Hypermature cataracts are uncommon in modern ophthalmic practice due to earlier surgical intervention. When complicated by phacolytic glaucoma, they present as an ophthalmic emergency requiring prompt management. An elderly female presented with pain and vision loss in the right eye for one week. Examination revealed hand-movement vision, intraocular pressure (IOP) of 54 mmHg, and a milky white cornea obscuring anterior segment details. Ultrasound B-scan showed a normal posterior segment. IOP was reduced with intravenous mannitol and topical therapy. Cataract extraction was performed via a sclerocorneal tunnel with trypan blue staining, nucleus prolapse, and aspiration. Intraoperative findings included a broken anterior capsule and zonular dialysis. A three-piece intraocular lens was implanted in the sulcus. Postoperatively, IOP normalized, corneal clarity improved, and vision recovered to 6/12 by the fourth week. This report highlights the importance of timely recognition and management of a hypermature cataract with secondary glaucoma. Despite advanced pathology and intraoperative challenges, tailored surgical techniques and appropriate lens placement can achieve favorable outcomes.
Parri et al. (2026) studied this question.