Lens-induced Glaucoma Research Articles

Comparison of Cataract Surgery Techniques: Safety, Efficacy, and Cost-Effectiveness

To compare the safety, efficacy, and cost-effectiveness of manual sutureless small-incision cataract surgery (SICS) and phacoemulsification (Phaco) as treatment options for cataract surgery with focus on intumescent, mature, and hypermature lenses (white cataracts). A systematic search of research articles was conducted to develop an internal database for the investigators' appraisal. Literature searches were conducted by using key words and MeSH terms including cataracts, phacoemulsification, small-incision cataract incision, visual acuity, costs, training, time, and barriers to cataract surgery. The final synthesis included 42 manuscripts. All studies show that both Phaco and SICS are safe and effective techniques to rehabilitate cataract patients, but Phaco is costlier, with its preoperative and postoperative medicines, anesthetic agents, viscoelastic materials, disposables, instrumentation, and intraocular lens (IOLs), and had a steeper learning curve. Small-incision cataract surgery, in comparison, has been shown to be faster and more cost-effective. It is useful in intumescent white, black, brown, and lens-induced glaucoma cataracts and could incorporate recent trends like topical and sub-Tenon anesthesia and temporal incisions. Both give equal best-corrected visual acuity but unaided vision has been shown to be slightly better in Phaco due to lesser astigmatism. The literature points to SICS being more useful for intumescent and hard cataracts and is the preferred technique for less-resourced settings. Small-incision cataract surgery is comparable to Phaco in almost all aspects except postoperative astigmatism.

English

INTRODUCTION: The cataract backlog is estimated to be around 12 million1 and annually increasing at an estimated rate of 3.8 million.2 Lens induced glaucoma (LIG) is also found to be fairly common in India.3, 4 Lens induced glaucoma (LIG) due to hyper mature cataracts are an important cause of secondary glaucoma in the developing world. There is an ever-increasing backlog of cataract due to the population explosion, increased life expectancy and low productivity in terms of utilization of the available surgical services. The uptake of eye care services by the rural community has also been suboptimal in countries like India where lens induced glaucoma (LIG) is a common cause of ocular morbidity.5 Pre-operative and post-operative morbidity is more in an eye with lens induced glaucoma than that with a simple uncomplicated cataract. Prognosis and visual outcome are also affected to some extent. Hence timely intervention is important in achieving good results. Each case depending on the mechanism by which glaucoma occurs, has to be managed in a different way. In general, after controlling the intraocular pressure, cataract extraction with IOL implantation should be performed preferably. The present study was undertaken and aimed at a clinical study of various lens induced glaucoma, their management, post operative visual outcome and intraocular pressure control as practiced in the department of ophthalmology, Dr. B. R. Ambedkar Medical College Hospital, Bangalore.

Lens-Induced Glaucoma: The Need to Spread Awareness about Early Management of Cataract among Rural Population

Purpose. To determine the clinical profile of lens-induced glaucoma (LIG), reasons for late presentation, and outcome of current management. Methods. Retrospective analysis of 50 eyes with LIG over a 6-year period between 2005 and 2011 at a tertiary care centre in rural India. Visual acuity and intraocular pressure (IOP) were assessed preoperatively and postoperatively along with postoperative complications. Results. Fifty (2.4%) of 12,004 senile cataracts operated at Pravara Rural Hospital, Loni, presented with LIG. There were 39 (78%) phacomorphic cases and 11 (22%) phacolytic glaucoma. Following cataract surgery, 21 of 50 operated eyes (42%) had visual acuity 6/60 or worse. Conclusion. The results highlight the importance of early diagnosis and treatment of visually disabling cataract. There is a need to educate both the patient and the cataract surgeon about the dangers of lens-induced glaucoma and of about poor outcome if treatment is delayed.

Lens particle glaucoma secondary to untreated congenital cataract and persistent fetal vasculature.

