Clinical Study of Lens Induced Glaucoma at a Tertiary Eye Care Centre

BACKGROUND Lens induced glaucomas are common in India. There were different types of lens induced glaucomas based on clinical features and morphological features. This study was undertaken to evaluate the various characteristics and presentations of glaucomas, to define the risk factors and to evaluate as to how they influence the post-operative visual acuity, intra ocular pressure, inflammation and optic disc changes. METHODS This longitudinal study included 90 cases of lens induced glaucoma admitted in the ophthalmic wards of the Great Eastern Medical School and Hospital, Srikakulam, during the period March 2018 to March 2020. All consecutive patients diagnosed as lens induced glaucoma on the basis of clinical symptoms and signs were included. At presentation, visual acuity, IOP, inflammation including corneal changes were recorded, which were repeated after institution of medical line of treatment and postoperatively patients were followed up regularly at 2, 4 and 6 weeks intervals and the same parameters were evaluated including optic disc changes. RESULTS Occurrence of lens induced glaucoma in the hospital during the study period was 1.72 %. The mean age of presentation of various types of glaucomas was 60.57 years and the female to male ratio was 2:1. The most frequent type of lens induced glaucoma was phacomorphic glaucoma (70 %). In 34.4 % patients best corrected visual acuity was found to be better than 6 / 18. In 14.4 % of cases, visual acuity was found be worse than 6 / 60. In patients who presented with symptoms of less than two weeks duration, better visual acuity of 6 / 12 or more was noted (76.2 %, P < 0.01). In 60 % patients who presented with IOP levels of less than 35 mmHg, better visual acuity of 6 / 12 or more was noted in 76.2 %. The mean IOP noted in patients with symptoms of 2 to 4 weeks duration was found to be 40.33 ± 9.36 mmHg. Inflammation was more severe in patients who were symptomatic for more than 2 weeks (37.50 %, P < 0.05) and also in cases with IOP more than 35 mmHg (40 %). Optic disc of the presented eye was found to be damaged in 35.5 % of cases and in patients presenting with symptoms of more than 2 weeks’ duration it was 62.5 % (P < 0.01). CONCLUSIONS Presentation with intraocular pressure value greater than 35 mm of Hg and with symptoms of more than two weeks would result in severe inflammation further affecting the cornea and causing optic nerve damage which would ultimately jeopardize vision. This can be prevented by early presentation and regular screening of people above 60 years of age. KEYWORDS Lens-Induced, Glaucoma, Cataract