Lens-induced Glaucoma Research Articles

A clinical study of lens-induced glaucoma and its outcome after cataract surgery

A clinical study of lens-induced glaucoma and its outcome after cataract surgery

STUDY OF CLINICAL PROFILE OF PSEUDO-EXFOLIATION SYNDROME AND PSEUDO-EXFOLIATION CATARACT IN A TERTIARY HEALTH CARE HOSPITAL IN WESTERN ODISHA

Objective: The pseudo-exfoliation (PEX) syndrome is a complex disorder characterized by the deposition of fibrillary materials around the blood vessels of organs. This study was conducted with the aim of knowing the actual prevalence of PEX in Western Odisha and the characteristics of cataracts in those PEX patients. Methods: This cross-sectional study included 340 OPD patients and was conducted between January 1, 2021, and December 31, 2022, at Hitech Medical College and Hospital. The prevalence of PEX and cataracts was studied. The data was analyzed using basic descriptive statistics and reported in frequencies and percentages. Results: The study showed 74 patients out of 340 were diagnosed with pseudoexfoliation syndrome, with a prevalence of 23%. 42 patients (58%) were male and 32 (42%) were female, with a M: F ratio of 1.3:1. The mean age of presentation was 67 y (range 51–84 y), and the majority of patients (41%) were in the age group of 61–70 y. The increased intraocular pressure was noticed in 11 cases (15%) in our study. Two patients each had open-angle glaucoma and lens-induced glaucoma. Nuclear cataract was the most common type of cataract observed in 27% of the study group, followed by cortical cataract with nuclear sclerosis in 19% of cases. Conclusion: It is concluded that pseudo-exfoliation syndrome is more common in males than in females, with a higher number of patients in the age group of 81 y and older. Therefore, it can be assumed that it is associated with the age factor. Nuclear cataract was the most common type of cataract observed in our study population.

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

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.

One-Step Surgical Approach for Treating Lens-Induced Glaucoma with Iridodialysis Following Blunt Trauma

Introduction : Traumatic glaucoma is one of secondary glaucoma that can be challenging to treat. Blunt trauma to the eye may result in iritis, hyphema, lens subluxation, or dislocation leading to increased intraocular pressure (IOP). Every complication needs to be addressed promptly. Here we present about one-step surgical approach to treat lens indued glaucoma with iridodialysis following blunt trauma.
 Case Illustration : A 65-year-old man presented with a chief complaint of blurred vision and pain in his right eye for a month following blunt ocular trauma where he was hit with piece of wood while operating a chainsaw. Ophthalmologic examination revealed RE VA of 2/60 with IOP 32 mmHg. Anterior examination revealed a shallow anterior chamber, iridodialysis 90 degrees, cloudy lens with phacodonesis (Fig 1). Patient was diagnosed with lens-induced glaucoma, lens subluxation, iridodialysis and traumatic cataract. Patient was treated with antiglaucoma agents prior to surgery. One-step surgical approach: trabeculectomy, phacoemulsification with capsular tension ring, and iridodialysis repair become the treatment of choice (Fig 2). After one month of surgery, IOP decreased to 16 mmHg without anti-glaucoma medication, final VA RE achieved 0.2 (Fig 3).DiscussionManagement of traumatic glaucoma depends on the underlying cause of increased IOP. Trabeculectomy combined with lens extraction should be considered with degree of subluxation that may cause pupillary block. Repair iridodialysis can be done using various techniques.
 Conclusion : Management of traumatic glaucoma can be done with trabeculectomy, lens extraction and repair iridodialysis in one-step surgery. Surgical technique should be considered depending on the patient’s eye condition.