Purpose. To present a case of lens particle glaucoma in a child with an untreated unilateral congenital cataract and persistent fetal vasculature (PFV) and to discuss the implications for the management of unilateral congenital cataract. Methods. A 4-year-old boy presented with a unilateral congenital cataract affecting the right eye. Examination revealed a cataract and PFV. Intraocular pressure (IOP) measured 18 mmHg right, 14 mmHg left, and he was managed conservatively. Nine months later, he attended clinic with a painful right eye. He had quiet anterior and posterior segments but free lens particles in the anterior vitreous and an IOP of 12 mmHg. Over 4 weeks, the IOP rose to 23 mmHg and the patient underwent vitreolensectomy. Results. The affected eye has at no point become inflamed but macrophages laden with lens proteins were identified during histopathologic analysis of the vitreous. The proposed mechanism in this case is that the PFV weakened the posterior capsule leading to its rupture. The resultant macrophages then caused mechanical obstruction of aqueous outflow through the trabecular meshwork. Conclusions. Lens particle glaucoma secondary to posterior capsular rupture is a rare form of lens-induced glaucoma. It is common practice to manage conservatively those patients who present late with unilateral congenital cataract. This case highlights the need for vigilant follow-up of these patients to enable lens-induced glaucoma to be detected at an early stage.

Lens-induced glaucoma in the elderly

Lens-induced glaucoma comprises a number of different glaucomatous processes occurring in the elderly that share in common the role of the crystalline lens in the mechanism of increase in intraocular pressure. We will review the anatomic predisposing factors, their physiology, signs and symptoms, and therapeutic approach. We will consider two studies and discuss the visual results and risk factors associated with these pathologic conditions.

Reduction in admissions of patients with acute primary angle closure occurring in conjunction with a rise in cataract surgery in Taiwan

Using 8 year nationwide administrative data, this study sets out to investigate the relationship between the total number of cataract operations undertaken in Taiwan and admissions for acute primary angle closure (APAC). Monthly cataract surgery and APAC admission rates, per 100,000 of the population, were provided by 1997-2004 inpatient and outpatient data obtained from the Taiwanese National Health Insurance Research Database. The 3814 cases of APAC and 503 687 patients who had undergone cataract operations were categorized by age groups (40-49, 50-59, 60-69 and > or =70 years) and by gender. Spearman rank correlation coefficients were used to examine the direction and strength of the relationships. Throughout the study period, the admissions for APAC showed a steady decline from 630 cases in 1997 to 351 cases in 2004, while the number of cataract operations revealed a gradual increase from 26 600 in 1997 to 77 924 in 2004. The Spearman rank correlation coefficients showed significant inverse relationships between monthly APAC admission rates and monthly cataract operation rates for the total group (r = -0.407, P < 0.001), males (r = -0.330, P < 0.001), females (r = -0.444, P < 0.001), 40-49 year olds (r = -0.335, P < 0.001), 50-59 year olds (r = -0.497, P < 0.001) and 60-69 year olds (r = -0.417, P < 0.001). No significant inverse relationship was observed for the > or =70 age group. Significant inverse relationships were noted between the monthly APAC admission rates and the monthly cataract operation rates. We recommend that data should be collected from other regions and ethnic groups to determine the inter-relationships.

Mature cataract and lens-induced glaucoma associated with an asymptomatic intralenticular foreign body

We report a case of mature cataract and lens-induced glaucoma associated with an asymptomatic intralenticular foreign body. At initial presentation, the patient had no definite history of ocular trauma. During cataract surgery, a metallic intralenticular foreign body was expressed with hydrodissection and easily removed with intraocular forceps. Postoperative visual acuity, ocular status, and electroretinographic findings indicated that the crystalline lens served as a natural barrier to irreversible intraocular toxicity.

Lens-induced Glaucoma 65 Years After Congenital Cataract Surgery

We observed an unusual case of lens-induced glaucoma that occurred 65 years after congenital cataract extraction. We successfully treated the patient by removing the residual lens material with pars plana vitrectomy. The intraocular specimen exhibited lens material, epithelial cells, and macrophages. It may have taken years for the residual lens material to denature and break into small pieces, which resulted in phacolytic and lens-particle glaucoma.

Lens-induced glaucoma.

