Phacolytic Glaucoma Research Articles

Management and visual outcome in patients of phacolytic glaucoma at a tertiary eye care hospital

Phacolytic glaucoma is one of the commonest cause of secondary glaucoma due to senile cataracts. This study was conducted to evaluate the visual outcome of phacolytic glaucoma. 1. To study the management of phacolytic glaucoma; 2. To study the visual outcome after planned manual SICS. Participants were 30 patients in a tertiary eye care hospital for both urban and rural population diagnosed as phacolytic glaucoma. Demographic data, duration of the symptoms, IOP of the patients before presenting to the hospital were noted. Patient underwent Manual SICS with PCIOL implantation after the control of intraocular pressure and inflammation. The data was analyzed by simple statistical methods. Mean age of the patients was 61.63 yrs. Female to male ratio was 1.8:1. Duration of the presenting symptoms before reporting to the hospital was <1 week in 16 (53%), 1-2 week in 11 (37%) and >2 week in 3 (10%). Mean IOP was 40.7mmHg preoperatively. Visual Acuity was perception of light in 16 (53.33%) and hand movements in 14 (46.66%) preoperatively. Postoperative visual acuity at 6 weeks was 6/6-6/12 in 19(63.33),6/18-6/60 in 8 (27%), <6/60 in 3 (10). Following surgery 28 of 30 eyes (93.33%) had IOP less than 21 mmHg at discharge. Fellow eye showed pseudophakia in 18 (60%), immature cataract in 12 (40%). Cataract surgery proves to be effective in lowering the intraocular pressure and visual recovery in phacolytic glaucoma.

Impact of Covid-19 on the Morphology of Cataract

Objective: To see the impact of Covid-19 on the morphology of cataract during lockdown. Study Design: Observational and interventional study. Place and Duration of Study: Department of Ophthalmology, Niazi Medical and Dental College from 1st April 2020 to 30th September 2020. Methodology: All the patients of eye related complaints were referred to eye department from emergency of hospital after screening them for Covid-19 suspected symptoms as well as patients coming directly to eye OPD from reception. Patients suffering from phacomorphic, phacolytic glaucoma and cataract of every type except traumatic type were included. Results: The ratio of males and females patients was almost equal because cataract is a common age related problem in both sexes. Due to lock down there is a significant increase in the number of mature cataract as well as phacomorpic and phacolytic glaucoma which was decreased for last many years .Although the awareness increased regarding cataract surgery but due to stop of elective work like other specialties and COVID 19 become the focus point the morphology of cataract changed (mature and hypermature), complicated cataract (phacomorphic, phacolytic glaucoma) irrespective of socioeconomic status of patients. Conclusion: During lockdown period there is increase in the maturity of cataracts and secondary glaucoma (phacolytic, phacomorphic). Although this pattern of cataract presentation has been decreased for last many years but due to covid 19 strong lock down occur and this pattern was again observed. Keywords: Covid-19. Phacolytic glaucoma, Phacomorphic glauco

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

A CLINICAL STUDY ON LENS INDUCED GLAUCOMA IN PATIENTS ATTENDING GOVERNMENT GENERAL HOSPITAL,SRIKAKULAM.

AIM: To determine the prevalence and visual outcomes after cataract surgery in different LIG patients METHODS:In this prospective study 50 patients were taken into study. Detailed history was taken and slit lamp examination was done & IOP was recorded by AT. All the patients were treated preoperatively appropriately. Patients were operated with SICS with PC IOL implantation and Peripheral Iridectomy.During follow up a detailed Ocular examination was done including Refraction using snellens chart and IOP measurement with AT. RESULTS: Among 50 patients 21(42%)were male patients and 29(58%)were female. Maximum patients had Phacomorphic Glaucoma accounting 72% (36patients) and Phacolytic Glaucoma 24%. Highest percentage was among 40-49mmHg (52%) followed by 30-39mmHg (36%) and >50mmHg (10%). Highest patients were between 10-19mmHg (76%). Visual acuity on admission, highest patients were seen in HM positive (64%) followed by PL+(32%). Even No PL were also seen (4%). On follow up after 6weeks ,majority were seen between 6/12- 6/18(52%) CONCLUSION: LIG is an important vision-threatening disease presenting as a painful red eye. It is remaining as one of the important cause of Blindness not only because of Senile cataract but even after cataract surgery due to Glaucoma caused by neglected cataractous lens.Hence, importance should be given for timely surgery for better visual outcome .

