|Year : 1984 | Volume
| Issue : 6 | Page : 506-507
Intraocular lenses and glaucoma
Dept, of Ophthalmology, Medical College, Amritsar, India
Dept, of Ophthalmology, Medical College, Amritsar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh D. Intraocular lenses and glaucoma. Indian J Ophthalmol 1984;32:506-7
There are three types of cases of cataract which are associated with glaucoma, treated or untreated
- Cataract with chronic simple glaucoma
- Cataract with secondary glaucoma
- Cataract in glaucoma operated cases
Should intraocular lens implantation be done in these cases considering that lens implantation by itself alone is a difficult procedure ?
| Material and methods|| |
56 cases treated during the last 5 years are presented herewith.
Glaucoma operated : 35, Lens induced glaucoma 20, Cataract with chronic simple glaucoma 1. The age distribution was as follows
No special precaution were taken other than the usual local antibiotic drops and preoperative oral Diamox 500 mg about 2 hours before surgery. In lens induced glaucoma group most patients had higher than acceptable tension at the time of surgery.
A triple procedure involving pre-trabecular filtration , extracapsular extraction aid Singh-Worst Iris Claw lens implantation was done in 20 patients of lens induced glaucoma group. A fornix based conjunctival flap for doing pre-trabecular filtration was made. Anterior capsulotomy was performed through peripheral iridectomy after which the incision was extended on either side of the pre-trabecular opening. In cases where delivery of the lens was difficult due to a small pupil. radial iridotomy was done starting from peripheral iridectomy. In some cases the pupil was reformed by suturing the iris with a steel suture. The cortical matter was removed by irrigation/aspiration. Singh-Worst lens was implanted as usual. 
In the second group involving 35 cases, the lens implantation was done as usual. The only difference was in the making of the incision since most cases bad a filtering bleb at the upper limbus. In these cases the incision from 10.30 o' clock was made at least i mm away from the filtering bleb. The presence or absence of a round pupil made no difference to the implantation.
| Observations|| |
Contrary to expectations the raised intraocular pressure in lens induced glaucoma group produced no operative problems. The eye became soft after the delivery of the lens nucleus and the vitreous most often did not buldge forward. Two cases in the full series of 56 cases had vitreous problems and vitrectomy had to be done.
One case in lens induced glaucoma group had endophthalmitis. Four patients had moderate striate keratitis which cleared in 1-3 weeks time. One patient in the lens induced group had a forward tilt of the lower edge of the lens, without touching the back of the cornea.
A number of patients had varied degrees of field losses due to glaucoma and they were generally known before surgery. The visual acuity obtained in this series was as follows
| Discussion|| |
In our experience patients with pre-existing - chronic simple glaucoma or those with surgically treated glaucoma or those with lens induced glaucoma are not very difficult to deal for implantation of intraocular lenses. A few years back there has been a general hesitation in putting intraocular lenses in cases with glaucoma, treated or untreated. With greater experience it is possible to operate with intraocular lenses on such cases too. The surgical results should not be very different from those obtained on normal cases except perhaps a little extra risk to endothelium. The technique of surgery and the choice of intraocular lens will have to be decided on Individual basis.
| References|| |
Singh, D., Trans of Ophthalmol. Soc,, U. K. vol. XI III Part I, 1978:
Singh, D, 1982, Ind. J. Ophthalmol. 30: 457
[Table - 1], [Table - 2]