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Clinical study of lens-induced glaucoma at community health center in India

Background and Objective: 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.- These lens-induced glaucomas are a common occurrence in India, hardly surprising in a situation where the incident of cataract cases far exceeds the total number of surgeries performed currently. In the developing world, like India, financial, cultural, and psychosocial barriers to accessing excellent surgical services still exist. There is an ever-increasing backlog of cataract due to the population explosion, increased life expectancy, and low productivity in terms of utilization of the available surgical services. The uptake of eye care services by the rural community has also been sub-optimal in countries like India, where lens-induced glaucomas (LIGs) are a common cause of ocular morbidity. The present study has endeavored to determine the characteristics, risk factors, and their consequences on postoperative visual outcome, intraocular pressure (IOP), including optic disc changes in LIGs. Materials and Methods: This study included 50 cases of different types of LIG, admitted in the wards of the Community Health Center, Bandikui, Dausa, Rajasthan, during the period January–September 2019. All consecutive patients diagnosed as LIG on the basis of clinical symptoms and signs were included. Clinical features included pain, loss of vision, redness of the eye, presence of an intumescent, mature, or hypermature cataract associated with raised IOP of >21 mm Hg. Results: In this study series, it is observed that the most frequent type of LIG was phacomorphic glaucoma (PMG) (64%) followed by PhacoLyticc Glaucoma (PLG) (28.00%). In this study, good visual acuity achieved by cases with phacolytic glaucoma (57.00%) was more than PMG (50.00%) optic disc, at last, follow-up in the affected eyes was normal in the majority (36.00%). There were six cases of cystoid macular edema, and the media was hazy in two cases. Glaucomatous disc damage was found in 52% of cases. Although clinically significant disc damage was found more in PMG (57.7%) than PLG (33.33%). Conclusion: Results have shown that the LIGs were more common in the age group of 60–69 years and in females, good visual acuity can be achieved in lens-induced glaucoma presenting within 2 weeks, with intraocular pressure of <35 mm Hg and with meticulous control of intraocular pressure and inflammation with medications preoperatively. Planned small incision cataract surgery with intraocular lens implantation, minimal tissue handling, a good follow-up with efficient management of attendant complications and inflammation, are the key factors in the management.