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Burugupally K, Senthil S, Parameshwarappa DC, Ali H, Balakrishnan D, Garudadri C. Outcomes of lensectomy with glued intraocular lens and factors associated with failure in eyes with spherophakia and glaucoma. Indian J Ophthalmol 2023; 71:2487-2492. [PMID: 37322667 PMCID: PMC10417956 DOI: 10.4103/ijo.ijo_1866_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 12/04/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023] Open
Abstract
Purpose To evaluate the outcomes of lensectomy with a glued intraocular lens (IOL) in spherophakic eyes with secondary glaucoma and assess factors associated with failure. Methods We prospectively evaluated outcomes of lensectomy with glued IOL in 19 eyes with spherophakia and secondary glaucoma (intraocular pressure (IOP) ≥22 mm Hg and/or glaucomatous optic disc damage) between 2016 and 2018. The vision, refractive error, IOP, antiglaucoma medications (AGMs), optic disc changes, need for glaucoma surgery, and complications were assessed. Success was defined as complete when IOP was ≥5 and ≤21 mmHg without AGMs; qualified success as similar IOP with up to 3 AGM; the need for >3AGM/additional surgery for IOP control was considered a failure. Results Preoperatively, the median (interquartile range: IQR) age was 18 (13.5-30) years. IOP was 16 (14-22.5) mmHg on a median of 3 (2,3) AGMs. Median postoperative follow up was 27.7 months (11.9, 39.7). Postsurgery, most patients achieved emmetropia, with significantly decreased refractive error from a median spherical equivalent of -12.5D to + 0.5D, P < 0.0002. The complete success probability was 47% (95% confidence intervals (CIs): 29-76%) at 3 months and was 21% (8 - 50%) at 1 year and 3 years. The qualified success probability was 93% (82-100%) at 1 year, which reduced to 79% (60-100%) in 3 years. None of the eyes had any retinal complications. The higher number of preoperative AGM was found to be a significant risk factor (p < 0.02) for the failure of complete success. Conclusion One-third of the eyes had IOP control without the need for AGM postlensectomy with glued IOL. Surgery resulted in significant improvement in visual acuity. The higher number of preoperative AGM was associated with poor glaucoma control after glued IOL surgery.
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Affiliation(s)
- Keerthi Burugupally
- VST Glaucoma Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sirisha Senthil
- VST Glaucoma Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Deepika C Parameshwarappa
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Hasnat Ali
- Center for Biostatistcs and Epidemiology, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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Chattannavar G, Mohamed A, Malgi V, Kekunnaya R. Visual outcomes and safety profile of intraocular lens implantation versus aphakia in children with microspherophakia with no subluxation. BMJ Open Ophthalmol 2023. [PMCID: PMC9835943 DOI: 10.1136/bmjophth-2022-001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective To study the visual, refractive and surgical outcomes of intraocular lens (IOL) implantation versus aphakia in children with microspherophakia. Design Retrospective, comparative, non-randomised interventional study. Methods All consecutive children with microspherophakia who satisfied the inclusion criteria were included. The eyes that underwent in-the-bag IOL implantation and those that were left aphakic were included in groups A and B, respectively. The postoperative visual outcomes, IOL stability and complications during the follow-up period were studied. Results 22 eyes (13 patients, male 76%), of which 12 eyes were in group A and 10 eyes in group B. The mean±SE of age at surgery was 9.4±1.4 and 7.3±0.9 years in group A and group B, respectively (p value 0.18). The mean follow-up of group A was 0.9±0.4 years (median 0.5 years; Q1 0.04, Q3 2.16) and group B was 1.3±0.9 years (median 0.147 years; Q1 0.08, Q3 0.39) (p value 0.76). All the baseline biometric variables including best-corrected visual acuity (BCVA) were comparable in each group. The final BCVA in logMAR adjusted for follow-up was comparable in both group A (0.29±0.06) and group B (0.52±0.09) (p value 0.06). Mean predictive error of IOL power in microspherophakia was 0.17±0.43. The most common complication in group A was visual axis opacification of two eyes (16.7%, 95% CI 2.9% to 49.1%), of which one eye (8.3%, 95% CI 0.4% to 40.2%) needed membranectomy. Vitreous in anterior chamber was the most common complication in group B, seen in two eyes (20%, 95% CI 3.5% to 55.8%), of which one eye (10%, 95% CI 0.5% to 45.9%) underwent YAG laser vitreolysis. The survival analysis (p value 0.18) was comparable in each group. Conclusion In-the-bag IOL is an option, which can be considered in selected cases of microspherophakia in developing nations where regular follow-up and economic constraints are a major concern.
