Journal of Current Glaucoma Practice

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VOLUME 7 , ISSUE 2 ( May-August, 2013 ) > List of Articles

Original Article

Manual Small Incision Cataract Surgery in Phacomorphic Glaucoma: Surgical Technique and Outcome in North-eastern India

Vidyarani Rajkumari, Khongbantabam Singh Kaminibabu, Rajkumari Devi Bhabanisana, Rajkumar Victor

Keywords : Phacomorphic glaucoma, Intraocular pressure, Intraocular lens implantation, Manual small incision cataract surgery

Citation Information : Rajkumari V, Singh Kaminibabu K, Bhabanisana RD, Victor R. Manual Small Incision Cataract Surgery in Phacomorphic Glaucoma: Surgical Technique and Outcome in North-eastern India. J Curr Glaucoma Pract 2013; 7 (2):43-48.

DOI: 10.5005/jp-journals-10008-1136

License: CC BY-NC 4.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2013; The Author(s).


Background: North-eastern region of India continue to suffer from limited resources, added upon by Mongoloid racial similarity and poor cataract surgery rate has contributed to the increase incidence of advanced cataract like phacomorphic glaucoma. Objective: To evaluate the visual prognosis and related complications of phacomorphic glaucoma cases by manual small incision cataract surgeries in North-eastern region of India. Materials and methods: This retrospective case series study includes 65 phacomorphic glaucoma cases diagnosed between June 2009 to December 2011 in Jawaharlal Nehru Institute of Medical Sciences, Manipur. Preoperative routine evaluation includes slit-lamp biomicroscopy, measurement of IOP, gonioscopy of fellow eye, axial length measurement, AC depth and lens thickness by A-scan. Manual small incision cataract surgery with intraocular lens implantation was performed in all the 65 eyes. Complete ophthalmic examination was done at each follow-up visit. Results: The mean preoperative IOP was 35.14 (±6.35) mm Hg and IOP at the 3rd month follow-up was 18.65 (±1.3) mm Hg with a statistically significant lowering of IOP (p < 0.0001) at the last follow-up. Intraoperative complications were minimal. Corneal edema, fibrinous exudates in AC was seen in few cases. Postoperative best corrected visual acuity was 6/6-6/12 in 46 eyes, 6/18-6/36 in 12 eyes, 6/60-3/60 in 4 eyes and less than 3/60 in three eyes. Antiglaucoma medication was discontinued immediately after each surgery. Conclusion: Manual small incision cataract surgery being inexpensive play a key role in management of poor outreach program marker like phacomorphic glaucoma in effectively controlling the IOP and achieving good visual acuity with minimal complications.

