A clinical study on lens-induced glaucoma and its visual outcome after cataract surgery at Tertiary Eye Care Center in Western Maharashtra

Abstract

Introduction: Lens-induced glaucomas (LIG) are a common occurrence in rural areas of India. 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. The present study has endeavored to determine the characteristics, risk factors, and their consequences on the postoperative visual outcome, intraocular pressure (IOP), including optic disc changes in lens-induced glaucoma.

Purpose: To study the demographics, clinical presentations of different types of LIG, and its surgical outcome in terms of visual acuity and IOP control after cataract surgery.

Material and methods: This prospective study was conducted in the Ophthalmology department at Tertiary eye care center in Western Maharashtra from January 2015 to December 2019.
Patients visiting the Hospital with classical symptoms of LIG were taken into study. All these patients underwent a complete ocular examination using Slit lamp biomicroscopy, Schiotz tonometry and Applanation tonometer. These patients were operated after explaining the possible prognosis by Small Incision Cataract Surgery (SICS) with PCIOL implantation.

Results: Total of 194 patients were taken into this study in which 88 (45.36%) were male patients and 106 (54.64%) were Female. Among different LIG patient’s maximum patients had Phacomorphic Glaucoma accounting 61.86% (120 patients) and Phacolytic Glaucoma 37.11% (72 patients). Subluxated glaucoma was seen in 2 cases (1.03%). The majority of patients 61.86% presented after 1 week of symptoms and the reason for late presentation in more than half of the patients were financial constraints. Visual acuity was either hand-movement or just perception of light in the majority of the eyes at the time of presentation. At last, follow-up 12 cases (6.19%) had best-corrected visual acuity of more than 6/12.

Conclusion: Good visual acuity can be achieved in lens‑induced glaucoma presenting within 1 week, with intraocular pressure of <35 mm of Hg and with meticulous control of intraocular pressure and inflammation with medications preoperatively.  Necessary steps should be taken to educate especially the rural population of India, the importance of timely surgery for the better visual outcome and the dangers of poor visual results if cataract surgery is delayed.