Expected vs. Actual Refractive Error in Patients Presenting With Phacomorphic Glaucoma

Aim Phacomorphic glaucoma (PG) is a rare but clinically significant presentation requiring emergent cataract surgery. We chose to investigate whether the expected refractive error based on the intraocular lens (IOL) calculations differed from the expected refractive outcome post-surgery. Materials & Methods A retrospective analysis of patients with PG between 2009 to 2018 who underwent cataract surgery and had postoperative refraction was included. Information collected included presenting and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP) pre­ and postoperatively, and the presence of corneal edema. Predicted spherical equivalence (SphEq) data was collected from IOL calculations, and postoperative SphEq was calculated from postoperative manifest refraction. Results Twenty patients with PG who underwent cataract surgery were identified; of these, 10 patients and 10 eyes who underwent manifest refraction post­op were included. Mean BCVA at presentation was 20/544 [Logarithm of Minimal Angle of Resolution (LogMAR) 1.44], and mean pre-op IOP was elevated at 24.6 ± 14.2 mmHg. Mean BCVA measured at one month post-op improved to 20/192 (LogMAR 0.983). Mean IOP decreased to 19 ± 8.8 mmHg at one month post-op. The mean difference between the predicted and actual refractive error, as calculated by SphEq was ­0.088 (p=0.570). Conclusion The study shows an improvement in visual acuity and IOP post-cataract surgery in patients with PG, as would be expected. The study also demonstrates that patients ended up with a slightly more myopic refractive error than expected postoperatively, and illustrates the clinical variability in postoperative refractive outcomes from a large standard deviation. This is a new and clinically important finding, although not statistically significant, that has not been previously published.