Visual Outcome in Patients with Phacomorphic Glaucoma After Manual Small Incision Cataract Surgery

Background: Phacomorphic glaucoma is a sight-threatening secondary angle-closure glaucoma caused by an intumescent cataractous lens, leading to a shallow anterior chamber, raised intraocular pressure, pain, redness, and marked visual loss. Manual small-incision cataract surgery is a practical and effective option in such settings, but visual outcome may depend on the timing of presentation and the severity at admission. Aim of the study: This study aimed to assess visual outcomes in patients with phacomorphic glaucoma following manual small-incision cataract surgery. Methods & Materials: This hospital-based prospective observational study was conducted at the National Institute of Ophthalmology and Hospital, Dhaka, Bangladesh, from January to June 2025. A total of 50 clinically diagnosed phacomorphic glaucoma patients were enrolled purposively. All patients underwent manual small incision cataract surgery, with posterior chamber intraocular lens implantation. Follow-up was done on the 1st postoperative day, at 1 week, 4 weeks, and at the final visit to assess visual acuity, intraocular pressure, and postoperative complications. Data were analyzed using SPSS version 26.0. Results: Among 50 patients, the mean age was 64.8 ± 9.1 years, and most were female (64.0%) and from rural areas (64.0%). The right eye was affected in 54.0% of cases, and most patients presented within 3 to 7 days, with a mean symptom duration of 5.8 ± 3.4 days. Diminution of vision was present in all cases, while ocular pain and redness were also common. Most patients required combination anti-glaucoma therapy preoperatively, and 94.0% underwent MSICS with PCIOL implantation. Visual outcome improved progressively during follow-up, and at final follow-up, 64.0% achieved good vision, 26.0% had moderate vision, and 10.0% had poor vision. Most patients, 72.0%, had no postoperative complications; persistent corneal oedema was the most common complication, and no case of endophthalmitis was observed. Conclusion: Manual small incision cataract surgery provided a favourable visual outcome in most patients with phacomorphic glaucoma. The majority achieved good final vision with a low rate of serious postoperative complications. J.Natl.Inst.Ophthalmol.2025;8(1):15-20