A Study of Phacolytic Glaucoma and Visual Outcome

This chapter was conducted to evaluate the visual outcome of phacolytic glaucoma, a common cause of ocular morbidity.

The study selected 30 patients in a tertiary care hospital for both urban and rural population. 30 eyes of patients clinically diagnosed as phacolytic glaucoma were treated. Phacolytic glaucoma with a history of trauma, acute angle closure glaucoma, phacomorphic glaucoma, phacoanaphylactic glaucoma, inflammatory glaucoma and neovascular glaucoma were excluded. For this study, demographics of the sample and the duration of their symptoms prior to hospital presentation were recorded. Visual acuity and intraocular pressure (IOP) were also recorded both preoperatively and postoperatively. Small Incision cataract surgery with posterior chamber intraocular lens implantation (IOL) was done after the control of intraocular pressure and inflammation. Postoperative complications were noted. The data was analyzed by simple statistical methods.

Age group distribution was 19 (63.3%) in >50-60 yrs, 9 (30.0%) in >60-70 yrs and 2(6.4%) in >70 yrs. Sex distribution was 21 (70.0%) of males and 9 (30.0%) of females. Mean age of the all the patients was 60.7 yrs (males 59.95 yrs and females 62.6 yrs). Laterality was RE in 16 (70.9%) and LE in 9 (30.0%). Duration of the presenting symptoms before reporting to the hospital was <1 week in 17 (56.6% and >1 week in 13 (43.3%). Mean IOP was 45.8 mmHg preoperatively. Visual Acuity was PL doubtful in 2 (6.6%), PL +ve in 15 (50.0%) and HM<3/60 in 13 (43.4%) preoperatively. Postoperative visual acuity at 6-8 weeks was <6/60 in 8 (26.7%) and >6/60 in 22 (73.3%). Postoperative complications were bullous keratopathy in 5 (16.6%), anterior uveitis with membrane on IOL in 7 (23.3%), posterior capsular tear in 3 (10.0%) and Zonular dialysis in 2 (6.6%). Fellow eye showed pseudophakia in 22 (73.4%), immature cataract in 6 (20.0%) and Aphakia in 2 (6.6%). Postoperative complication of uveitis seen in more than 50% of eyes was easily controlled with topical and systemic corticosteroids similar to 82.0% in Prajna et al. and 65.2% in A Briganza et al. [1,2]. Examination of the fellow eye showed pseudophakia 73.4%, immature cataract 20.0% and aphakia 6.6% not comparable with Prajna et al of aphakia (72.0%) and immature cataracts (27.0%) and in Briganza et al of aphakia (56.5%) and phakic in 43.5% [1,2].

This study of phacolytic glaucoma concludes that small incision extracapsular cataract surgery with PC IOL implantation with controlled preoperative IOP and inflammation is an effective method in the management of phacolytic glaucoma with a good postoperative visual outcome.