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Affiliation(s)
- Goura Chattannavar
- Pediatric and Neuro-ophthalmology Services, Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
| | | | - Vishwesh Malgi
- Pediatric and Neuro-ophthalmology Services, Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Ramesh Kekunnaya
- Pediatric and Neuro-ophthalmology Services, Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
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Factors Related to Visual Outcomes after Lens Surgery in Isolated Microspherophakia. J Ophthalmol 2022; 2022:9089203. [PMID: 35721227 PMCID: PMC9201369 DOI: 10.1155/2022/9089203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/06/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose. To evaluate the main factors influencing visual performance after lens subluxation surgery in subjects with isolated MSP. Design. Retrospective study. Methods. In this study, 38 eyes of subjects with isolated MSP (microspherophakia) were included and divided into two groups based on preoperative IOP (intraocular pressure), IOP <21 mmHg, or IOP ≧21 mmHg. Phacoemulsification and scleral-fixated modified capsular tension ring implantation were performed with or without goniosynechialysis according to the IOP. Some ocular biometric parameters, such as corneal curvature, corneal pachymetry, endothelial cell count (ECC), anterior chamber depth (ACD), and axial length, were evaluated. The best-corrected visual acuity (BCVA) and IOP of these subjects were measured before the surgery and during <1 month and 3- to 6-month postoperative follow-ups. Results. Compared with the high IOP group, the normal IOP group was significantly younger and had better preoperative BCVA, a higher ECC, deeper ACD, a lower postoperative IOP, and flatter total corneal refractive power K1. The multivariable analysis revealed that preoperative ACD (b = −0.113, t = −2.070,
) and preoperative BCVA (b = 0.153, t = 2.562,
) were significantly associated with postoperative BCVA at 3–6 months. A preoperative ACD of 1.86 mm was found to be the optimal cut-off point for 3- to 6-month postoperative BCVA of ≧20/63 (≤0.52 logMAR). Conclusions. In addition to the effect of normal IOP, better preoperative BCVA and deeper ACD also correlated with better visual outcomes after lens surgery. Preoperative ACD served as a warning for isolated MSP subjects, especially for the risk of irreversible loss of postoperative vision. This trial is registered with “ChiCTR2000039132.”
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Chen ZX, Zhao ZN, Sun Y, Jia WN, Zheng JL, Chen JH, Chen TH, Lan LN, Jiang YX. Phacoemulsification Combined With Supra-Capsular and Scleral-Fixated Intraocular Lens Implantation in Microspherophakia: A Retrospective Comparative Study. Front Med (Lausanne) 2022; 9:869539. [PMID: 35492301 PMCID: PMC9047048 DOI: 10.3389/fmed.2022.869539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/23/2022] [Indexed: 01/19/2023] Open
Abstract
BackgroundMicrospherophakia (MSP) is a rare ocular condition, the lens surgery of which is complicated by both insufficient zonules and undersized capsule.MethodsThis study included MSP eyes managed with phacoemulsification combined with supra-capsular and scleral-fixated intraocular lens implantation (SCSF-IOL) and made the comparison with those treated by transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation (MCTR-IOL).ResultsA total of 20 MSP patients underwent SCSF-IOL, and 17 patients received MCTR-IOL. The postoperative best corrected visual acuity was significantly improved in both groups (P < 0.001), but no difference was found between the groups (P = 0.326). The IOL tilt was also comparable (P = 0.216). Prophylactic Nd:YAG laser posterior capsulotomy was performed 1 week to 1 month after the SCSF-IOL procedure. In the SCSF-IOL group, two eyes (10.00%) needed repeated laser treatment and one eye (5.00%) had a decentered capsule opening. Posterior capsule opacification was the most common complication (6, 35.29%) in the MCTR group. No IOL dislocation, secondary glaucoma, or retinal detachment was observed during follow-up.ConclusionsSCSF-IOL is a viable option for managing MSP and is comparable with the MCTR-IOL. Nd:YAG laser posterior capsulotomy was necessary to prevent residual capsule complications after the SCSF-IOL procedure.