Types of Glaucoma and Associated Comorbidities Among Patients at King Abdulaziz Medical City, Jeddah.

AimTo identify the types of glaucoma and associated comorbidities among patients attending the ophthalmology clinic at King Abdulaziz Medical City (KAMC) in Jeddah.MethodsA cross-sectional study that included all glaucoma patients at KAMC in Jeddah between June 1st, 2016 and November 30th, 2020. Data were collected through retrospective chart review from the electronic medical record system (BestCare) and utilized a structured data collection sheet.ResultsA total of 283 patients met the inclusion criteria. The most common type was primary open-angle glaucoma (POAG; 53%) followed by secondary glaucomas (SG; 26.5%) then childhood glaucoma and primary angle-closure glaucoma (CG, PACG; 7.4%). The majority of secondary glaucoma cases were due to neovascular glaucoma (NVG; 44.9%), followed by phacomorphic glaucoma (17.9%) and phacolytic glaucoma (10.3%). Hypertension (60.8%) and diabetes (58.3%) were the most prevalent systematic comorbidities, and cataract (49.1%) was the most prevalent ocular comorbidity.ConclusionPOAG was the most common glaucoma type, followed by SG, CG, and PACG. Among secondary glaucoma types, neovascular glaucoma was found to be the most common subtype. Hypertension was the most prevalent comorbid condition.

Intra-operative control of positive vitreous pressure in a graded manner by pars plana sutureless, small gauge trocar-cannula.

The purpose of this paper is to delineate a technique of using a 23G, single, sutureless transconjunctival pars plana sclerotomy to facilitate anterior segment surgery in eyes with increased positive vitreous pressure (PVP) ascribe to predisposing or intraoperative factors. We have implemented this technique in five eyes when PVP was anticipated before the surgery because of risk factors or it was encountered during anterior segment surgery. Different case scenarios in which PVP occurs during the surgery comprising phacolytic glaucoma, corneal tear repair combined with cataract surgery with IOL in a case with traumatic corneal injury, anterior capsule rupture and secondary glaucoma, Trabeculectomy in case of uveitic glaucoma, routine phacoemulsification cataract surgery with PVP encountered during surgery were addressed by using this technique. The new technique outlined by the authors consists of passing sutureless 23 G trocar cannula which enables controlled and gradual efflux of clear watery fluid, resulting in passive vitreous decompression with minimal risk of vitreous traction and retinal breaks. Once PVP is reduced, anterior segment surgery can be safely completed without risk of developing devastating complications. This sutureless single port pars plana trocar cannula technique is minimally invasive, safe, effective and fast technique which can cause reduction of PVP intraoperatively in a controlled and graded manner, thereby minimizing complication rates in difficult case scenarios.

The kebab technique uses a bipolar pencil to retrieve a dropped nucleus of the lens via a small incision

We developed a new method to retrieve a dropped nucleus of the lens via a small incision using bipolar pencils, the kebab technique, to solve the lack of small-gauge fragmatomes, and the expense and toxicity of perfluorocarbon liquids (PFCL). A total of 8 eyes in 6 patients underwent this technique and were reviewed. After vitrectomy, the dropped nucleus of the lens was lifted from the retina by adhesion with a bipolar pencil, and phacoemulsification was performed while rotating the lens. The outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), and corneal endothelial cell density before and after surgery. Surgical indications included zonular weakness, trauma, acute angle closure attack, and phacolytic glaucoma. At 1 month, BCVA improved from a mean (standard deviation, SD) 1.67 logMAR (0.90) to 1.14 logMAR (1.01). The mean preoperative IOP was 24.5 (16.8) mmHg and postoperative IOP was 11.0 (2.8) mmHg. The mean preoperative corneal endothelial cell count was 2600 (322) cells/mm2 (one eye was unmeasurable) and postoperative corneal endothelial cell count was 2387 (431) cells/mm2. There were no postoperative complications. The retrieval of a dropped nucleus of the lens using a bipolar pencil enables small incisions without using PFCL.