DIFFERENT APPROACHES IN MANAGING LENS-INDUCED ANGLE CLOSURE GLAUCOMA: A SERIAL CASE

Introduction : Lens-induced angle-closure glaucoma can be caused by phacomorphic lens and ectopia lentis. Several factors affect the disease progression. Early diagnosis and appropriate management are important.
 Case Illustration : Case 1. A 67-year-old woman presented with acute redness and blurred vision in her left eye with visual acuity (VA) of 1/300 and intraocular pressure (IOP) of 60 mmHg. Axial length showed 23.66 mm and anterior chamber depth (ACD) was 1.61mm (Figure1). She was diagnosed with phacomorphic glaucoma. Phacoemulsification combined with trabeculectomy was performed (Figure2&3). Her VA was improved to 0.08 and her IOP was reduced to 19mmHg after surgery. Case2. A 67-year-old man came with painful blurred vision in his right eye. His VA was a perception of light with an IOP of 40 mmHg. He had axial length of 22.7 mm and ACD of 2.07 mm (Figure4). The lens was anteriorly subluxated and showed zonular laxity. Intracapsular cataract extraction combined with trabeculectomy was performed (Figure5&6). His VA was unchanged while his IOP was reduced to 18 mmHg after surgery.
 Discussion : Age older than 60 years old, female gender, short axial length (<23.7 mm), shallow ACD, and zonular laxity are factors for progressivity of lens-induced glaucoma. Cataract removal was a definitive treatment along with IOP-lowering medications. The choice of lens extraction technique varies among individuals.
 Conclusion : Removal of cataractous lens is a definitive treatment in conjunction with intraocular pressure and inflammatory regulations for managing lens-induced angle-closure glaucoma. Comprehensive clinical assessments in patients are necessary for managing the symptoms and preventing complications.

DIFFERENT APPROACHES IN MANAGING LENS-INDUCED ANGLE CLOSURE GLAUCOMA: A SERIAL CASE

Introduction : Lens-induced angle-closure glaucoma can be caused by phacomorphic lens and ectopia lentis. Several factors affect the disease progression. Early diagnosis and appropriate management are important.
 Case Illustration : Case 1. A 67-year-old woman presented with acute redness and blurred vision in her left eye with visual acuity (VA) of 1/300 and intraocular pressure (IOP) of 60 mmHg. Axial length showed 23.66 mm and anterior chamber depth (ACD) was 1.61mm (Figure1). She was diagnosed with phacomorphic glaucoma. Phacoemulsification combined with trabeculectomy was performed (Figure2&3). Her VA was improved to 0.08 and her IOP was reduced to 19mmHg after surgery. Case2. A 67-year-old man came with painful blurred vision in his right eye. His VA was a perception of light with an IOP of 40 mmHg. He had axial length of 22.7 mm and ACD of 2.07 mm (Figure4). The lens was anteriorly subluxated and showed zonular laxity. Intracapsular cataract extraction combined with trabeculectomy was performed (Figure5&6). His VA was unchanged while his IOP was reduced to 18 mmHg after surgery.
 Discussion : Age older than 60 years old, female gender, short axial length (<23.7 mm), shallow ACD, and zonular laxity are factors for progressivity of lens-induced glaucoma. Cataract removal was a definitive treatment along with IOP-lowering medications. The choice of lens extraction technique varies among individuals.
 Conclusion : Removal of cataractous lens is a definitive treatment in conjunction with intraocular pressure and inflammatory regulations for managing lens-induced angle-closure glaucoma. Comprehensive clinical assessments in patients are necessary for managing the symptoms and preventing complications.

Clinical Profile, Prognostic Factors and Surgical Outcomes in Lens Induced Glaucoma: A Prospective Study from a Tertiary Care Centre in Western Maharashtra, India

Introduction: Cataracts are a major cause of preventable blindness in India. A considerable number of patients continue to present with advanced cataracts, which can result in complications such as Lens Induced Glaucoma (LIG). LIG is a secondary glaucoma that occurs due to mature or hypermature cataracts, potentially causing significant visual impairment. Aim: To determine the clinical presentation, prognostic factors, and surgical outcomes in patients with LIG. Materials and Methods: A prospective study involving 60 patients with LIG was conducted at a tertiary care centre in Western Maharashtra, India from September 2022 to June 2024. All patients underwent Small Incision Cataract Surgery (SICS) and were followed-up postoperatively on day 1, day 7, and week 6. Results: The mean age of the patients was 69.03 years, with 66.7% being females. Symptoms such as pain, redness, headache and diminished vision were present in all patients. The mean duration of symptoms was 4.08 days. All patients presented with poor visual acuity (<6/60), and the majority had shallow Anterior Chamber (AC) depth (83.3%). The highest number of cases exhibited elevated Intraocular Pressure (IOP), with a range of 41-50 mmHg. Postoperative visual outcomes improved significantly by week 6 in 51.7% of patients. Conclusion: Early diagnosis and management of cataracts are crucial in preventing LIG and improving visual outcomes. Community outreach programs for early detection and management are essential in a developing country like India.

