the 45 eyes, 17 eyes underwent extracapsular cataract extraction (ECCE) with primary posterior chamber intraocular lens (PC IOL) implantation (group 1). The rest of the eyes (n = 28) underwent only ECCE (group 2) in view of satisfactory aphakic vision in the contralateral eye. Preoperative IOP, visual acuity, and anterior segment appearance were compared with postoperative data.

RESULTS: IOP was controlled (IOP < 21 mm Hg) in all of the patients without any antiglaucoma medication, with a mean follow-up of 29.11 +/- 16.25 months (range 12 to 60) and 43.2 +/- 21.5 (12 to 78) months in groups 1 and 2, respectively. The IOP remained controlled without antiglaucoma medication even in the patients where the desired visual recovery was not obtained due to glaucomatous disc damage because of delayed presentation (2 to 3 weeks or more). A visual acuity of 20/40 or better was achieved in 76.5% and 60.7% in groups 1 and 2, respectively. Eighteen of the 45 patients initially presented with light perception without projection. Eight of these 18 patients (44%) regained a visual acuity of 20/40 or better. There was no significant intraoperative and postoperative complication in any patient.

CONCLUSIONS: ECCE with or without primary PC IOL implantation is safe and curative in patients with phacolytic glaucoma. The addition of trabeculectomy to cataract extraction seems to be superfluous in the control of IOP in patients with phacolytic glaucoma operated on within 2 to 3 weeks of the onset of symptoms. Light perception without projection is not a contraindication for cataract surgery in phacolytic glaucoma.