Pattern of Presentation, Management and Outcome of Lens Induced Glaucoma at a Tertiary Eye Care Centre

Objective: To outline the clinical presentation, management and outcome of lens induced glaucoma in Chittagong Eye Infirmary and Training Complex. Methods: A case series review was done among the patients who visited Chittagong Eye Infirmary and Training Complex from January 2015 to December 2018. Demographic data, clinical presentations, management and outcome were recorded and analysed. Results: 30 phacomorphic cases and 20 phacolytic glaucoma patients were included in our study. The mean age at presentation was 60 years. Female to male ratio was 2:1. The reason for late presentation was distance which was 60% in phacomorphic glaucoma and 50% in phacolytic glaucoma. The main symptoms were reduced vision followed by ocular pain and redness of eye. Visual acuity was either HM or just PL in all eyes before surgery. All patients underwent SICS with posterior chamber lens implantation. IOP reduced tremendously upon discharge and vision kept improving up to a month after surgery. Conclusion: Reduced vision, ocular pain and redness are the main clinical presentations of lens induced glaucoma. Cataract surgery proves to be effective in lowering IOP and visual recovery in patients with lens induced glaucoma.

Clinical profile, visual outcome and complications after cataract surgery in patients with lens induced glaucoma

Purpose: To assess the clinical profile of lens-induced glaucoma (LIG), reasons for late presentation, and outcome of medical and surgical management. Materials and Methods: Retrospective analysis of 48 eyes with LIG over a 5-year period between 2014 and 2018 at a tertiary care centre in rural Southern India. Type of LIG, symptoms, preoperative and postoperative corrected distant visual acuity (CDVA), intraocular pressure (IOP), intraoperative and postoperative complications were assessed. Results: Forty-eight eyes of 23(47.9%) males and 25(52.1%) female aged between 50 to 80 years were included in this study. 32(66.7%) cases had presented with phacomorphic glaucoma and 13 (27.1%) with Phacolytic glaucoma who underwent medical and surgical treatment of the same. Mean pre-operative and postoperative IOP was 35.60 ± 5.81 mmHg and 20.417 ± 2.33 respectively. Similarly, the mean preoperative and postoperative CDVA was 1.44 ± 0.76 and 0.34 ± 0.20 respectively which was statistically significant. (P Conclusion: LIG is an important vision-threatening disease occurring in the elderly due delayed treatment of mature cataract. This study shows that it is important to conduct periodic screening of the elderly to identify cataracts and manage it accordingly to prevent irreversible blindness. Keywords: Intraocular pressure, Glaucoma, Phacomorphic, Phacolytic.

Comparison of visual outcome and complications following early and delayed cataract surgery in phacolytic glaucoma

To compare the Visual outcome, intraoperative and post operative complications following early and delayed Cataract surgery in Phacolytic glaucoma. A Prospective and interventional study in a district hospital. Confirmed cases of phacolytic glaucoma after medical control grouped into group A and group B. Group A patients under went small incision cataract surgery (SICS) within 7 days (early) and group B patients after 7 days(delayed). They were compared for complications and post operative distant corrected visual acuity (DCVA) at the end of 8 weeks.There were38 eyes from 38 patients. The demographic factors and clinical findings are comparable between two group. Cumulative intraoperative complications like difficulty in doing continuous curvilinear capsulorhexis (CCC), Zonular dialysis and posterior capsule (PC) tear with vitreous disturbance were more in group B 55.6%(10/18) compare to group A 35.0% (7/20). Postoperative DCVA of 6/12 or more was comparable between two group A and B 60.0% (12/20) and 55.6 % (10/18) respectively. Post operative persistent corneal edema in 5.0% (1/20) in group A, 5.5% (1/18) persistent uveitis and 5.5% (1/18) optic nerve damage in group B observed. Early surgical intervention is to be preferred choice in all cases of phacolytic glaucoma. However in patients with genuine personal, family and socio economical reasons delayed surgery will not alter final visual outcome. Adequate preoperative preparation are to be taken to reduce and handle intra operative complication.