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Affiliation(s)
- Ze-Xu Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Zhen-Nan Zhao
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yang Sun
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wan-Nan Jia
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jia-Lei Zheng
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jia-Hui Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Tian-Hui Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Li-Na Lan
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yong-Xiang Jiang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- *Correspondence: Yong-Xiang Jiang
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Gupta S, Mahalingam K, Ramesh P, Gupta V. Need of additional iridotomies despite lens extraction in spherophakes. BMJ Case Rep 2021; 14:e242838. [PMID: 33875515 PMCID: PMC8057550 DOI: 10.1136/bcr-2021-242838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 11/04/2022] Open
Abstract
Spherophakes are known to have irregular anterior chamber (AC) depths due to their poorly supported zonules. This irregularity leads to an unstable AC, often resulting in angle closure glaucoma from anterior subluxation of globular lenses. A peripheral iridotomy may be helpful to encourage aqueous drainage in initial stages, however, is not often required once lens is extracted. But, we have observed persistent instability of AC in spherophakic eyes despite lens extraction, leading to frequent iridocorneal contact locally over some quadrants. The presumed aetiology in such scenarios could be constant anteroposterior instability of IOL-bag complex due to generalised zonulopathy and hence localised iris bombe in areas with previous iridocorneal contact. Timely identification and performing additional iridotomies during surgery at such sectors even after lens extraction facilitated symmetric deepening of the AC. Hence, we recommend use of additional iridotomies at areas with persistent iridocorneal contact even after lens extraction.
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Affiliation(s)
- Shikha Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | | | - Priyanka Ramesh
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Viney Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Cai L, Han X, Jiang Y, Qiu X, Qian D, Lu Y, Yang J. Three-Year Outcomes of Cionni-Modified Capsular Tension Ring Implantation in Children Under 8 Years Old With Ectopia Lentis. Am J Ophthalmol 2021; 224:74-83. [PMID: 33253663 DOI: 10.1016/j.ajo.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE This study evaluated visual outcomes and complications at 3 years post-implantation of a Cionni-modified capsular tension ring (MCTR) with an intraocular lens (IOL) in ectopia lentis patients ≤8 years old. DESIGN Prospective clinical cohort study. METHODS Included were 101 eyes from 57 patients <8 years of age, who underwent surgery for nontraumatic ectopia lentis between November 2015 and December 2016. Exclusion criteria were planned IOL fixation in the ciliary sulcus, severe intraoperative complications, and incomplete follow-up. All eyes received in-the-bag implantation of a posterior IOL and Cionni-MCTR. Posterior capsulectomy and anterior vitrectomy were performed through the pars plana in 23 eyes of children <5 years of age. Patients were examined at 1 day, and 1, 6, and 12 months, and at 2 and 3 years postoperatively. Outcome; measurements included best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and posterior capsule opacification (PCO). RESULTS In all eyes, BCVA improved significantly after surgery, especially during the first 12 months (P < .05). Three years post-operatively, 44 eyes had BCVA 0.9 or better. Prophylactic Nd:YAG laser capsulotomy was performed 3 months post-surgery in 24 eyes; 34 eyes underwent this; procedure 6 months post-surgery because of PCO. A second surgery was; warranted in 4 eyes because of severe IOL decentration and combined anterior capsule contraction. No severe postoperative complications, such as retinal detachment or endophthalmitis, occurred. CONCLUSIONS Implantation of in-the-bag IOL with Cionni MCTR is effective for visual rehabilitation in young children with ectopia lentis. A close follow-up of these patients is necessary to monitor IOL centration and stability.
