Retrospective Audit of Phacomorphic Glaucoma in Last 12 Years in a Tertiary Eye Care Centre, New Delhi, India

Abstract

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.

Keywords

• cataract surgery
• lens-induced glaucoma
• laser peripheral iridotomy
• optic nerve damage