Retrospective Audit of Phacomorphic Glaucoma in Last 12 Years in a Tertiary Eye Care Centre, New Delhi, India
Introduction: Phacomorphic glaucoma is a type of secondary glaucoma caused by lens swelling in eyes with mature or intumescent cataract. It is encountered more commonly in developing countries. Its management includes initial lowering of Intraocular Pressure (IOP) followed by definitive treatmen...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2021-04-01
|
| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/14833/46462_CE[Ra]_F(Sh)_PF1(AKA_SL)_PFA(AKA_KM)_PN(KM).pdf |
| _version_ | 1831642134640328704 |
|---|---|
| author | Shanu Kumar Julie Pegu Safeena Tabassum Suneeta Dubey Umang Mathur |
| author_facet | Shanu Kumar Julie Pegu Safeena Tabassum Suneeta Dubey Umang Mathur |
| author_sort | Shanu Kumar |
| collection | DOAJ |
| description | Introduction: Phacomorphic glaucoma is a type of secondary
glaucoma caused by lens swelling in eyes with mature or
intumescent cataract. It is encountered more commonly in
developing countries. Its management includes initial lowering
of Intraocular Pressure (IOP) followed by definitive treatment
of removal of lens by cataract surgeries. The visual prognosis
remains unpredictable due to the irreversible optic nerve damage
that may have incurred in a matter of few days. It is equally
pertinent to know the postoperative IOP values and whether these
patients would require long term Anti-Glaucoma Medications
(AGM). The role of Laser Peripheral Iridotomy (LPI) in IOP control
preoperatively in such patients also needs to be evaluated.
Aim: To assess the visual outcome, IOP control and the
requirement of AGM after cataract surgery in phacomorphic
glaucoma.
Materials and Methods: This was a retrospective, observational
study conducted from March 2019 to January 2020 on all patients
diagnosed with phacomorphic glaucoma at the tertiary eye care
centre. The primary variables were IOP and visual acuity. All patients
underwent a complete ophthalmic examination. Cataract surgery was
done after instituting treatment for IOP control. Preoperative LPI was
done according to consulting doctors’ discretion. Trabeculectomy
was combined with cataract surgery based on surgeons’ decision.
Patients were followed for 6 weeks postoperatively. Fisher-test and
paired t-test were used for statistical analysis.
Results: A total of 118 patients (25 males and 93 females,
mean age 64.55±6.35 years) were recruited in the study and
94 patients followed-up till last visit at 6 weeks. The mean
presenting IOP was 39.55±12.55 mmHg. The mean IOP at
day-1 postoperatively was 14.66±4.55 mmHg, the difference
was statistically significant (p-value <0.001). There was a
significant drop in IOP seen postoperatively at day 1 and 6
weeks (p<0.001). At 6 weeks, the mean IOP was 13.19±3.83
mm Hg. A combined cataract extraction and trabeculectomy
did not result in statistically significant difference in the final IOP
values. At 6 weeks follow-up, 87.23% patients did not require
any AGMs; 63.83% patients gained good vision, 26.59% gained
borderline vision and 9.58% had poor vision. LPI resulted in a
better IOP control preoperatively (p=0.003).
Conclusion: Cataract surgery alone results in good IOP control
in phacomorphic glaucoma without a need for long term
AGMs. However, to prevent permanent angle damage and disc
changes an early surgical intervention is required. LPI appears
to have a beneficial role in controlling the preoperative IOP in
these eyes. |
| first_indexed | 2024-12-19T12:36:06Z |
| format | Article |
| id | doaj.art-8205277792a841168e0d10d8deba8e51 |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-12-19T12:36:06Z |
| publishDate | 2021-04-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-8205277792a841168e0d10d8deba8e512022-12-21T20:21:08ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2021-04-01154NC18NC2110.7860/JCDR/2021/46462.14833Retrospective Audit of Phacomorphic Glaucoma in Last 12 Years in a Tertiary Eye Care Centre, New Delhi, IndiaShanu Kumar0Julie Pegu1Safeena Tabassum2Suneeta Dubey3 Umang Mathur4Fellow, Department of Glaucoma, Dr Shroff Charity Eye Hospital, New Delhi, India.Consultant, Department of Glaucoma, Dr Shroff Charity Eye Hospital, New Delhi, India.Ex Fellow, Department of Cataract, Dr Shroff Charity Eye Hospital, New Delhi, India.Consultant, Department of Glaucoma, Dr Shroff Charity Eye Hospital, New Delhi, India.Consultant, Department of Cornea, Dr Shroff Charity Eye Hospital, New Delhi, India.Introduction: Phacomorphic glaucoma is a type of secondary glaucoma