Lens induced glaucoma – Clinical profile and prognosis in tertiary care centre

Conditions in which cataractous lens and abnormalities of lens leads to elevated intra ocular pressure have been termed as Lens induced glaucoma (LIG). Objective of our study was to know the clinical profile of patients, describe management and visual outcome in lens induced glaucoma. Hospital based prospective study conducted on 40 patients of LIG from November 2016 to October 2018 attending the outpatient department of Ophthalmology at Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute. After taking informed consent, detail history, detailed examination, IOP by Applanation tonometry, Gonioscopy, examination of posterior segment, patients diagnosed as lens induced glaucoma admitted and managed with medical and surgical treatment. Post operative day 1 visual acuity and IOP recorded and followed up on day 8 and 6 weeks for above. Data analyzed with descriptive statistics and chi square test. In our study mean age of presentation in phacomorphic glaucoma is 67.25 ± 6.58 years and phacolytic glaucoma mean age was 64.10years ± 9.78. Female to male ratio being 1.8 : 1. Phacomorphic glaucoma was found in 57% and phacolytic glaucoma in 43%. Mean IOP at presentation was 42.6mmHg ±5.36. Most of them underwent SICS + PCIOL (52.5%). Study showed that most of them had better visual acuity at the end of 6 weeks. Final IOP was 15.8 mmHg± 1.78.Our study demonstrated that lens induced glaucoma is still a challenging complication of cataract which can be prevented by early treatment of cataract. SICS is still gold standard that effectively controls IOP and gives better visual outcome.

Lens-induced glaucoma - In a Tertiary Eye Care Center, Ethiopia

Background: Lens-induced glaucoma after untreated mature cataract is the commonest cause of secondary glaucoma in the developing world. The purpose of this study was to determine the common clinical features of lensinduced glaucoma, its management, and its outcome at Menelik II tertiary hospital, in Ethiopia.Methods and Materials: This was a retrospective study of cases that were seen at the hospital from January to December 2020. Lens-induced glaucoma patients who undergo cataract extraction were included in the study. Medical charts review was performed, and analysis was done using SPSS version 24.0 Software.Results: Forty-four lens-induced glaucoma patients were included in this study. Female participants were 65.9%. The mean age was 63.3(±Standard deviation (SD) 8.7) years. Phacomorphic glaucoma 88.6% was the leading cause. The common clinical symptoms identified were eye pain (100%), visual reduction (97.7%), and redness (38.8%). Visual acuity (3/60) or worse was reported in all patients with mean intraocular pressure of 37.3mmHg. After cataract surgery, the mean intraocular pressure reduced to 14.5± 6.55 mmHg while vision improved to better than 6/60 in 28 (63.6%) of patients. Of these, 21 (75%) patients seek medical treatment in the first two weeks of initial symptom.Conclusion: This study has identified the main cause of LIG was phacomorphic with the common clinical findings of pain, redness, and visual reduction. Early cataract extraction was associated with better final visual recovery and intraocular pressure control. An intraoperative complication was often observed in those with delayed presentation. Therefore, creating awareness among the general population and healthcare givers is key to the timely management of lens-induced glaucoma.

