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Phacolytic glaucoma or lens protein glaucoma
Medical expert of the article
Last reviewed: 08.07.2025
[ Pathophysiology of phacolytic glaucoma
In phacolytic glaucoma, high-molecular proteins (more than 150x10 6 daltons) block the outflow from the trabecular meshwork, leading to an increase in intraocular pressure. Based on the detection of macrophages in the intraocular fluid and in the trabecular apparatus of patients with phacolytic glaucoma, it was believed that the increase in pressure was caused exclusively by blockade of the outflow by macrophages. However, Epstein et al. suggested that obstruction of the trabecular meshwork is caused by proteins with a high molecular weight.
- When examining samples of intraocular fluid from patients with phacolytic glaucoma, Epstein discovered excess amounts of high-molecular proteins, the concentration of which increased as the cataract matured.
- In vitro perfusion of cadaveric eyes with soluble high molecular weight proteins resulted in a 60% reduction in outflow after 1 h.
- High molecular weight proteins were present in the aqueous humor of patients with phacolytic glaucoma in sufficiently high concentrations, causing outflow obstruction.
- In some samples with phacolytic glaucoma, low numbers of macrophages were detected.
Lens proteins are able to induce the migration of blood monocytes and macrophages, which possibly function as scavengers, removing soluble lens proteins and lens fragments from the anterior chamber and trabecular apparatus.
Symptoms of phacolytic glaucoma
With mature or hypermature cataracts, patients complain of a gradual decrease in vision, pain due to inflammation and an increase in intraocular pressure.
Clinical examination
Phacolytic glaucoma develops with mature or hypermature cataract. In such patients, intraocular pressure increases sharply, redness and pain appear. The outbreak of clinical manifestation is associated with soluble proteins released from the lens with mature cataract. The cellular response is an accumulation of mainly macrophages and cells that are larger in size and more transparent than lymphocytes. Hypopyon is not typical. White areas can be seen on the surface of the lens, which are considered to be aggregates of macrophages phagocytizing lens proteins where they leak from the anterior capsule. Gonioscopy shows an open anterior chamber angle. In some cases, retinal perivasculitis is observed.
Special tests
Samples of aqueous humor concentrated by MilHpore filtration reveal macrophages and an amorphous substance consistent with lens protein material. Diagnosis is usually made only by clinical examination.
Treatment of phacolytic glaucoma
Treatment of phacolytic glaucoma should begin with drug therapy to reduce elevated intraocular pressure. The basis of drug therapy is beta-blockers, prostaglandin analogs, a-adrenergic drugs and carbonic anhydrase inhibitors. Local glucocorticoids are also used to reduce inflammation activity, cycloplegic drugs to stabilize the blood-aqueous humor barrier and reduce pain. Drug therapy partially reduces pressure, but the final treatment is only cataract extraction.