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Affiliation(s)
- Lei Cai
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Xiaoyan Han
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Yongxiang Jiang
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Xiaodi Qiu
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Dongjin Qian
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Yi Lu
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Jin Yang
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China.
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Abstract
As a rare congenital disease, microspherophakia (MSP) is characterized by small and spherically shaped crystalline lenses. The common complications of MSP include secondary glaucoma and crystalline lens dislocation or subluxation. Patients with MSP often show high lenticular myopia. The special morphological characteristics and complex complications bring challenges to the treatment of patients with MSP. Although there are some studies on MSP, most are case reports. In this article, the morphological characteristics, complications, genetic diagnosis, and treatment of MSP were systematically reviewed, providing valuable insight into the clinical diagnosis and treatment of this disease.
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Rao DP, John PJ, Ali MH, Kekunnaya R, Jalali S, Garudadri CS, Senthil S. Outcomes of lensectomy and risk factors for failure in spherophakic eyes with secondary glaucoma. Br J Ophthalmol 2017; 102:790-795. [PMID: 28928265 DOI: 10.1136/bjophthalmol-2017-310861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE To report the outcomes of lensectomy in spherophakic eyes with subluxated or dislocated crystalline lenses and secondary glaucoma. METHODS Lensectomy was performed in 52 eyes, 36 eyes with lens subluxation and 16 eyes with lens dislocation with secondary glaucoma from 1991 to 2016. Glaucoma was diagnosed based on intraocular pressure (IOP) ≥22 mm Hg and/or glaucomatous optic disc damage. Complete success was defined as IOP ≥5 and ≤21 mm Hg without antiglaucoma medications (AGMs) or surgery, and eyes needing oral AGM or surgical intervention for IOP control or those with complication causing loss of light perception were considered failure. RESULTS Median (IQR) age at lensectomy was 12 (6-18) years, and median spherical equivalent was -14.5D (-23.7to -13). Median follow-up was 30.6 (5.4-103.4) months. Median logMAR (logarithm of minimal angle of resolution) visual acuity improved from 0.95 (0.6-1.8) to 0.4 (0.2-1.3) after lensectomy (p=0.01). Median IOP decreased from 22 mm Hg (17-31) to 14 mm Hg (11-19) at final follow-up (p=0.01). Median number of AGM decreased from 2 (2-3) to 1 (0-2) at final follow-up (p<0.0001), and glaucoma surgery was needed in four eyes (7.7% eyes). Complete success probability was 69% at 1 year and 51% at 5 years. Younger age (<6 years), higher presenting IOP (>32 mm Hg) and larger cup to disc ratio at presentation were found to be significant risk factors for failure. CONCLUSION Lensectomy was effective in controlling IOP in close to half of all eyes with spherophakia and secondary glaucoma, 40% eyes needed AGM and only 7.7% eyes needed glaucoma surgery for IOP control. In this cohort, younger age, higher IOP and larger cup to disc ratio at presentation were risk factors for poor glaucoma control after lensectomy.
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Affiliation(s)
- Divya P Rao
- VST Centre for Glaucoma, L V Prasad Eye Institute, Hyderabad, India
| | - Praveen J John
- VST Centre for Glaucoma, L V Prasad Eye Institute, Hyderabad, India
| | - Mohammed Hasnat Ali
- Department of Clinical Epidemiology and Biostatistics, L V Prasad Eye Institute, Hyderabad, India
| | - Ramesh Kekunnaya
- Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Subhadra Jalali
- Srimathi Kanuri Santhamma Vitreoretinal Services, L V Prasad Eye Institute, Hyderabad, India
| | | | - Sirisha Senthil
- VST Centre for Glaucoma, L V Prasad Eye Institute, Hyderabad, India
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