Difficulties of Cataract Surgery in Lens-Induced Glaucoma Due to Subluxated Cataract

Introduction: Cataract is a disease of the eye in which the normal clear lens has opacified and obscured the passage of light. A mature cataract occurs when the lens is opacified. Lens subluxation is a condition when the crystalline lens is not in its anatomical position that can result in decreased anterior chamber depth. It is a potentially high risk of developing pupillary block, leading to lens-induced glaucoma (secondary angle closure glaucoma). In this case, the definitive therapy is lens extraction, which is challenging for cataract surgeons. This case report aims to expose the difficulties of cataract surgery in lens-induced glaucoma due to subluxated cataract. Case Presentation: A 56-year-old male presented with unable to see in his right eye, followed by foggy vision, glare when seeing the light, and a history of an acute glaucoma attack. His right best corrected visual acuity (BCVA) was 1/300, and the intraocular pressure (IOP) was 5 mmHg on therapy with glaucoma medications. Slit lamp examination of the right eye showed a shallow anterior chamber, irradiated iris, mid-dilated pupil, completely cloudy lens, and a capsular instability around 12 to 6 clock hours (180°/2 quadrant). This patient was diagnosed with mature cataract and lens-induced glaucoma due to subluxated mature cataract and was given glaucoma medications also underwent phacoemulsification (PE) along with Intraocular lens (IOL) and capsular tension ring implantation due to the lens instability and excessive lens movement. Conclusions: Cataract surgery for subluxated mature cataract and lens-induced glaucoma is challenging because of the shallow anterior chamber, capsular instability, and excessive lens movement. A thorough diagnosis, preoperative evaluation, postoperative monitoring, and evaluation are essential for safe cataract surgery, reducing the risk of complications and achieving a good result.

Lens-induced Glaucoma, a Collateral Damage during COVID-19 Pandemic

Cataract if left untreated, can lead to complications such as lens induced glaucoma and permanent visual loss. The COVID-19 outbreak resulted in movement control orders causing closure and reduction of non-COVID hospital services resulting delayed appointment dates. This study described the side effects of delayed patient appointments due to COVID-19 pandemic. A 70-year-old man presented with right eye (RE) pain and redness. There was gradual reduction in RE vision over the last year but treatment was delayed due to pandemic. In examination, visual acuity on his RE was hand movement and left eye (LE) was 6/12 (ph6/12) and near vision of N5. The right pupil was mid-dilated, reacting sluggishly with presence of relative afferent pupillary defect. Intraocular pressure (IOP) on the RE was 54 mmHg and LE was 16 mmHg. Circumciliary injection of right conjunctiva with central corneal haziness was seen. The anterior chamber was deep with the presence of 3+ cells with whitish lens material at the pupillary axis. A Morgagnian cataract with phacodonesis was present. A diagnosis of lens induced glaucoma was made. Immediate reduction of IOP included topical and systemic medication and pain relief were instituted. Intracapsular cataract extraction with anterior vitrectomy and surgical peripheral iridectomy was performed. This highlights the late presentation of a patient with mature cataract during the COVID-19 pandemic. Patient awareness and education are essential in recognising the complications of mature cataract if it is presented later. A reminder of signs and symptoms of lens induced glaucoma should be conveyed to patient when appointment is delayed.

Surgical Outcomes of Glaucoma Drainage Device Implantation in Refractory Glaucoma Patients in Thailand.

To study the surgical outcomes of glaucoma drainage device (GDD) implantation in refractory glaucoma patients. Retrospective chart review of glaucoma patients undergoing GDD implantation, Ahmed glaucoma valve (AGV), Baerveldt glaucoma implants (BGI), and Aurolab aqueous drainage implantation (AADI) from January 2012 to June 2021. Glaucoma patients were classified into two groups: primary glaucoma including: primary open angle glaucoma (POAG), primary angle closure glaucoma (PACG) and juvenile open angle glaucoma (JOAG) and secondary glaucoma including: neovascular glaucoma (NVG), ocular surgery (vitreoretinal surgery, scleral buckling procedure, postoperative extra capsular cataract extraction, scleral fixation intraocular lens, penetrating keratoplasty), intraocular trauma, uveitis glaucoma, lens-induced glaucoma, pseudoexfoliation glaucoma (PXG), iridocorneal endothelial (ICE) syndromes and Axenfeld Rieger Syndrome. Surgical outcomes were studied. Primary glaucoma included 57 eyes from 49 patients. Secondary glaucoma included 87 eyes from 85 patients. The cumulative probability of complete or qualified success of refractory glaucoma patients at five years were 53.4% (95%CI: 38.4%, 66.3%). Higher success rate was discovered in primary glaucoma at 65.8% (95%CI: 38.4%, 83.3%) than 45.2% (95%CI: 26.9%, 61.9%) in secondary glaucoma group significantly with p=0.003. While the results among success rate, adverse events and complications was not different between types of GDD. Predictors for failure were neovascular glaucoma with unadjusted hazard ratio (HR) 3.62 (95%CI: 1.45, 9.04) with p=0.006, and lens-induced glaucoma with adjusted HR 4.19 (95%CI: 1.10, 15.86) with p=0.035 in multivariable analysis. Tube malposition and occlusion were the most frequent adverse events at 11.11%, corneal decompensation at 5.5%, hypotony at 2% in the nonvalved group, and endophthalmitis at 0.69%. Surgical success in refractory primary glaucoma was superior to secondary glaucoma with no difference between nonvalved and valved GDD implantation. Lens-induced glaucoma was a strong predictor for failure in GDD implantation.

