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Outcomes of lensectomy and risk factors for failure in spherophakic eyes with secondary glaucoma
  1. Divya P Rao1,
  2. Praveen J John1,
  3. Mohammed Hasnat Ali2,
  4. Ramesh Kekunaya3,
  5. Subhadra Jalali4,
  6. Chandra Sekhar Garudadri1,
  7. Sirisha Senthil1
  1. 1VST Centre for Glaucoma, L V Prasad Eye Institute, Hyderabad, India
  2. 2Department of Clinical Epidemiology and Biostatistics, L V Prasad Eye Institute, Hyderabad, India
  3. 3Jasti V Ramanamma Children’s Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India
  4. 4Srimathi Kanuri Santhamma Vitreoretinal Services, L V Prasad Eye Institute, Hyderabad, India
  1. Correspondence to Dr Sirisha Senthil, L V Prasad Eye Institute, Kallam Anji Reddy campus, Road No: 2, Banjara Hills, Hyderabad 500034, India; sirishasenthil{at}lvpei.org

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.

  • lens and zonules
  • glaucoma
  • intraocular pressure

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Footnotes

  • Contributors DPR and PJJ contributed in the data collection, interpretation of data and writing of the manuscript. MHA helped with data analysis and interpretation of data. RK, SJ and CSG contributed in critically revising the manuscript for important intellectual content and final approval of the version to be published. SS contributed in the conception, design, acquisition, analysis, interpretation of data and drafting of the manuscript and critically revising it.

  • Funding Hyderabad Eye Research Foundation.

  • Competing interests None declared.

  • Ethics approval L V Prasad Eye Institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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