Glaukoma fakomorfik (phaco = lensa; morph= bentuk) adalah glaukoma sudut tertutup sekunderyangdisebabkanolehlensaintumesens. Ini dapat terjadipadamatayangsebelumnya memiliki sudut terbukaatau yangmemilikisudutsempit atautertutup.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.1Glaukoma fakomorfik disebabkan oleh 2 hal, yaitu penutupan sudut oleh gaya mekaniklensaterhadap diafragma irislensakeanteriordan olehblokadepupilpadalensa.4Matahiperopia dan lensa yang relatif besar terhadap ukuran sumbu mata akan beresiko terjadinyapenutupan sudut dan menjadi faktorpredisposisi. Pertambahan ukuran lensa dapat disebabkanolehbeberapafaktortermasukpenuaan,dimanalensaakanbertambahukurankurvaturaanteriornya, trauma pada lensa, diabetes melitus dan reaksi idiosinkrasi terhadap obat-obatan.4,5Fakomorfik glaukoma dapat terjadi dalam bentuk serangan akut, sub akut dan kronikglaukoma.Gejalaklinisglaukomafakomorfikterbataspadagangguanpenglihatankarenakatarak. Akan tetapi pasien lebih sering datang dalam keadaan akut dengan keluhan yangmenonjol nyeri matadan kepala, muntah dan penurunan tajam penglihatan yangterjadi secaratiba-tiba.Pada pemeriksaan dapat ditemukan tanda tanda penurunan visus yang cukup berat,peningkatantekananintraokulerdapatmencapai>30mmHg,pelebaranpembuluhdarahkonjungtiva, injeksi siliar, edema kornea, pupil yang berdilatasi dan bereaksi lambat terhadapcahaya.Lensayangintumesendenganatautanpablokpupil.Pemeriksaangonioskopimenunjukan sudut yang tertutup. Funduskopi seringkali sulit dilakukan karena adanya edemakorneadanlensakatarak.Padakeadaanfundusmasihdapatdievaluasiseringkalibelumditemukan 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 tekananintraokulerdanoperasikatarak.6Penurunantekananintraokulerdapatdicapaidenganmengatasi 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.FrequencyInternationalAlthough 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.RacePhacomorphic glaucoma can occur in any race.SexPhacomorphic glaucoma occurs equally in men and women.AgeGenerally, 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 fakomorfikPhacomorphic 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 beta-blockers, 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. 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