Visual Outcomes of Phacomorphic Glaucoma in filipino Adults: A Single-Center Retrospective Review

Background. Cataracts remain the leading cause of preventable blindness in the Philippines, affecting over one million Filipinos. Delayed surgical intervention leads to complicated cases, including phacomorphic glaucoma, a lens-induced glaucoma characterized by angle closure and pupillary block from a mature cataractous lens. Unlike the reversible visual impairment of cataracts, phacomorphic glaucoma causes irreversible optic nerve damage. While uncommon in developed countries, phacomorphic glaucoma persists in settings with limited healthcare access. 

Objective. This study aimed to evaluate the clinical presentation, surgical management, and visual outcomes of patients with phacomorphic glaucoma at a tertiary referral center in the Philippines.

Methods. A retrospective chart review was conducted at the Department of Ophthalmology and Visual Sciences, University of the Philippines-Philippine General Hospital, identifying adult patients diagnosed with phacomorphic glaucoma from January 2018 to December 2022. Inclusion criteria comprised patients presenting with decreased vision or eye pain, elevated intraocular pressure, mature cataracts, and secondary angle closure who completed at least three months of follow-up. Patients with trauma-related lens subluxation, iridodialysis, or angle recession were excluded. Data collected included presenting symptoms and duration, ophthalmologic examination findings, preoperative biometry, surgical interventions, complications, and postoperative outcomes. Visual acuity was converted to log MAR, and cataracts were classified using the Lens Opacities Classification System III criteria. Descriptive statistics and correlational analyses were performed.

Results. Thirty (30) patients met the inclusion criteria. The majority were female (70%) and aged 60 years or older (80%), with a mean age of 65 years. Painless blurring of vision was the predominant presenting symptom (60%), with a prolonged delay to consult, with a mean of 11.4 months. Patients with painless blurring of vision demonstrated significantly longer delays (mean 15.5 months) compared to those with eye pain (mean 4.2 months). At presentation, mean visual acuity was 2.6 log MAR (hand movement), and mean intraocular pressure was 45.8 mmHg. All affected eyes had mature cataracts, with 56.7% presenting as total white cataracts and 73.3% with shallow anterior chambers. Surgical interventions included phacoemulsification with intraocular lens implantation (40%), combined phacoemulsificationtrabeculectomy (20%), phacoemulsification with goniosynechiolysis (10%), phacoemulsification with vitrectomy (13.3%), and other procedures (16.7%). Complications included prolonged corneal edema (20%), corneal decompensation (10%), aphakia (13.3%), and vitreous loss (10%). At three months postoperatively, 86.7% achieved intraocular pressure ≤21 mmHg and 90% were medication-free. However, while 40% achieved visual acuity better than 0.3 log MAR, 30% still had visual acuity ≥1 log MAR. Structural damage from glaucoma was evident in 73.3% of patients. 

Conclusion. Phacomorphic glaucoma in the Filipino population frequently presents as chronic, painless blurring of vision, leading to prolonged delays in seeking care. While surgical intervention effectively controls intraocular pressure, a significant proportion of patients sustain irreversible structural and functional damage. These findings underscore the urgent need for improved public awareness regarding cataract-related complications and enhanced access to timely ophthalmic care to prevent permanent visual impairment.