Reasons for Delayed Presentation for Cataract Surgery in Patients of Lens Induced Glaucoma – A Questionnaire-based Study at a Tertiary Eye Care Centre of Central Rural India

ABSTRACT Purpose To describe the socioeconomic profile, awareness level and reasons for the delay in accessing timely eye care for cataract surgery in patients of lens-induced glaucoma (LIG). Methods This cross-sectional observational study included all patients with LIG who presented to a tertiary eye care centre in central rural India between March 2019 to February 2020. Data were collected through a questionnaire. Results Out of the 731 patients included in the study, the majority were females (69.36%). The mean age of the patients at presentation was 62.66 ± 10.37 years. Only a few participants, 193 (26.40%) were aware of LIG. Lower socioeconomic profile, older age, female gender and illiteracy were found to be strongly associated with awareness about LIG (p < .001). Patients waiting for the winter season (58.27%) to get operated was the major reason for delayed presentation to the hospital. Other reasons for the delayed presentation were – need not felt (feeling that intervention was not necessary) due to good vision in other eye (14.36%), financial issues (11.63%), long travelling distance (7.11%), no caretaker (6.89%), medical illness (1.78%) and fear of surgery (0.55%). Conclusion Delayed reporting for eye healthcare in patients of LIG is found to be multifactorial. Most patients preferred waiting for the winter season to get their eyes operated, which throws light on the mindset and ignorance of the patients in this part of central rural India. We further emphasize on strengthening the education and counseling efforts in the community to enable patients to access services in a timely fashion.

Lens Induced Glaucoma

Lens related elevation in Intraocular pressure results from a variety of mechanisms such as lens dislocation, lens swelling (intumescent cataract), inflammation due to phacoanaphylaxis and lens particle blocking the trabecular meshwork. This review was done with the aim of studying the types of lens-induced glaucoma, their clinical features and current management. Different published articles were discussed to see the result of management

Lens-Induced Glaucoma: An Audit of Cataract Cases in Hospital Sultanah Nur Zahirah, Kuala Terengganu (HSNZKT).

Introduction: Cataract is the main cause of preventable blindness worldwide and as such, it is important to identify these patients early before complications develop. Cataracts may progress to become intumescent (phacomorphic) or hypermature (phacolytic). This can lead to lens-induced glaucoma, which may subsequently cause permanent optic nerve damage.Objective: To report on lens-induced glaucoma (LIG) of cataract cases treated in Hospital Sultanah Nur Zahirah, Kuala Terengganu (HSNZKT), Malaysia.Method: National Eye Database (Malaysia) data from 2011 till 2017 were collected and analysed.Results: A total of 81 (1.08%) cases of lens-induced glaucoma were calculated from 7468 cataract cases treated during the seven years of the study period. The number of cases showed an increasing trend with 0.78% in 2011 to 1.26% in 2017. Most of the patients were in the age group of 70-79 years (44.30%), followed by 60-69 years (34.18%), 50-59 years (11.39%), 80-89 years (7.59%), 40-49 years, and 90-99 years (1.27%). Most of the cases are female (57%). The majority of them (79.75%) underwent cataract operation for the first eye.Conclusion: Overall, this study was able to highlight the significant association between the incidence of LIG and increasing age as well as surgery series (either first or second eye). Therefore, more outreach programs should be conducted in the future to enable younger elderly patients from all areas to receive treatment. More online education and talk series can be organized to increase the community’s awareness and acceptance of cataract operations.