Visual Outcome after Manual Small Incision Cataract Surgery for Phacolytic Glaucoma

Aim: To evaluate the visual outcome after manual small incision cataract surgery (MSICS) as a treatment of phacolytic glaucoma.
 Methods: The study included 43 patients with phacolytic glaucoma treated by manual small incision cataract surgery with intraocular lens implantation. Preoperative and postoperative visual acuity and intraocular pressure have been recorded and compared at the end of six weeks after surgery.
 Results: The mean preoperative intraocular pressure was 36.23 (± 10.86) mm of Hg. There were no significant intraoperative complications such as posterior capsular tear or expulsive hemorrhage. Post operative mean intraocular pressure (IOP) was 12.58 (± 3.45) mm Hg. Pre operative visual acuity in all the affected eyes were perception of light with projection of rays in all quadrant. Postoperative best corrected visual acuity was 6/6-6/18 in 27 patients (62.80%), 6/24- 6/36 in 10 patients (23.25%) and ≤ 6/60 in 6 patients (13.95%).
 Conclusion: Manual small incision cataract surgery is a safe and effective method of treatment for phacolytic glaucoma and the visual outcome and IOP reduction is satisfactory.

Phacolytic glaucoma mimicking Endophthalmitis

Phacolytic glaucoma is one of the varieties of various lens induced glaucoma, also known as lens protein glaucoma is a sequelae of hypermature cataract. In our case 60 years old male presented with lid edema, pain, redness, loss of vision of right eye with exudates or fluffy deposits in the anterior chamber mimicking endophthalmitis. Endophthalmitis is infection of eye involving aqueous and vitreous humors with exudates in vitreous cavity. Here we report a cytology proven case of lens induced glaucoma managed with phacoemulsification and intraocular lens implantation followed by good visual outcome. This case highlights the importance of right and early diagnosis.

Indirect choroidal neovascularization secondary to a posterior-segment intraocular foreign body \u2013 case report

BackgroundWe reported a rare case of indirect choroidal neovascularization (CNV) secondary to a posterior-segment intraocular foreign body (IOFB) that was not located in the area of direct injury but in the fovea. After intravitreal injections (IVIs) of aflibercept, the choroidal neovascularization (CNV) lesion disappeared and vision improved.Case presentationA 26-year-old male patient suffered from a fast-shot metallic IOFB in his right eye. He underwent primary corneal repair, pars plana vitrectomy, IOFB removal and an IVI of antibiotics in the right eye. Two weeks later, cataract surgery was performed on the right eye for traumatic cataract after an episode of acute phacolytic glaucoma. The best-corrected visual acuity (BCVA) of the right eye improved to 20/20 5 months after the first surgery. However, the vision of the right eye worsened suddenly with metamorphopsia 1 year after the first surgery. Color fundus images showed a whitish lesion with faint retinal hemorrhage and surrounding sensory elevation. Fluorescein angiography (FA) revealed a lesion with early- and late-phase severe leakage. Optical coherence tomography (OCT) demonstrated a CNV lesion with surrounding subretinal fluid. The patient received an IVI of aflibercept every 8 weeks for 3 times. Finally, the BCVA of the right eye improved to 20/25.ConclusionsFor rare cases of fovea-spared injury by a metallic IOFB, it is still necessary to pay close attention to the foveal microstructure to avoid possible CNV formation. Treatment with IVIs of anti-VEGF, aflibercept, as early as possible could provide good visual outcomes.

Clinical study of lens-induced glaucoma at community health center in India

Background and Objective: It has long been recognized clinically that several forms of glaucoma may occur in association with the formation of cataracts, which are an important cause of secondary glaucoma in the developing world.- These lens-induced glaucomas are a common occurrence in India, hardly surprising in a situation where the incident of cataract cases far exceeds the total number of surgeries performed currently. In the developing world, like India, financial, cultural, and psychosocial barriers to accessing excellent surgical services still exist. 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 sub-optimal in countries like India, where lens-induced glaucomas (LIGs) are a common cause of ocular morbidity. The present study has endeavored to determine the characteristics, risk factors, and their consequences on postoperative visual outcome, intraocular pressure (IOP), including optic disc changes in LIGs. Materials and Methods: This study included 50 cases of different types of LIG, admitted in the wards of the Community Health Center, Bandikui, Dausa, Rajasthan, during the period January–September 2019. All consecutive patients diagnosed as LIG on the basis of clinical symptoms and signs were included. Clinical features included pain, loss of vision, redness of the eye, presence of an intumescent, mature, or hypermature cataract associated with raised IOP of >21 mm Hg. Results: In this study series, it is observed that the most frequent type of LIG was phacomorphic glaucoma (PMG) (64%) followed by PhacoLyticc Glaucoma (PLG) (28.00%). In this study, good visual acuity achieved by cases with phacolytic glaucoma (57.00%) was more than PMG (50.00%) optic disc, at last, follow-up in the affected eyes was normal in the majority (36.00%). There were six cases of cystoid macular edema, and the media was hazy in two cases. Glaucomatous disc damage was found in 52% of cases. Although clinically significant disc damage was found more in PMG (57.7%) than PLG (33.33%). Conclusion: Results have shown that the LIGs were more common in the age group of 60–69 years and in females, good visual acuity can be achieved in lens-induced glaucoma presenting within 2 weeks, with intraocular pressure of

