Rapid onset phacolysis

Phacolysis involves the breakdown of a hypermature cataract, causing an antigenic reaction to the lens proteins released into the anterior chamber with subsequent inflammation. To date, the time it takes for a crystalline lens to reach hypermaturity and induce a phacolytic response has never been clearly detailed. It is believed that cataract maturation is a slow process. The process by which the lens proteins begin to leak is thought by many to be similarly slow. However, the immune-related inflammatory process that develops when the lens proteins begin to leak may be quite rapid. It may be an error to consider this aspect of the phacolytic process to be slow.

We present a case with a clear, timed delineation of the phacolytic process. A mature cataract became hypermature with subsequent phacolysis and inflammatory pressure rise over the course of 17 days. It appears that this is the first published account of the time involved in the development of phacolysis and, we believe, the fastest onset of the process.

While cataract maturation is generally considered to be a slow, insidious process, it should be recognized that the phacolytic process might not be slow. Once a lens reaches hypermaturity, phacolysis could occur quite rapidly over the course of several days. This case could be an important consideration in management of the removal of advanced cataracts. This case may be the shortest reported time from diagnosis of a mature cataract to the development of inflammatory phacolysis and secondary glaucoma, occurring over a period of only 17 days.