English

Abstract

AIM OF THE STUDY: To clinically analyse visual outcome and intraocular pressure control in surgically treated cases of lens induced glaucoma. MATERIALS AND METHODS: 100 patients with LENS INDUCED GLAUCOMA attending glaucoma services of Regional Institute of Ophthalmology and Government Ophthalmic Hospital were included in the study. Patients with presence of phacolytic, phacomorphic, lens particle, phaco anaphylaxis glaucoma and subluxated or dislocated lens with elevated intraocular pressure were included in the study. Patients with previous history of Primary Open Angle glaucoma and primary angle closure glaucoma, other secondary glaucomas, uncontrolled diabetes and IHD were excluded. All were subjected to detailed anterior segment examination, best corrected visual acuity, intraocular pressure measurement either by Goldmann applanation tonometry or in cases with presence of corneal edema rebound tonometry reading was recorded, fundus examination, gonioscopic examination were done. Surgical procedures like SICS/ECCE or combined surgery in cases with peripheral anterior synechiae or lens removal with secondary iol implantation were done. Surgical complications were analysed in patients undergoing sics/ecce/lens removal with secondary IOL and combined surgery and followed up periodically with visual acuity and intraocular pressure measurements and gonioscopic examination. RESULTS: In our study, 52% cases were in the age group of 56 -60 years, there was a slight male preponderance (59%), 47% presented with an IOP of 28-32mmhg. 60% cases were phacolytic glaucomas, 29% were phacomorphic glaucomas, 10% were lens particle glaucomas, 1% was due to subluxated lens induced glaucoma. 72% cases had PCIOL in other eye, 57% had a visual acuity in 6/36-6/18 range in other eye. At the end of six weeks the visual acuity for maximum number of cases (55%) was in the range 6/36-6/18, 20% cases had vision of range 3/60-6/60, 20% cases had vision of range 6/12-6/9. Hence visual improvement occurred in 95% of cases at the end of sixth post-operative week. 68% of cases had striate keratopathy, Post-operative iritis was present in all cases (100%), zonular dehiscence occurred in 43% cases, 12% cases had posterior capsular rent and 5% cases had vitreous loss. Out of 10 lens particle glaucoma cases, 50% (5 cases) had a good vision of 6/12 when compared to other types of lens induced glaucoma. Intraocular pressure was in the range of 12-14mmhg in 60% cases, 16-18mmhg in 40% cases at the end of six weeks. CONCLUSION: In our study, most of the patients had good vision in fellow eye and PCIOL status. This shows that patients ignored the reduced vision in affected eye due to good vision in fellow eye so their daily life was not affected until they developed symptoms. In lens induced glaucoma, surgery is the main stay of treatment after adequate control of intraocular pressure and inflammation with medications. Following surgery, intraocular pressure reduction occurs in all cases and visual improvement occurs in 95% cases.