Glaukoma fakomorfik (phaco = lensa; morph= bentuk) adalah glaukoma sudut tertutup

sekunder yang disebabkan oleh lensa intumesens. I n i d a p a t

t e r j a d i p a d a m a t a y a n g sebelumnya memiliki sudut terbuka atau
yang memiliki sudut sempit atau tertutup. Glaukomafakomorfik lebih sering terjadi di negara
yang sedang berkembang. Ini disebabkan akses kefasilitas operasi mata yang masih terbatas
sehingga pasien datang terlambat atau kebiasaanmenunggu katarak sampai matang untuk dilakukan
operasi.
1
Glaukoma fakomorfik disebabkan oleh 2 hal, yaitu penutupan sudut oleh gaya mekanik lensa terhadap
diafragma iris lensa ke anterior dan oleh blokade pupil pada lensa.
4
Matahiperopia dan lensa yang relatif besar terhadap ukuran sumbu mata akan beresiko
terjadinya penutupan sudut dan menjadi faktor predisposisi. Pertambahan ukuran lensa dapat
disebabkanoleh beberapa faktor termasuk penuaan, dimana lensa akan bertambah u
kuran kurvaturaanteriornya, trauma pada lensa, diabetes melitus dan reaksi idiosinkrasi terhadap obatobatan.
4,5
Fakomorfik glaukoma dapat terjadi dalam bentuk serangan akut, sub akut dan
kronik glaukoma. Gejala klinis glaukoma fakomorfik terbatas pada gangguan peng
lihatan karenakatarak. Akan tetapi pasien lebih sering datang dalam keadaan akut
dengan keluhan yangmenonjol nyeri mata dan kepala, muntah dan penurunan tajam
penglihatan yang terjadi secaratiba-tiba.Pada pemeriksaan dapat ditemukan tanda tanda
penurunan visus yang cukup
berat, peningkatan tekanan intraokuler dapat mencapai >30 mmHg, pelebaran pembuluh dara
hkonjungtiva, injeksi siliar, edema kornea, pupil yang berdilatasi dan bereaksi lambat
terhadapc a h a y a . L e n s a y a n g i n t u m e s e n d e n g a n a t a u t a n p a b l o k p u p i l . P e m
e r i k s a a n g o n i o s k o p i menunjukan sudut yang tertutup. Funduskopi seringkali sulit
dilakukan karena adanya
edemakornea dan lensa katarak. Pada keadaan fundus masih dapat dievaluasi serin
gkali belum
ditemukan neuropati optik pada serangan akut pertama kali. Seiring perjalanan
glaukoma,kerusakan papil nervus optik akan semakin terlihat.Penanganan glaukoma fakomorfik
dilakukan pada 2 tahap, yaitu menurunkan tekananintraokuler dan operasi katarak.
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P e n u r u n a n t e k a n a n i n t r a o k u l e r d a p a t d i c a p a i d e n g a n mengatasi blok pupil,
menekan produksi aqueus, dan membuka sudut yang tertutup. Hal inidapat dicapai dengan
medikamentosa dan beberapa manuver atau tindakan sebelum operasikatarak.Operasi katarak
sedini mungkin menurunkan morbiditas dan memungkinkan kontroltekanan yang lebih baik
pada pasien glaukoma fakomorfik. Glaukoma fakomorfik meskipundapat akut dalam onset,
berbahaya dalam perjalanannya, tapi dapat dikenal dengan mudahdalam klinik, dapat ditangani
dan dapat dicegah
In an eye with advanced cataract formation, the lens is swollen or intumescent. Progressive reduction
occurs in the iridocorneal angle. In such eyes, pupillary block glaucoma is caused by changes in the
size of the lens and the position of the anterior lens surface. Angle closure may be secondary to an
enhanced pupillary block mechanism, or it may be due to forward displacement of the lens-iris
diaphragm.

Frequency

International
Although no formal epidemiologic statistics are available, angle closure from hypermature cataracts is
more common in countries where cataracts are common and surgery is not readily available.

Race
Phacomorphic glaucoma can occur in any race.

Sex
Phacomorphic glaucoma occurs equally in men and women.

Age
Generally, phacomorphic glaucoma is observed in older patients with senile cataracts, but it can occur
in younger patients after a traumatic cataract or a rapidly developing intumescent cataract.
History

Patients with phacomorphic glaucoma complain of acute pain, blurred vision, rainbow-colored
halos around lights, nausea, and vomiting.

Patients generally have decreased vision before the acute episode because of a history of a
cataract

Glaukoma fakomorfik
Phacomorphic glaucoma is the term used for secondary angle-closure glaucoma due to lens
intumescence. The increase in lens thickness from an advanced cataract, a rapidly intumescent lens,
or a traumatic cataract can lead to pupillary block and angle closure.

Medical treatment of phacomorphic glaucoma is aimed at rapidly reducing the IOP to prevent further
damage to the optic nerve, to clear the cornea, and to prevent synechiae formation. The reduction of
IOP is necessary to prepare the patient for laser iridotomy, which relieves the pupillary block that is
causing the glaucoma.

Initial management should address the acute nature of the angle closure and include betablockers, alpha 2-adrenergic agonists, and carbonic anhydrase inhibitors. Miotics can worsen the
secondary angle closure attack by increasing iridolenticular contact.

Argon laser peripheral iridoplasty (ALPI) has been studied and has been shown to be safe
and effective as a first-line treatment of acute phacomorphic glaucoma. [1] This would still need to be
followed by cataract extraction for a definitive treatment.

Secondary management begins with laser iridotomy to relieve the pupillary block.
o

This procedure provides an alternate route for aqueous trapped in the posterior
chamber to enter the AC, allowing the iris to recede from occluding the trabecular meshwork. Both
the argon laser and the Nd:YAG laser can be used.

Laser iridectomy sometimes relieves the acute angle-closure attack, but the AC
remains shallow. These eyes are susceptible to repeated attacks of angle closure; therefore,
cataract extraction should be performed if the AC does not deepen after laser iridectomy.

Gonioscopy is useful after an iridectomy for retrospective assessment of the angle. If the
angle is markedly widened, the pupillary block was the likely main mechanism causing the elevated
IOP, and laser iridectomy is sufficient in that case. If the angle does not deepen significantly, lens
intumescence or forward displacement of the lens is the causative factor, and the patient needs
cataract extraction. If the angle closure is not relieved by a laser iridotomy, plateau iris syndrome
also is a differential diagnosis.

OCT may serve as an additional aid in establishing a diagnosis prelaser and postlaser