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  1. World Health Organization [Internet]. Global data on visual impairment 2010. Geneva: World Health Organization; [updated 2013 Feb 3]. Available from: http://www.who/int.
  2. Murthy G, Gupta SK, John N, Vashist P. Current status of cataract blindness and Vision 2020: the right to sight initiative in India. Indian J Ophthalmol 2008 Nov-Dec;56(6):489-494.
  3. Thulasiraj RD, Nirmalan PK, Ramakrishnan R, Krishandas R, Manimekalai TK, Baburajan NP, Katz J, Tielsch JM, Robin AL. Blindness and vision impairment in a rural south Indian population: the Aravind Comprehensive Eye Survey. Ophthalmology 2003 Aug;110(8):1491-1498.
  4. Murthy GV, Gupta SK, Bachani D, Jose R, John N. Current estimates of blindness in India. Br J Ophthalmol 2005 Mar;89(3):257-260.
  5. Thulasiraj RD, Rahamathulla R, Saraswati A, Selvaraj S, Ellwein LB. The Sivaganga eye survey: I. Blindness and cataract surgery. Ophthalmic Epidemiol 2002 Dec;9(5):299-312.
  6. Dua, AS. National Programme for Control of Blindness. National Commission on Macroeconomics and Health (NCMH) Background papers: Burden of Disease in India [Internet]. New Delhi, India: Ministry of Health & Family Welfare; 2005 Sep. p. 299-304.
  7. Muralikrishnan, R.; Krishna, RP.; Thulasiraj, RD.; Bachani, D.; Gupta, S.; Murthy, GV. Blindness estimations, projections and service delivery. National Commission on Macroeconomics and Health (NCMH) Background papers: Burden of Disease in India [Internet]. New Delhi, India: Ministry of Health & Family Welfare; 2005 Sep. p. 305. (Appendix 2).
  8. Vision 2020 India XIIth Plan Team, NPCB. The XIIth fiveyear plan (2012-17) for elimination of avoidable blindness from India [Internet]. New Delhi, India: Ministry of Health and Family Welfare; 2011 Apr 28. p. 12. (Annexures 3).
  9. Kanski, JJ. Clinical ophthalmology: a systematic approach. 4th ed. UK: Butterworth-Heineman; 1999 Jun. p. 229.
  10. Angra SK, Pradhan R, Garg SP. Cataract induced glaucoma— an insight into management. Indian J Ophthalmol 1991 Jul- Sep;39(3):97-101.
  11. Pradhan D, Hennig A, Kumar J, Foster A. A prospective study of 413 cases of lens-induced glaucoma in Nepal. Indian J Ophthalmol 2001 Jun;49(2):103-107.
  12. Jain IS, Gupta A, Dogra MR, Gangwar DN, Dhir SP. Phacomorphic glaucoma—management and visual prognosis. Indian J Ophthalmol 1983 Sep;31(5):648-653.
  13. Duke-Elder, S. System of ophthalmology. London: Henry Kimpton; 1969. p. 662-663. (Vol. 11).
  14. Gressel, MG. Lens-induced glaucoma. In: Tasman W, Jaeger E, editors. Duane's clinical ophthalmology. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 1998. p. 554.
  15. Bhartiya S, Kumar HM, Jain M. Phacomorphic glaucoma: Evolving management strategies. J Curr Glaucom Pract 2009 May-Aug;3(2):39-46.
  16. Tomey KF, al-Rajhi AA. Neodymium: YAG laser iridotomy in the initial management of phacomorphic glaucoma. Ophthalmology 1992 May;99(5):660-665.
  17. Tham CC, Lai JS, Poon AS, Chan JC, Lam SW, Chua JK, Lam DS. Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study. Eye (Lond) 2005 Jul;19(7):778-783.
  18. Qamar AR. Phacomorphic glaucoma: An easy approach. Pak J Ophthalmol 2007;23(2):77-79.
  19. Chung FC, Liang CC, Lai JS, Lo ES, Lam DS. Safety of trypan blue 1% and indocyanine green 0.5% in assisting visualization of anterior capsule during phacoemulsification in mature cataract. J Cataract Refract Surg 2005 May;31(5):938-942.
  20. Dada VK, Sharma N, Sudan R, Sethi H, Dada T, Pangtey MS. Anterior capsule staining for capsulorhexis in cases of white cataract: comparative clinical study. J cataract Refract Surg 2004 Feb;30(2):326-333.
  21. Leibmann, JM.; Ritch, R. Glaucoma associated with lens intumescence and dislocation. In: Ritch R, Shields MB, Krupin T, editors. The glaucomas. 2nd ed. St Louis: Mosby; 1996. p.1033. (Vol. 2).
  22. Lee JW, Lai JS, Yick DW, Tse RK. Retrospective case series on the long-term visual and intraocular pressure outcomes of phacomorphic glaucoma. Eye (Lond) 2010 Nov; 24(11):1675- 1680.
  23. Venkatesh R, Muralikrishnan R, Balent LC, Prakash SK, Prajna NV. Outcomes of high volume cataract surgeries in a developing country. Br J Ophthalmol 2005 Sep;89(9):1079- 1083.
  24. Ramakrishanan R, Maheshwari D, Kader MA, Singh R, Pawar N, Bharathi MJ. Visual prognosis, intraocular pressure control and complications in phacomorphic glaucoma following manual small incision cataract surgery. Indian J Ophthalmol 2010 Jul-Aug;58(4):303-306.
  25. Lee JW, Lai JS, Lam RF, Wong BK, Yick DW, Tse RK. Retrospective analysis of the risk factors for developing phacomorphic glaucoma. Indian J Ophthalmol 2011 Nov- Dec;59(6):471-474.
  26. Speaker MG, Guerriero PN, Met JA, Coad CT, Berger A, Marmor M. A case-control study of risk factors for intraoperative suprachoroidal expulsive hemorrhage. Ophthalmology 1991 Feb;98(2):202-209.
  27. Davison JA. Acute intraoperative suprachoroidal hemorrhage in extracapsular cataract surgery. J Cataract Refract Surg 1986 Nov;12(6):606-622.
  28. Gogate PM, Deshpande M, Wormald, Deshpande R, Kulkarni SR. Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in western India; a randomized controlled trial. Br J Ophthalmol 2003 Jun;87(6):667-672.
  29. Tezel G, Kolker AE, Kass MA, Wax MB. Comparative results of combined procedures for glaucoma and cataract: I. Extracapsular cataract extraction versus phacoemulsification and rigid versus foldable intraocular lenses. Ophthalmic Surg Lasers 1997 Jul;28(7):539-550.
  30. Baasanhu J, Johnson GJ, Burendei G, Minassian DC. Prevalence and causes of blindness and visual impairment in Mongolia: a survey of populations aged 40 years and older. Bull World Health Organ 1994;72(5):771-776. 31. Wang D, Qi M, He M, Wu L, Lin S. Ethnic difference of the anterior chamber area and volume and its association with angle width. Invest Ophthalmol Vis Sci 2012 May;53(6):3139-3144.
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