|Year : 1984 | Volume
| Issue : 5 | Page : 456-459
Lens induces glaucoma-a clinical study
GL Dhar, Sudhir Bagotra, Anil Bhalla
Department of Ophthalmology Government Medical College, Jammu-Tawi, India
G L Dhar
Department of Ophthalmology, Government Medical College, Jammu-Tawi (J&K)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dhar G L, Bagotra S, Bhalla A. Lens induces glaucoma-a clinical study. Indian J Ophthalmol 1984;32:456-9
Lens induced glaucoma (L.I.G.) was first described is year 1900 by Gifford and Von Reuss independent of each other. While former described it as a glaucoma associated with hypermature cataract, the letter described it as a glaucoma associated with spontaneous absorption of lens substance through intact lens capsule. Subsequently various workers,, described such types of cases under different names like L.I.G., Lens induced uveitis and glaucoma, phakotoxic glaucoma, phakogenetic and phakogenic glaucoma and finally phakolytic glaucoma. These terms including the more popular terms phakolytic glaucoma have been discarded by and for various reasons and convenience in favour of the term 'L.I.G.'. At present, L.I.G. connotes a clear cut clinical condition characterised by (i) a violent secondary glaucoma, (resembling acute angle closure glaucoma) in one eye with senile mature cataract, hypermature senile cataract (rarely immature senile cataract) yet with an open angle, (ii) normal intraocular pressure and open angle in other eye and (iii) a prompt relief of symptoms and restoration of vision after cataract extraction in the effected eye.
This preventable and curable condition, though rare in developed countries for decades,,, is unfortunately still prevalent in our country. Survey of Indian Ophthalmic literature reveals that the condition has not been reported for last one decade.
| Material and methods|| |
214 cases with clear cut clinical picture of L.I.G. (as defined above) attending eye department of Government Medical College Hospital Jammu between January 1977 to December 1982 were studied. They were reviewed clinically with regard to their incidence, age, sex, socio-economic status. their urban/rural residence, symptoms, signs, duration of visual impairment, condition of other eye, response to treatment, complication of surgery and over all results of treatment. For various reasons gonioscopic studies were undertaken in only 186 cases, while aqueous studies were conducted at random in only 47 cases.
| Observations|| |
214 cases recorded over 6 years contributed about 3.4% of all cases of senile cataract admitted for cataract extraction during this period.
Age and sex Incidence
The youngest patient in this series was aged 51 years and the oldest patient aged 83 years, with the mean average age being 65.5 years., The majority of the patients in the whole lot were in the 6th decade of their life as per [Table - 1].
From the above table, it is clear that females were in preponderence (121 cases) compared to males (93 cases) and in a ratio roughly 4:3.
As per socio-economic status scale, there was no patient from upper and upper middle class. Only 41 (19.15%) cases were from lowermiddle class, while 199 (55.60%) cases were from upper-lower class and 54 (25.23%) cases were from lower class. 51 cases belong to Jammu city, 94 cases to surrounding semiurban townships and 69 cases were from pure rural background.
Symptoms and their duration
Most symptoms were of acute onset except the diminution of vision which patients had for months and years. the symptoms complained by the patients, in order of frequency are recorded in [Table - 2].
Patients sought admission to hospital at varying intervals from the onset of acute symptoms. Only 16 (7.47%) patients sought admission on the same day as onset of acute symptoms, 21 (9.81 %) on 2nd day, 34 (15.80%) on 3rd day, 27 (12.61 %) on 4th day, 25 (11.68%) on 5th day, 21 (9.81%) on 6th day, 24 (11.21%) on 7th day, 27 (12.61%) on 8th to 10th day, 12 (5.6%) between 11th and 14th days, and 7 (3.27%) between 15th and 22nd days, 21 (9.81%) had a history of one similar attack before the present attack.
Examination revealed a number of sings which in order of frequency are given in [Table - 3].
Hypermature cataracts were seen in only 83 (39.0%) cases, -mature intumescent cataract in 126 (58.5%) cases and immature cataracts in 5 (2.5%) cases. Mean intraocular pressure in the affected eye was 36.6 mm Hg ± 7.4 mm Hg schiotz. The highest recorded tension was 60.3. mm Hg Schiotz and lowest was 26.6 mm Hg Schiotz.
Examination of aspirated aqueous from anterior chamber was performed in only 47 cases, under microscope. In only 11 cases typical swollen macrophages were made out in aqueous. Their number was not however related to severity and duration of the attack. Of the remaining 36 cases no extra-ordinary findings could be made out
The other eye, invariably was quiet with aphekia in 96 cases (with useful aphekic vision in 75 and with poor or no vision in 21 cases), immature cataract in 64 cases, mature senile cataract in 38 cases and hypermature cataract in 16 cases. In aphakic group only 9 patients had evidence to suggest extracapsular cataract extraction anterior chamber was normal in all the 186 patients in whom gonioscopy was performed and its angle was wide open.
The intraocular pressure was controlled by 20% mannitol, oral glycerol, Diamox and/or Timolal - in different combinations, with local antiiotic drops. Surgical treatment was carried out as quickly as possible after an initial medical treatment. Cataract extraction wad performed in single stage alongwith peripheral iridectomy in 156 cases on the very next day and in 54 cases between 24 to 48 hours of admission in hospital. Only in 4 casess surgery was carried in 2 stages a preliminary peripheral iridectomy followed 2 weeks after by cataract extraction. Intracapsular cataract extraction was planned in all cases but failed in 9 patients resulting in extra capsular cataract extraction.
Various complications during surgery and immediate post operative period are recorded in [Table - 5].
Thus complication rate in all these operations except postoperative corneal haze (which usually disappeared by 7 to 10 days) was not high.
The corrected visual acuity at the end of 4 to 6 weeks of the operation with aphakic correction is given in [Table 6].
Corrected aphakic vision upto 6/18 and
above was obtained in 169 (79.0%) cases, poor vision between 3/60 to 6/24 was recorded in only 36 (16.8%) cases, while 9 (4.2%) cases had poor vision not exceeding hand movements close to face.
| Discussion|| |
L.I.G. is a condition to reckon with in our ophthalmic patients from this part of the country. The condition seems to be fairly common in our neighbouring states of Punjab, Haryana and Himachal Pradesh. This may be due to poor health-education, lower socioeconomic status, poor geriatric care, fear of operation and inacessability to ophthalmic surgeon by these patients. The majority of the patients in this series were from villages or semi-urban townships surrounding Jammu city and not from the city itself.
Although acute in onset, violent in its course, this condition is clinically recognisable, easily treatable and also preventable.
This condition has by and large an excellent prognosis, even in the apparently hopeless cases, if treated within 7 days of its onset Even in patients with only doubtful P.L. at admission, visual improvement did take place after adequate treatment.
| References|| |
Fifford, H., 1900 Amer. J. Ophthalmol., 17:289.
Von Reuses., 1900 Centralbl. F. Prakt. Augenh., 24:33.
Irvine, S.R, and Irvine, A.R, 1952 Jr. Amer. J. Ophthalmol., 35:177, 370, 489.
Flocks, Littwin and Zimmdrman 1955. Arch. Ophthalmol., 54:37.
Chandler P.A., 1958. Arch. Ophthalmol., 60:829.
Taylor, H.F.L. 1911., Trans. Ophthalmol., Soc. of U.K, 31:146.
Chance., J. 1912. A.M.A., 59:1013.
Kaufman, S.I., 1933. Arch. Ophthalmol., p. 56.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]