|Year : 1982 | Volume
| Issue : 3 | Page : 121-124
HC Agarwal, NN Sood, BR Kalra, B Ghosh
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
H C Agarwal
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agarwal H C, Sood N N, Kalra B R, Ghosh B. Secondary glaucoma. Indian J Ophthalmol 1982;30:121-4
The relative frequency of various causes leading to secondary glaucoma is likely to show variation in different parts of the world with passage of time. Phacogenic glaucoma is likely to be encountered more frequently in the areas where hyper maturity of the lenses is seen more often. The use of corticosteroids whilst reducing secondary uveitis has resulted in an iatrogenic glaucoma. The regional variations in the frequency of corneal ulcers & their complication would also change the pattern. Further, the improvements in techniques for lens extraction should reduce the frequency of aphakic glaucoma.
In recent years there has been a paucity of reports on the relative frequency of causes of secondary glaucoma. As far as we are aware, no large series has been published from India. This series describes the causative factors for the secondary glaucoma in the period-1970. 1980 encountered in the glaucoma clinic of this Centre.
| Materials and methods|| |
All cases of raised intraocular pressure with antecedent or a concomitant ocular disease attending the glaucoma clinic from 1970 to 1980 were reviewed. A detailed history and clinical examination including biomicroscopy, tonometry, ophthalmoscopy, gonioscopy which were recorded on the standard glaucoma sheets were analysed. The other eye was investigated to exclude primary glaucoma.
| Observations|| |
During this period one thousand sixty five cases of secondary glaucoma were seen. The aetiological factors are listed in [Table - 1][Table - 2].
| Discussion|| |
The relative frequency of various causes of secondary glaucoma such as aphakic glaucoma, glaucoma secondary to uveitis, phacogenic glaucoma etc. have been reported differently by different workers,. Glaucoma secondary to uveitis has been found to be the commonest cause 31.5 percent and 21.4 percent, of secondary glaucoma. However, in the present study aphakic glaucoma 37.7 percent was the commonest cause of secondary glaucoma involving 401 eyes out of which only 43 eyes were operated in this Centre. It is evident that aphakic glaucoma due to cataract extraction done at this Centre constituted only 10.7 percent of all the case of aphakic glaucoma. The higher incidence, therefore, is ascribable to the large number of referrals to this hospital from outside. An incidence of 6.5 percent and 22.1 percent of aphakic glaucoma has been reported by previous workers,.
The various causative factors in aphakic glaucoma have been highlighted in an earlier study from this Centre. We feel that, with improvement in the techniques of lens extraction and meticulous wound closure, the incidence of aphakic glaucoma would show a decline. This condition, therefore, requires particular attention in view of large number of cataract operations envisaged under the National Plan for Control of Blindness in this country.
The second commonest cause in this series was phacogenic glaucoma, 12.4 percent. This included glaucoma due to pupillary block associated with intumescent or hypermature morgagnian cataract, phacolytic glaucoma, phacotoxic glaucoma and secondary glaucoma associated with displacement of lens. This incidence may be on the lower side as all such cases were not referred to glaucoma clinic. Many a times these cases attended the casualty department of this Centre where appropriate medical and surgical treatment was given. Therefore, it is possible that if all the cases of phacogenic glaucoma were taken into account, the incidence of phacogenic glaucoma would be much higher than reported here. The commonest cause of curable blindness in our country being cataract (55 percent) a higher prevalence of glaucoma due to cataract is not beyond expectation. In previous series the incidence varied from 5 percent to 19.4 percent,. From this study it is evident that as high as 50 percent of all the cases of secondary glaucoma are accountable either to the problems of lens or to the complications of lens extraction. Almost all these are preventable causes of serious visual impairment. An in time appropriate management of cases of cataract by qualified ophthalmologists would greatly reduce the incidence of phacogenic glaucoma and aphakic glaucoma.
