Despite the benefits of cataract surgery, some patients will delay the procedure for so long that they eventually develop a secondary glaucoma known as lens induced glaucoma (LIG). Patients primarily get to this point either because they report having no escort to drive them to and from the surgery, or because they have good vision in the fellow eye,  a report published in Ophthalmology Glaucoma explains. In fact, researchers say 81.2% of reasons for these late presentations could be categorized as “nonfinancial.” 

However, following cataract surgery, only “a few” LIG cases needed further glaucoma management, researchers report. 

The prospective observational study included 165 patients (mean age at presentation, 63.8 years) with LIG who had cataract surgery at Aravind Eye Hospital in Pondicherry, India. Researchers aimed to determine the clinical outcomes and causes of late presentation in LIG. They collected preoperative data with a questionnaire asking about reasons for late presentation, socioeconomic status, visual acuity, intraocular pressure (IOP), and lens and angle status of the fellow eye. 


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All patients had manual small-incision cataract surgery. Then, postoperative vision, IOP, the anterior segment, and the fundus were evaluated at days 1, 15, and 30.

Researchers found that 70.3% of those studied were phacolytic and 29.7% had phacomorphic glaucoma.

“The main causes for late presentation was nonfinancial (81.2%); of these, good vision in fellow eye and lack of escort to the hospital were the major reasons. Most fellow eyes were pseudophakic (72.1%),” according to investigators.

Following cataract surgery, 75.6% of patients gained best-corrected visual acuity of 6/18 or more; 6% had poor visual recovery (≤6/60) with optic atrophy as the major cause. 

“Only 7.9% required further glaucoma management in the form of topical medications,” the study says. “Delayed presentation (>15 days) was associated with poor visual outcome.”

The study’s observational design in a specific patient population was one limitation, so reasons for late presentation and status of the fellow eye might not be generalized to a wider group. Another limitation included how the need for additional glaucoma management was based on clinical findings like IOP and optic nerve head changes. “Ideally, additional investigations including visual fields and nerve fiber layer analysis would have been done to assess the glaucoma stage and adequacy of IOP control, but these were not done at the post-op month 1 visit with enough consistency to be analyzed,” investigators report. 

“Longer follow-up among all participants would provide useful information about the long-term need for glaucoma treatment and outcomes among these patients.”

Reference

Ayub R, Tom LM, Venkatesh R, Srinivasan K. Lens induced glaucoma: outcomes and reasons for late presentation- prospective study. Ophthalmol Glaucoma. Published online February 4, 2021. doi:10.1016/j.ogla.2021.01.005