Challenges in managing glaucoma-related morbidity due to lockdown in a developing country

Objective:The aim of this study was to assess the ocular morbidity due to delayed presentation in glaucoma patients because of COVID lockdown.Methodology:This was a retrospective study of 15 cases presented to us between October 2020 and February 2021. Cause of glaucoma in our study group was either primary angle closure, pseudoexfoliation, lens-induced glaucoma, or neovascular glaucoma. The cause of delayed presentation was identified and patients were treated with antiglaucoma medications, Nd-Yag laser, and surgery as per the standard treatment protocol.Results:With both medical and surgical intervention, some useful vision was restored in five cases while in rest it was not salvageable. The vision in the affected eye ranged from 6/60 in Snellen’s chart to perception of light and projection of rays positive. Better results were achieved in angle, closure, and lens-induced glaucoma cases as compared to neovascular glaucoma cases.Conclusion:The time of presentation in such cases is as important as the etiopathogenesis. We are left with limited treatment options if the presentation is late. The lockdown ended but it unraveled quite a few instances of disease presentation which were totally preventable under normal circumstances. Introspection on finding out newer and proactive methods to reach people suffering from such irreversible but preventable diseases is the need of the day especially when preventable but irreversible diseases like glaucoma are considered.

A Clinical Study on the Incidence and Visual Outcome after Surgical Management of Lens-Induced Glaucoma

Aims and Objectives: To determine 1) the incidence of lens-induced glaucoma. 2) the more prevalent type of LIG. and 3) Visual outcome following surgical management of LIG. Material and Methods: 50 patients of lens-induced glaucoma, who presented in OPD of Regional Institute of Ophthalmology, were included in the study. All patients were admitted and managed in indoor wards. Informed and written consents were taken. A detailed history and a thorough ocular examination was done. Surgical correction was done by SICS or Phacoemulsification or triple procedures operations. Results: A standardized proforma was used to compile data and it was analyzed statistically using Chi-square test and Probability value. The incidence of LIG was found to be 0.174 among all OPD attendees. Phacomorphic glaucoma (58%) was found to be the highest followed by phacolytic glaucoma (32%). No significant association with respect to sex and age of the cases was found. The presenting symptoms varied in severity and were directly proportional to the degree of rise of IOP. 38% of cases in our study achieved best corrected visual acuity of 6/9 and 28% achieved 6/12 acuity at the end of 6 weeks. Visual outcome was found to be better for cases with early detection and treatment. Conclusion: The mainstay to prevent and treat LIG is early diagnosis and treatment of cataract. Delayed treatment of LIG may result in poor visual outcome. Keywords: LIG, IOP, Phacomorphic glaucoma, Phacolytic glaucoma, SICS, Phacoemulsification.

English

BACKGROUND In developing countries like India, it is essential to spread awareness about cataract and its complications like lens induced glaucoma, uveitis. Lens induced glaucoma (LIG) can lead to irreversible blindness due to secondary optic atrophy. The purpose of this study was to stress on early diagnosis and timely management in preventing blindness due to lens induced glaucoma in patients visiting ESIC Medical College and Hospital, Gulbarga. Karnataka. METHODS This retrospective descriptive type of statistical study was conducted in the Department of Ophthalmology, ESIC Medical College and Hospital, Gulbarga. Karnataka, from March 2018 to March 2021. Intraocular pressure (IOP) and visual acuity was recorded in all patients after through history taking, ocular examination and fundoscopy. After subjecting for exclusion criteria, cases of LIG were confirmed and included in the study. RESULTS In our study we found total 25 cases having LIG, in that 9 were male patients (36 %) and 16 were females (64 %). Phacomorphic glaucoma was recorded in 19 patients (76 %) and phacolytic glaucoma in 5 cases (20 %). Intraocular pressure of 40 - 49 mmHg was recorded in 16 patients (64 %) followed by 30 – 39 mmHg in 5 patients (20 %) and 50 – 59 mmHg in 4 patients (16 %). In our study, 13 patients had visual acuity of counting fingers (CF) 3 meters to 5 meters (52 %) followed by 6/60 to 6/24 (20 %) and hand movements to counting fingers 3 metres in (12 %) and one patient had no perception of light (4 %). All patients underwent cataract surgery with intraocular implantation under local anaesthesia. After 2 weeks of follow up, vision restored was between 6/9 - 6/18 (40 %) in 10 patients followed by 6/18 - 6/60 (28 %) in 7 patients and no improvement in vision in one patient. CONCLUSIONS Glaucoma is one of the causes for irreversible blindness. Though overall prevalence is less than 5 % but gets its one of major contribution from lens induced glaucoma. One good thing about LIG is patient presents early due to loss of vision and pain, so if we intervene with early diagnosis and manage patients, vision can be restored successfully. KEYWORDS LIG, Cataract, IOP, Phacomorphic Glaucoma, Photolytic Glaucoma

