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.

Clinical Study of Lens–Induced Glaucoma in Elderly Population of Gulbarga

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 .

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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

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.