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    Can You Guess October's Mystery Condition?

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    Make your diagnosis in the comments, and look for the answer in next month’s Blink.

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    Last Month’s Blink

    Phacolytic Glaucoma

    Written by Rym Maamouri, PhD, Ouafi Bouazzaoui, and Monia Cheour, MD. Photo by Dr. Maamouri. All are at the Habib Thameur Hos¬pital and the University of Tunis El Manar In Tunisia.

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    A 65-year-old man presented with a three-day history of rapid-onset, painful visual loss in his left eye. He also reported having bilateral blurred vision for a year, for which he did not seek treatment. His VA was 20/200 in the right eye and light perception in the left. Slit-lamp examination of the left eye showed conjunctival injection, corneal edema, and a deep, white-appearing anterior chamber with pseudohypopyon (Fig. 1); the IOP was 42 mm Hg. Gonioscopy was blurry but revealed an open angle with no synechiae in the superior quadrant. B-scan ultrasonography of this eye ruled out vitritis, vitreous hemorrhage, and retinal detachment. Examination of the right eye was unremarkable except for the presence of a dense cataract (Fig. 2).

    The patient was diagnosed with phacolytic glaucoma (PG). He received systemic ocular hypoten­sive drugs and underwent extracapsular cataract extraction and implantation of a posterior cham­ber IOL in the left eye. Subsequently, an IOL was implanted in the right eye. At follow-up, his final VA was 20/25 and 20/70 in the right and left eyes, respectively.

    PG is a form of open-angle glaucoma that can occur when a hypermature or Morgagnian cata­ract leaks lens proteins into the anterior chamber through a macroscopically “intact” lens cap­sule.1 The leakage leads to trabecular meshwork blockage by protein-laden macrophages, high-mo­lecular-weight proteins, and inflammatory cells, resulting in increased IOP, pseudohypopyon, and, rarely, corneal haze.1-3.

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    1 Papaconstantinou D et al. Clin Interv Aging. 2009;4:331-336.

    2 Dhingra D et al. Eur J Ophthalmol. 2020;30(5):NP32-NP35.

    3 Macovei ML et al. Rom J Ophthalmol. 2021;65(2):191-195.

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