caused by lens swelling in eyes with mature or intumescent cataract. It is encountered more commonly in developing countries. Its management includes initial lowering of Intraocular Pressure (IOP) followed by definitive treatment of removal of lens by cataract surgeries. The visual prognosis remains unpredictable due to the irreversible optic nerve damage that may have incurred in a matter of few days. It is equally pertinent to know the postoperative IOP values and whether these patients would require long term Anti-Glaucoma Medications (AGM). The role of Laser Peripheral Iridotomy (LPI) in IOP control preoperatively in such patients also needs to be evaluated. Aim: To assess the visual outcome, IOP control and the requirement of AGM after cataract surgery in phacomorphic glaucoma. Materials and Methods: This was a retrospective, observational study conducted from March 2019 to January 2020 on all patients diagnosed with phacomorphic glaucoma at the tertiary eye care centre. The primary variables were IOP and visual acuity. All patients underwent a complete ophthalmic examination. Cataract surgery was done after instituting treatment for IOP control. Preoperative LPI was done according to consulting doctors’ discretion. Trabeculectomy was combined with cataract surgery based on surgeons’ decision. Patients were followed for 6 weeks postoperatively. Fisher-test and paired t-test were used for statistical analysis. Results: A total of 118 patients (25 males and 93 females, mean age 64.55±6.35 years) were recruited in the study and 94 patients followed-up till last visit at 6 weeks. The mean presenting IOP was 39.55±12.55 mmHg. The mean IOP at day-1 postoperatively was 14.66±4.55 mmHg, the difference was statistically significant (p-value <0.001). There was a significant drop in IOP seen postoperatively at day 1 and 6 weeks (p<0.001). At 6 weeks, the mean IOP was 13.19±3.83 mm Hg. A combined cataract extraction and trabeculectomy did not result in statistically significant difference in the final IOP values. At 6 weeks follow-up, 87.23% patients did not require any AGMs; 63.83% patients gained good vision, 26.59% gained borderline vision and 9.58% had poor vision. LPI resulted in a better IOP control preoperatively (p=0.003). Conclusion: Cataract surgery alone results in good IOP control in phacomorphic glaucoma without a need for long term AGMs. However, to prevent permanent angle damage and disc changes an early surgical intervention is required. LPI appears to have a beneficial role in controlling the preoperative IOP in these eyes.https://www.jcdr.net/articles/PDF/14833/46462_CE[Ra]_F(Sh)_PF1(AKA_SL)_PFA(AKA_KM)_PN(KM).pdfcataract surgerylens-induced glaucomalaser peripheral iridotomyoptic nerve damage |
| spellingShingle | Shanu Kumar Julie Pegu Safeena Tabassum Suneeta Dubey Umang Mathur Retrospective Audit of Phacomorphic Glaucoma in Last 12 Years in a Tertiary Eye Care Centre, New Delhi, India Journal of Clinical and Diagnostic Research cataract surgery lens-induced glaucoma laser peripheral iridotomy optic nerve damage |
| title | Retrospective Audit of Phacomorphic Glaucoma in Last 12 Years in a Tertiary Eye Care Centre, New Delhi, India |
| title_full | Retrospective Audit of Phacomorphic Glaucoma in Last 12 Years in a Tertiary Eye Care Centre, New Delhi, India |
| title_fullStr | Retrospective Audit of Phacomorphic Glaucoma in Last 12 Years in a Tertiary Eye Care Centre, New Delhi, India |
| title_full_unstemmed | Retrospective Audit of Phacomorphic Glaucoma in Last 12 Years in a Tertiary Eye Care Centre, New Delhi, India |
| title_short | Retrospective Audit of Phacomorphic Glaucoma in Last 12 Years in a Tertiary Eye Care Centre, New Delhi, India |
| title_sort | retrospective audit of phacomorphic glaucoma in last 12 years in a tertiary eye care centre new delhi india |
| topic | cataract surgery lens-induced glaucoma laser peripheral iridotomy optic nerve damage |
| url | https://www.jcdr.net/articles/PDF/14833/46462_CE[Ra]_F(Sh)_PF1(AKA_SL)_PFA(AKA_KM)_PN(KM).pdf |
| work_keys_str_mv | AT shanukumar retrospectiveauditofphacomorphicglaucomainlast12yearsinatertiaryeyecarecentrenewdelhiindia AT juliepegu retrospectiveauditofphacomorphicglaucomainlast12yearsinatertiaryeyecarecentrenewdelhiindia AT safeenatabassum retrospectiveauditofphacomorphicglaucomainlast12yearsinatertiaryeyecarecentrenewdelhiindia AT suneetadubey retrospectiveauditofphacomorphicglaucomainlast12yearsinatertiaryeyecarecentrenewdelhiindia AT umangmathur retrospectiveauditofphacomorphicglaucomainlast12yearsinatertiaryeyecarecentrenewdelhiindia |