Rameez, N Hussain (2010) To compare anatomical parameters and biometric findings of ocular structures in phacomorphic glaucoma, intumescent cataract with normal eyes using ultrasound biomicroscope and conventional A scan. Masters thesis, Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli.
|
Text
2203041rameeznhussain.pdf Download (1MB) | Preview |
Abstract
INTRODUCTION: Lens induced glaucomas are a common occurrence in India, hardly surprising in a situation where the incident of cataract cases far exceeds the total number of surgeries performed currently. Though these are clinically distinct entities, they have certain common factors in that they are lens induced, they compromise the function of the optic nerve due to rise of intraocular pressure, cataract surgery is curative in these cases, and finally they uniformly share a guarded prognosis. With a cataract backlog of around 12 million and annually increasing at an estimated rate of 3.8 million, it is not surprising that the occurrence of lens induced glaucomas is not an infrequent event in India. Though not all inclusive, these lens induced glaucomas (LIG) are either secondary angle closure glaucomas (phacomorphic glaucomas) or secondary open angle glaucomas Among lens induced glaucomas, phacomorphic glaucoma has a higher incidence (52.7%) when compared to Phacolytic glaucoma (47.3%). Phacomorphic glaucoma is the term used for secondary angle-closure glaucoma due to lens intumescence. The increase in lens thickness from an advanced cataract, a rapidly intumescent lens, or a traumatic cataract can lead to pupillary block and angle closure or it may be due to forward displacement of the lens-iris diaphragm. Phacomorphic glaucomas were recognized by the subjective complaints of pain and redness associated with the presence of corneal edema, shallow anterior chamber, an intumescent cataractous lens and intraocular pressure above 21 mmHg. Phacomorphic glaucoma is more common in smaller hyperopic eyes with a larger lens and a shallower AC. Recognizing phacomorphic glaucoma is important. After medical therapy to control glaucoma, the pupillary block needs to be relieved. Patients require cataract extraction for phacomorphic glaucoma at the earliest. Many biometric studies are available on primary angle closure glaucoma eyes but no biometric studies are available on phacomorphic glaucoma. Biometric studies of phacomorphic glaucoma may provide insight into the pathophysiology and show which eyes are more prone to develop glaucoma in order to initiate early treatment avoiding poor post operative visual acuity outcomes. AIM OF THE STUDY: To analyze anatomical parameters and biometric findings of ocular structures in phacomorphic glaucoma, intumescent cataract and compare them with normal eyes using Ultrasound Biomicroscope and conventional A Scan. MATERIALS AND METHODS: A cross-sectional study was conducted during a period March 2008 to November 2009 at Institute Of Ophthalmology, Joseph Eye Hospital, Trichy. A total of 75 eyes were, 15 phacomorphic glaucomatous eyes and the consecutive normal other eyes (total – 30), 15 intumescent cataractous eyes and the consecutive normal other eyes (total – 30) and 15 normal eyes in each group were studied. Study was in accordance with the regulations laid down in the Declaration of Helsinki. It was approved by the Institutional Review Board of our Institute. Informed consent was obtained from all patients in the study by providing details of the study. RESULTS: A total of 47 patients (77 eyes) were included in the study out of which 19 were males and 28 were females with age ranging from 35 years to 82 years. In the normal group, a total of 17 eyes were studied of which 11 were females and 6 were males. The age of the patients ranged from (40 to 74) years with a mean age of 58.29 ±7.83. In the intumescent cataract group, a total of 15 eyes (n=15) were studied out of which 9 were female and 8 were males. The mean age was 62.87±9.56yrs. In the phacomorphic glaucoma group, a total of 15 eyes (n=15), 8 were females and 7 were males. The mean age was 59.27±8.77yrs In normal group, mean intra ocular pressure (IOP) was 16±2.55mmHg. In intumescent group, mean IOP was 16.27±3.45mmHg and in phacomorphic eyes, it was 45.33±14.34mmHg. DISCUSSION: Biometric studies of phacomorphic glaucoma may provide insight into the pathophysiology and show which eyes are more prone to develop glaucoma in order to initiate early treatment. Anterior segment imaging may prove in future to be an additional diagnostic tool and aid in the diagnosis and evaluation of glaucoma. The information gained may provide the clinician with both qualitative and quantitative information about anatomical relationships of the anterior segment. The mean age of patients with phacomorphic glaucoma was 59.27±8.77yrs and that of intumescent cataract patients was 62.87±9.56yrs. Prajna et al in their study done on Indian eyes with lens induced glaucoma found that the mean age at presentation was 62±10 years (range 43-85) for phacomorphic glaucomas. Older patients present with phacomorphic glaucoma.65 In our study, the male to female ratio for phacomorphic glaucoma was 7:8 males (46.6%) and females(53.3%) and for intumescent cataract patents was 6:9 males (40%) and females (60%). Prajna et al in their study also found a slight female preponderance (54%) compared to the males (46%) for phacomorphic glaucoma.65 SUMMARY: Aim of the study was to analyze anatomical parameters and biometric findings of ocular structures in phacomorphic glaucoma, intumescent cataract and compare them with normal eyes using Ultrasound Biomicroscope and conventional A Scan A cross-sectional study was conducted during a period March 2008 to November 2009 at Institute Of Ophthalmology, Joseph Eye Hospital, Trichy. A total of 75 eyes were, 15 phacomorphic glaucomatous eyes and the consecutive normal other eyes (total – 30), 15 intumescent cataractous eyes and the consecutive normal other eyes (total – 30) and 15 normal eyes in each group were studied. A SCAN AND UBM imaging was done for all the eyes after a comprehensive ophthalmological evaluation. The parameters studied were axial length, anterior chamber depth, IOL power, lens thickness, vitreous distance, relative lens position and UBM parameters were trabecular iris angle ,angle opening distance trabecularciliary process distance, iris thickness, iris-ciliary process distance, iris lens contact distance, iris zonular distance, anterior chamber depth, lens thickness Statistical analysis of the data was done using SPSS version (13.0). CONCLUSION: Eyes with phacomorphic glaucoma and intumescent cataract have a shorter anterior chamber depth, thinner iris with a shorter trabecular iris angle, angle opening distance, and iris lens contact distance. Apart from these parameters, the intumescent eyes had a longer vitreous distance and iris-zonule distance. The UBM confirms this crowding of the anterior segment. A gradual progressive shift in anatomic characteristics is discernible on passing from intumescent cataract to phacomorphic glaucoma. The contact surface between the iris and the lens as quantified by iris lens contact distance (ILCD) signifies that pupillary block mechanism could also be one of the causes for glaucoma in phacomorphic eyes.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | intumescent cataract; normal eyes; ultrasound biomicroscope; conventional A scan; anatomical parameters; biometric findings; ocular structures; phacomorphic glaucoma |
| Subjects: | MEDICAL > Ophthalmology |
| Depositing User: | Devi S |
| Date Deposited: | 17 Jan 2018 09:31 |
| Last Modified: | 17 Jan 2018 09:31 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5481 |
Actions (login required)
 |
View Item |
