Clinical Outcome of Manual Small-incision Cataract Surgery in Patients with Phacolytic Glaucoma

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Abstract Aim and Objective: To study the clinical outcome of cataract surgery in patients with phacolytic glaucoma. Materials and Methods: This is a hospital based prospective interventional study done on 50 eyes of 50 cases of phacolytic glaucoma conducted over one year. Following initial medical management, patients underwent lens extraction through manual small incision cataract surgery (SICS). Clinical examination, best corrected visual acuity and intraocular pressure were noted preoperatively as well as postoperatively. Result: A total of 50 patients were enrolled in this study with female to male ratio of 1.5:1. The mean age of presentation was 62.48 years. Preoperative vision in the affected eye was only perception of light in all of them and IOP measured at presentation was <30 mm Hg in 11 (22%), 30-40 mm in 17 (34%), 40-50 mm in 14 (28%) and >50 mm in 8 (16%). Thirty patients (60%) had good vision in fellow eye due to pseudophakia. The average duration between the first and second eye surgery was 1-3 years. 94% of our patients were from rural areas. All patients presented within one week of the onset of symptoms. All patients underwent manual small incision cataract surgery with rigid IOL implantation in 35 patients (70%), whereas 15 cases (30%) were left aphakic and planned for secondary IOL at a later date. Intraoperative complications noted were zonular dehiscence in 38%, anterior capsular calcification which led to difficulty in anterior capsulorhexis in 32%, peripheral rhexis runoff in 20%, subluxated lens in 12% and posterior capsular rupture in 14%. BCVA at the end of 1 month was >6/12 in 21 patients (42%), 6/12-6/18 in 14 patients (28%), and <6/18 in 15 patients (30%). Among the 15 patients with vision <6/18, 14 had low vision due to aphakia, and 1 had cystoid macular edema which was treated with systemic and oral steroids and topical non-steroidal anti-inflammatory agents. Conclusion: We concluded that lens-induced glaucoma is a cause of preventable blindness, particularly in elderly patients. Factors such as ignorance, socioeconomic challenges, lack of awareness, absence of an escort, and good vision in the other eye contribute to delayed presentation. Early diagnosis and treatment, along with sequential cataract surgery, are crucial for achieving better visual outcomes and preventing complications like lens-induced glaucoma.