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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 1  |  Page : 50-51

Morgagnian cataract and phacomorphic glaucoma


Centre for Sight, Road No 2 Banjara Hills, Hyderabad, Telangana, India

Date of Submission12-Apr-2020
Date of Acceptance21-Jul-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Vanita Pathak-Ray
Centre for Sight, Road No 2 Banjara Hills, Hyderabad - 500 034, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_961_20

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  Abstract 


Keywords: Hypermature cataract, lens-induced glaucoma, morgagnian cataract, phacolytic glaucoma, phacomorphic glaucoma


How to cite this article:
Pathak-Ray V. Morgagnian cataract and phacomorphic glaucoma. Indian J Ophthalmol Case Rep 2021;1:50-1

How to cite this URL:
Pathak-Ray V. Morgagnian cataract and phacomorphic glaucoma. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Feb 26];1:50-1. Available from: https://www.ijoreports.in/text.asp?2021/1/1/50/305547



Lens-induced glaucoma is not an uncommon entity in low-to-middle income countries,[1],[2],[3] where uptake of healthcare may not only be delayed but access to it may be poor, or it may not be affordable. Such glaucoma usually occurs when the cataract becomes mature or hypermature. When a cataract becomes hydrated and intumescent, it can cause angle closure glaucoma (termed phacomorphic).[4] Hypermature cataract, where the cortex is liquefied and the lens proteins leak out through the capsule, typically gives rise to an open angle type of glaucoma (termed phacolytic). A morgagnian cataract is an extreme hypermature lens, where cortex is totally liquefied and nucleus sinks to the bottom. Such a lens is more likely to cause phacolytic glaucoma.[5]

A 68-year-old gentleman presented with progressive “blurred” vision for 5 years and pain for 6 weeks in the left eye. His vision was hand movements with corneal edema, shallow anterior chamber (AC), “mature” cataract [Figure 1]a and IOP of 52 mmHg on 3 topical and oral antiglaucoma medications (AGM) and closed angles on Sussman 4-mirror gonioscopy. IOP responded only partially to stepped-up AGM (34 mmHg); laser peripheral iridotomy was done following which corneal edema resolved, AC deepened [Figure 1]b, and IOP improved (22 mmHg). A morgagnian cataract with a very large nucleus was seen only postdilatation [Figure 1]c.
Figure 1: (a) Presentation with corneal edema, shallow anterior chamber (AC), and “mature” cataract. (b) Deeper AC with resolution of corneal edema post laser peripheral iridotomy (LPI). (c) Morgagnian cataract with a large nucleus was seen only postdilatation (LPI at 2.30 o'clock, white arrow)

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The fellow eye was pseudophakic (>4 years) with normal vision, IOP, and fundoscopy.

As presentation was delayed, cataract surgery was undertaken along with trabeculectomy;[6] patient wished to defer IOL implantation, as visual prognosis was indeterminate. Postoperatively at last follow-up, vision did not improve and IOP was controlled at 11 mmHg without AGM, but, more importantly, patient became asymptomatic. Fundoscopy revealed a pale and fully cupped disc; therefore, secondary IOL was not undertaken.


  Discussion Top


Morgagnian cataract occurs in a hypermature state, where the cortex is completely liquefied and has an association with phacolytic glaucoma. However, in this eye, phacomorphic glaucoma occurred, likely due to the extremely large nucleus simulating intumescence. Forward movement of the iris-lens diaphragm due to zonular laxity may have also contributed. Once a cataract is associated with glaucoma, pain ensues due to high intraocular pressure. It is pain in the eye that prompted this patient to seek ophthalmic consultation, albeit in a delayed manner (>6 weeks after its onset). At such late onset, inclusion of trabeculectomy in the surgical plan is mandatory for alleviation of pain. Morgagnian cataract causing phacomorphic angle closure is not reported in the literature.

Acknowledgements

Mr. Shiva Sankar, Ophthalmic Photographer, Centre for Sight, Hyderabad, India.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

Nil relevant (Santen, Novartis, Allergan).



 
  References Top

1.
Jain IS, Gupta A, Dogra MR, Gangwar DN, Dhir SP. Phacomorphic glaucoma--management and visual prognosis. Indian J Ophthalmol 1983;31:648-53.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Prajna N, Ramakrishnan R, Krishnadas R, Manoharan N. Lens induced glaucoma-Visual results and risk factors for final visual acuity. Indian J Ophthalmol 1996;44:14-155.  Back to cited text no. 2
    
3.
Pradhan D, Hennig A, Kumar J, Foster A. A prospective study of 413 cases of lens-induced glaucoma in Nepal. Indian J Ophthalmol 2001;49:103-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Kaplowitz KB, Kapoor KG. An evidence-based approach to phacomorphic glaucoma. J Clin Exp Ophthalmol 2012;S1:006. doi: 10.4172/2155-9570.S1-006.  Back to cited text no. 4
    
5.
Eadie B, Heathcote JG, Gupta RR. Acute phacolytic glaucoma and morgagnian cataract. JAMA Ophthalmol 2019;137:e184495. doi: 10.1001/jamaophthalmol. 2018.4495.  Back to cited text no. 5
    
6.
Senthil S, Chinta S, Rao HL, Choudhari NS, Pathak-Ray V, Mandal AK, et al. Comparison of cataract surgery alone versus cataract surgery combined with trabeculectomy in the management of phacomorphic glaucoma. J Glaucoma 2016;25:e209-13.  Back to cited text no. 6
    


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