Safety and efficacy of manual small incision cataract surgery for phacolytic glaucoma

In this issue Venkatesh and coworkers (see page 279) from The Aravind Eye Hospital in Pondicherry, India present their results of utilizing a manual sutureless extracapsular cataract surgery (MSICS) technique to treat thirty three consecutive cases of phacolytic glaucoma.1 Pre-operatively the mean intraocular pressure was 46.2 mmHG. Post-operatively the IOP was 22 mmHg or less in all cases and 87.9% achieved a post-operative visual acuity of 20/60 or better! They had no major complications. There were no expulsive hemorrhages and not a single case of posterior capsule rupture. These results are spectacularly good and point out the efficacy of sutureless manual extracapsular cataract extraction. The surgical technique they describe is not only much faster and far less expensive than phacoemulsification for mature cataracts, but it may well be a better and safer technique in the most advanced cases, particularly when phacolytic glaucoma is present. The definitive treatment for phacolytic glaucoma is surgery to remove the lens. However, phacolytic glaucoma presents a very challenging problem for the surgeon. In most cases the lens changes are very advanced. The pathology includes micro-leakage of high molecular weight proteins through an intact anterior lens capsule. This leads to inflammation and obstruction of aqueous outflow …