A Comparison of Clinical Profile and Treatment Outcomes of Phacomorphic and Phacolytic Glaucoma in a Tertiary Eye Care Hospital of India

Objective: To compare the clinical features, and treatment outcomes of phacomorphic glaucoma (PMG) versus phacolytic glaucoma (PLG) in a tertiary care eye hospital in India. Methods: A retrospective review of electronic medical record data of all patients operated for phacolytic and PMGs, between March 2013 and March 2020, was performed. Patients with a history of trauma pre-existing glaucoma or who were blind at presentation were excluded. Patients’ demographic data, clinical features, visual and surgical outcomes were analyzed. Results: There were 78 and 86 eyes with a mean age of 69.0 and 70.3 years for PMG and PLG, respectively. Time from onset of symptoms to presentation in the clinic was longer in PMG group of patients (30.7 ± 53.2 days) compared to the PLG group (15 ± 17.5 days). Visual acuities and/or intraocular pressures (IOPs) at presentation were comparable in the two groups. Corneal decompensation or scarring was 3.8% in PMG versus 2.8% in PLG. About 24.4% patients in PMG group were initially misdiagnosed and treated as either primary open angle or closed angle glaucoma, whereas there was no misdiagnosis in the PLG group. Small incisional cataract surgery (SICS) with posterior chamber intraocular lens implantation was performed in 65.4% of phacomorphic and 68.6% of phacolytic groups. Combined cataract and trabeculectomy were carried out in 8.9% of phacomorphic and 4.6% of phacolytic. Vitrectomy was required in 17.9% in phacomorphic and 12.8% in PLG, statistically significant improvement in overall mean logMAR visual acuity improved from 1.5 to 1.4, and IOP reduced by 53% by postoperative 1 week. Conclusion: Both PMG and PLG respond favorably to standard SICS, irrespective of their duration of symptoms. The final visual acuity gain and control of IOPs were comparable in the two groups.