Lens-Induced Glaucoma: The Need to Spread Awareness about Early Management of Cataract among Rural Population

Purpose. To determine the clinical profile of lens-induced glaucoma (LIG), reasons for late presentation, and outcome of current management. Methods. Retrospective analysis of 50 eyes with LIG over a 6-year period between 2005 and 2011 at a tertiary care centre in rural India. Visual acuity and intraocular pressure (IOP) were assessed preoperatively and postoperatively along with postoperative complications. Results. Fifty (2.4%) of 12,004 senile cataracts operated at Pravara Rural Hospital, Loni, presented with LIG. There were 39 (78%) phacomorphic cases and 11 (22%) phacolytic glaucoma. Following cataract surgery, 21 of 50 operated eyes (42%) had visual acuity 6/60 or worse. Conclusion. The results highlight the importance of early diagnosis and treatment of visually disabling cataract. There is a need to educate both the patient and the cataract surgeon about the dangers of lens-induced glaucoma and of about poor outcome if treatment is delayed. 1. Introduction There are twenty million blind people in India; eighty percent of this blindness is due to causes which are preventable. Cataract in India is the most important cause of preventable blindness accounting to 63.7 percent [1]. Lens-induced glaucoma (LIG) was first described in the year 1900 by Gifford [2] and von Reuss [3] independent of each other. While the former described it as a glaucoma associated with hypermature cataract, the latter described it as a glaucoma associated with spontaneous absorption of lens substance through intact lens capsule. Subsequently, various workers [4–6] described such types of cases under different names like LIG, lens-induced uveitis and glaucoma, phacotoxic glaucoma, phacogenic glaucoma, and finally phacolytic glaucoma. These terms including the more popular term phacolytic glaucoma have been discarded for various reasons and convenience in favour of the term “LIG.” At present, LIG is a clinical condition characterised by (i) a violent secondary glaucoma (resembling acute angle closure glaucoma) in one eye with senile mature cataract, hyper mature 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. Late reporting for treatment of cataract leading to serious complications like LIG remains one of the most important cause of irreversible loss of vision, especially so in the rural population. This preventable and curable condition, though rare in developed countries, is