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Diagnosis and management of malignant glaucoma at a tertiary eye institute of North India

Poster Details

First Author: S.Raj INDIA

Co Author(s):    S. Pandav   A. Singh   S. Kaushik        

Abstract Details



Purpose:

To retrospectively analyze the management of malignant glaucoma patients treated at a tertiary care eye institute.

Setting:

Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India, A tertiary care institute of North India

Methods:

The data of 14 eyes of 13 patients was retrieved from records of Glaucoma clinic of Advanced Eye Centre, Postgraduate Institute of Medical Education and Research , Chandigarh, India between 2003-2013 . All clinical details were noted from records as follow: precipitating ocular surgery, time elapsed before diagnosis, visual acuity, intraocular pressure, number of drugs at presentation and last follow up .Treatment received: conservative, lasers, surgery .

Results:

At the time of diagnosis of malignant glaucoma, 5 eyes were phakic and 9 were pseudophakic. Mean age at presentation was 66±12.8 years ( range from 49-81 years. There were 9 females and 4 males. Procedure done prior to presentation was trabeculectomy (04 eyes), cataract surgery (7 eyes), combined cataract and glaucoma surgery (1 eye), glaucoma drainage device(1 eye) and yag capsulotomy(1 eye). Of the 14 eyes, 4 eyes were managed with medical treatment and 10 with Pars plana vitrectomy. Mean IOP decreased from 34.3 ± 13.6 mmHg at presentation to 14.3 ±7.5 mmHg at the last visit (P-0.001). Antiglaucoma medication decreased from 2.14± 1.35 to 1.3 ± 0.61 (topicals) and from 0.5±0.65 to 0.21±0.42 (oral). There was no change in mean visual acuity at presentation and at the final visit. Six eyes gained 2 lines or more while 7 eyes lost 2 lines and no change in one eye. ). Resolution of malignant glaucoma was seen in all 14 eyes ( 100%).

Conclusions:

Malignant glaucoma is rare ( prevalence- 0.08%) in South East Asian countries including India compared to Whites ( prevalence- 0.4-6%) despite high prevalence of angle closure glaucoma. Ultrasound Biomicroscopy is crucial in diagnosis and ruling out other possibilities. It can be managed efficiently with various treatment options available: medical, lasers and vitrectomy. Success with pars plana vitrectomy varies between 80% to 100%. Prognosis depends upon time elapsed before presentation. Early the presentation and diagnosis, better is the prognosis. FINANCIAL INTEREST: NONE

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