Lens induced glaucoma in a tertiary eye care centre in Western Nepal.

Lens induced glaucoma due to hypermature cataracts is an important cause of secondary glaucoma in the developing world. The most common etiology of lens induced glaucoma is phacomorphic glaucoma from untreated senile cataract. To study the demographics, clinical presentations and surgical outcome of lens induced glaucoma (LIG). It is the prospective case series of fifty three patients eyes with LIG over a 6 months period from June 2015 to November 2015. All cases of lens induced glaucoma underwent cataract surgery. Data including demographics, clinical presentations, surgical outcome were analysed using Statistical Package for Social Studies 20.0. The mean age was 61.5 years (Standard deviation 8.9) with predominantly women (30, 56.6%) were affected. Phacomorphic glaucoma (38, 71.7%) was the main cause of lens induced glaucoma, followed by phacolytic glaucoma (15, 28.3%). The main clinical symptoms were reduced vision (100%), eye pain (96.2%) and redness of eyes (62.3%). All patients (100%) presented with visual acuity of <3/60 or worse and intraocular pressure (IOP) more than 40 mm Hg (34, 64.2%). All 53(100%) patients underwent cataract surgery and all of them had tremendously reduced intraocular pressure with a mean 13.9 mmHg and vision had improved from >6/18 as noted in 16(30.2%) cases. The main clinical presentations of LIG are triad of acute reduced vision, eye pain and redness. The better final BCVA is found when there is an early presentation and less IOP at the time of presentation Public awareness, early detection and early intervention aids in good visual recovery and control of intraocular pressure in LIG.

Assessment of Visual Outcome in Patients with Phacolytic Glaucoma- A Clinical Study

Assessment of Visual Outcome in Patients with Phacolytic Glaucoma- A Clinical Study

A CLINICAL STUDY ON LENS INDUCED GLAUCOMA AND ITS VISUAL OUTCOME IN PATIENTS ATTENDING GOVERNMENT GENERAL HOSPITAL, KADAPA.

Background: India being a developing country, causes of Blindness in India will be different than developed countries. There are 10million (37 million in world) blind people in India today in which 80 percent if taken care in time, completely preventable. AIM: To evaluate sex predominance, prevalence of different types of lens induced Glaucoma and its visual outcomes in patients attending government general hospital, kadapa. MATERIAL AND METHODS: This prospective study was conducted in Ophthalmology department of government general hospital, kadapa, Andhra Pradesh from January 2018 to June 2019. 32 Patients visiting the Hospital with classical symptoms of Lens induced Glaucoma were taken into study. RESULTS: A Total of 32 patients were taken into this study in which 12(37.50%) were male patients and 20(62.50%) were Female. Among different LIG patients maximum patients had Phacomorphic Glaucoma accounting 62.50% (20 patients) and Phacolytic Glaucoma 34.37% (11 patients).&#x0D; Keywords: Lens-induced glaucoma, Cataract, Phacomorphic glaucoma, Phacolytic glaucoma and Small incision cataract surgery (SICS)

The Untoward Effect of Neglected Cataracts: Phacolytic Glaucoma

The Untoward Effect of Neglected Cataracts: Phacolytic Glaucoma

Photographic Essay: A Hypermature and Shrunken Cataract with Phacolytic Glaucoma

We report an unusual presentation of a hypermature cataract that has shrunken in size over time due to resorption of the liquefied cortex and shrinkage of the lens capsule, and developed complications of lens subluxation and phacolytic glaucoma.