The crystalline lens is implicated as a causative element in producing several forms of glaucoma. Etiologically they represent a diversity in the presentation of the glaucomatous process. These conditions include glaucoma related to: lens dislocation (ectopia lentis), lens swelling (intumescent cataract), classical pupillary block, aqueous misdirection--ciliary block, phacoanaphylaxis, lens particle, and phacolytic glaucoma. The management of elevated intraocular pressure often requires altering the intraocular relationship of anatomic structures surrounding the lens or lens removal. We will review the entities that produce these lens-induced glaucomatous conditions and suggest a rational approach to their diagnosis and treatment.

Treatment of Glaucomas due to Lens-Induced Inflammations

We present 3 cases of glaucoma secondary to cataractous lens changes. The treatment of lens-induced glaucoma is cataract extraction, preferably intracapsular cataract extraction (ICCE). We performed ICCE in all 3 cases. An anterior chamber intraocular lens was implanted in 2 of the cases. Resolution of glaucoma and restoration of visual acuity were immediate just after the operations. Cytological findings of the aqueous humor revealed that in 2 cases a phacolytic mechanism was the cause, while in the third it was due to a phacoanaphylactic type of inflammation. This article presents an overview of glaucomas due to lens-induced inflammation and discusses the treatment of this specific condition.

Diagnosis and Management of Lens-induced Glaucoma

Lens-induced glaucoma may occur as either secondary angle-closure or open-angle glaucoma. Dislocation or swelling of the lens can cause papillary block and subsequent angle-closure glaucoma. Leakage of soluble lens proteins from a relatively intact cataractous lens can result in a severe secondary open-angle glaucoma (phacolytic glaucoma). Heavy molecular weight protein, believed to be of lens origin, has now been identified in 12 of 12 anterior chamber, specimens from such patients. This liberated lens protein can directly obstruct the trabecular outflow pathways. After extracapsular cataract surgery or after lens trauma, liberated fragments of lens material may mechanically impair the drainage of aqueous humor through the outflow channels (lens particle glaucoma). The diagnosis and management of these different lens-induced glaucomas are reviewed. With proper recognition; these glaucomas are promptly cured by the surgical removal of the lens (material).

Glaucoma at a tertiary referral eye hospital in Nepal

Glaucoma is an important cause of blindness. To report the distribution of various types of glaucoma among patients presenting to a tertiary eye hospital in Nepal. All new patients visiting the hospital between March 2007 and February 2008 underwent a comprehensive eye examination. Whenever glaucoma was suspected, patients were referred to fellowship-trained glaucoma specialists. Patients received a comprehensive glaucoma workup including applanation tonometry, stereoscopic examination of the optic nerve head performed by the glaucoma specialists, and a Humphrey visual field analysis (SITA 24 - 2). 447 patients were newly diagnosed with glaucoma. 171 (38.2 %) patients had primary open-angle glaucoma (POAG), while 143 (32 %) had primary angle-closure glaucoma (PACG). The average age of presentation of patients with POAG was 65.78 ± 9.1 years, while the average age for PACG patients was 54.6 ±12.8 years. 30 (21 %) patients with PACG had acute angle-closure on presentation, while 113 (79 %) had chronic angle closure glaucoma. 107 (75 %) of these patients with PACG had visual acuity of less than 3/60 (20/400) in the worse eye at presentation. The most common form of secondary glaucoma was lens-induced (5.3 %), followed by neovascular (3.2 %) and uveitic glaucoma (3.2 %). The most common glaucoma seen in a tertiary referral eye hospital of Nepal is primary open-angle glaucoma. Among the angle-closure glaucoma, chronic angle-closure is the most common. Lens-induced glaucoma is still the commonest cause of secondary glaucoma.

Lens-Induced Glaucoma

Lens-Induced Glaucoma

Lens-Induced Uveitis and Glaucoma : Part III. “Phacogenetic Glaucoma”: Lens-Induced Glaucoma; Mature or Hypermature Cataract; Open Iridocorneal Angle

Lens-Induced Uveitis and Glaucoma : Part III. “Phacogenetic Glaucoma”: Lens-Induced Glaucoma; Mature or Hypermature Cataract; Open Iridocorneal Angle