Outcomes and Reasons for Late Presentation of Lens Induced Glaucoma: A Prospective Study

To determine the clinical outcomes and causes of late presentation in lens induced glaucoma (LIG). Prospective observational study. One hundred sixty-five patients with LIG who underwent cataract surgery. Preoperative data collection included a questionnaire about reasons for late presentation, socioeconomic status, visual acuity, intraocular pressure (IOP), and the lens and angle status of the fellow eye. All patients underwent manual small-incision cataract surgery. Postoperative vision, IOP, the anterior segment, and the fundus were evaluated at days 1, 15, and30. Reasons for late presentation, status of the fellow eyes, and surgical outcomes, including visual acuity and IOP at the 1-month postoperative visit. Mean age at presentation was 63.8 years, and the female-to-male ratio was 1.4:1. Of the entire cohort, 70.3% were phacolytic and 29.7% had phacomorphic glaucoma. The main causes for late presentation was nonfinancial (81.2%); of these, good vision in fellow eye and lack of escort to the hospital were the major reasons. Most fellow eyes were pseudophakic (72.1%). After surgery, 75.6% gained best-corrected visual acuity of 6/18 or more. Six percent experienced poor visual recovery (≤6/60) with optic atrophy as the major cause. Only 7.9% required further glaucoma management in the form of topical medications. Delayed presentation (>15 days) was associated with poor visual outcome. Nonfinancial causes, including good vision in the fellow eye and lack of escort, were the major determinants of late presentation. Most patients were pseudophakic in the fellow eye. After cataract extraction, only a few LIG patients required further glaucoma management.

English

BACKGROUND Secondary glaucoma is an anatomically identifiable abnormality which in turn is an underlying cause of the events that lead to aqueous outflow obstruction and rise in the intraocular pressure. This prospective study mainly highlights the secondary glaucoma with special reference to its proportion, causes and its risk factors in a tertiary care hospital. METHODS This study was a cross sectional study. Patients, who attended the Department of Ophthalmology after fulfilling the inclusion and exclusion criteria diagnosed with secondary glaucoma, were included in the study. The study period was from February 2018 to June 2020. A standard form was filled up for each patient documenting parameters and findings of various examinations and was evaluated as per protocol. RESULTS Secondary glaucoma was seen in 0.2 % patients who visited during the study period. Out of 106 patients, males were 50, females were 56, with a male: female ratio of 1:1.1. The most common cause of secondary glaucoma was lens induced glaucoma seen in 44.34 % followed by uveitic glaucoma in 20.8 % cases, traumatic 17.9 %, neovascular 10.4 %, pseudoexfoliation glaucoma 2.8 %, pigmentary glaucoma 1.9 %, silicon oil induced 0.9 %, and uveitis-glaucomahyphema syndrome in 0.9 % cases. Around thirty five percent (34.9 %) cases presented with sudden onset of painful diminution of vision with nausea and vomiting. CONCLUSIONS Secondary glaucoma is still one of the prevalent diseases in this part of country. Lens induced glaucoma is still the most common cause of secondary glaucoma. Hypermature cataract, uveitis, trauma and neovascularisation are the different risk factors. KEYWORDS Secondary Glaucoma, Lens Induced Glaucoma, Phacomorphic Glaucoma, Uveitic Glaucoma