CRITICAL EVALUATION OF LENS INDUCED GLAUCOM
Abstract
Purpose: This longitudinal study was to outline the different characteristics of lens induced glaucoma (LIG), to determine the risk factors, to study the intra-operative and post-operative complications and their consequences on post-operative visual acuity & intraocular pressure, following small incision cataract surgery.
Methodology: A total of 50 patients were included in the study. A standardized detailed performa was used and the patient’s data was collected. Based on the clinical findings, etiological diagnosis of lens induced glaucomas was made. Reasons for late presentations were also noted. Appropriate medical management was given followed by surgical intervention (manual small incision cataract surgery). The intra-operative and post-operative complications were noted. Patients were followed up to 6 week postoperatively and clinical findings were noted. All data was analyzed statistically using Chi – square test.
Result:
• Most common subtype of lens induced glaucoma noted was phacomorphic variety (68%) & phacolytic glaucoma (24%).
• Most common Intra – operative complication being Shallow anterior chamber (AC), seen in 9 cases, Posterior capsule rupture with Vitreous loss (PCR with VL) 4 cases. Least common being, cortical remnants in 2 cases due to associated vitreous loss. The intra – operative complication rate was almost equal in all groups except shallowing of anterior chamber which was more common in cases of phacomorphic glaucoma.
• Post – operatively corneal oedema with striate keratopathy and iritis were noted in 10 cases (20%) each. Incidence of post – operative complication of corneal oedema with striate keratopathy was more in phacomorphic group while post – operative iritis was more in phacolytic group.
• All cases of lens particle glaucoma and glaucoma associated with subluxation / dislocation of lens, had post – operative complications of corneal oedema with striate keratopathy and iritis both.
• Good visual acuity (6/6 - 6/12) achieved in cases which presented within 1 week (83.33%) , whereas poor visual acuity of less than 6/60 was more in cases which presented beyond 2 weeks (25%) In this study, duration of symptoms had a linear relation with best-corrected visual acuity at final follow up. More the delay in presentation, poorer was the visual outcome, which was both clinically and statistically significant (p=0.001).
• Clinically, significant proportion of cases with IOP at presentation less than 40 mmHg (79.16%) achieved good visual acuity (6/6-6/12), than cases with IOP more than 40 mm Hg (42.30%). This was found to be statistically significant as well with p value = < 0.002. Whereas, no significant difference was found for poor visual outcome (<6/60). The IOP at last follow up was reduced to normal limits (14.73 ± 2.63 mm Hg). It was found that the IOP tends to be higher with the delay in presentation beyond 2 weeks.
Conclusion: There is no inclination found towards age, sex, religion. Phacomorphic glaucoma was the most common entity. Visual outcome is directly related with height of IOP and duration of raised IOP preoperatively. Early detection, medical and surgical intervention yields better visual outcome. Health education and awareness regarding cataract surgery will definitely decrease the incidence of LIG.
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References
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