The development of secondary glaucoma in eyes with corneal pathology such as adherent leukoma, keratitis, postkeratoplasty and corneal dystrophy, accounted for nearly 12.2 percent in this study. This is relatively high as compared to the reported incidence of 7.7 percent. It is probably due to high incidence of small pox corneal ulcers, which existed till some times back. The involvement of cornea in keratomalacia and malnutrition still continues to be a major cause of corneal blindness in children in this country. The improperly managed bacterial ulcers due to lack of medical facilities, ignorance, poverty with subsequent formation of leukomadherans and secondary glaucoma still persists.
The reported incidence of secondary glaucoma due to retinal vascular lesions has also been variable, (2.9 percent to 21.4 percent),. In the present study we found neovascular glaucoma (9.6 percent) to be the fourth commonest cause of secondary glaucoma. Retinal vascular blocks and diabetic retinopathy in older age whereas Eales' disease in the younger age (21-30 years) were the common causes of neovascular glaucoma.
Traumatic glaucoma (8.4 percent) formed the fifth common cause of secondary glaucoma. Reported incidence of traumatic glaucoma is again variable being-24.4 percent, 7.2 percent and 21.4 percent,,.
Uveitis as the commonest cause of secondary glaucoma, being 31.7 percent and 24.8 percent has been well documented,. A high incidence 21.4 percent equalling that of thrombotic glaucoma and aphakic glaucoma has also been described. With passage of time improvements in diagnostic and therapeutic regimes have helped to reduce the incidence of secondary glaucoma due to uveitis. Lower incidence (8.2 percent) in our series may also be because of non referral of some cases of acute uveitis associated with secondary glaucoma to the clinic.
The rise of intraocular pressure following long term use of corticosteroids is well described in literature. Studies from our country are also available to substantiate this facts,. In this study steroid induced secondary glaucoma has been found quite low, the seventh commonest cause of secondary glaucoma (6.8 percent). This is probably because of better understanding about the disease processes and the awareness of the problems associated with long term use of systemic and local steroids. It is important to mention that steroid induced response depends on the duration of therapy, type of steroids used, as well as genetic influence of a person. The steroid induced rise of intraocular pressure is reversible in early stages but if the raised intraocular pressure is allowed to persist for a considerable time, the changes became irreversible. Most of the cases included in this study had established glaucoma due to long term use of systemic and/or local steroids, indicating their late presentation to this hospital. Therefore it is important that all patients on systemic and/or local steroids should be kept under close observation to detect early rise of intraocular pressure.
Many developmental anomalies of the eye are complicated by development of secondary glaucoma, which occurs due to structural deformities in the angle of anterior chamber. The reported incidence vary from 0.24 percent to 5 percents,. In this study there were twenty five cases (2.3 percent) of secondary glaucoma due to developmental abnormality of iris and the angle of anterior chamber. There were sixteen eyes with congenital aniridia and nine eyes with essential atrophy of iris.
| Summary|| |
In the retrospective 10 year study on Secondary glaucoma cases, Aphakic glaucoma and glaucoma secondary to senile cataract account for nearly 50 percent of all causes of secondary glaucoma. Corneal pathology accounted for nearly 12 percent of cases of secondary glaucoma. The other causes of secondary glaucoma are described.
| References|| |
Lehrfeld L. and Reber J., 1937, Arch. Ophthalmol. 18:712.
Yamazi S., Kimura A., Hashimoto T., Shikahara S., Nakakura H., Sawa K. and Kono M. 1977, Folia ophthalmol' Jap. 28:739.
Agarwal, H.C., Sood, N.N. and Dayal, Y., 1981, Ind. J. Ophthalmol. 29:221.
Kurland, L.T. and Taub, R.G., 1957, Amer J. Ophthalmol. 43:539.
Francois, J., 1978; Metab,' Ophthalmol. 2:3.
Manjul, V.P., Dhir, S.P. and Jain, I.S.-Proc. All In. Ophthalmol. Soc. Cong, Udaipur, 1981.
Panda, A., Sood, N.N. and Agarwal, L.P.,1981, Ind. J. Ophthalmol. 29:377.
[Table - 1], [Table - 2]
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