Analysis of sociodemographic profile of glaucoma patients with risk factors, subtypes, and disease severity in a tertiary eye care facility in Northern India.

PURPOSE: To study the different subtypes of glaucoma and to analyze the demographic and clinical profile of glaucoma patients along with associated risk factors in a multi-locational North Indian study. METHODS: Newly diagnosed and known glaucoma patients on treatment were enrolled in the study. Complete history was taken, and clinical evaluation was done by senior glaucoma experts. RESULTS: Five hundred and eighty-six patients (1121 eyes) were included with 383 males (65.4%) and 203 females (34.6%). Of these, 508 (86.7%) had primary glaucoma and 78 (13.3%) had secondary glaucoma. Also, 263 (44.9%) patients had primary open angle glaucoma (POAG) and 172 (29.4%) had primary angle closure glaucoma. Four hundred and fifty-one (77%) were graduates or postgraduates and 293 (50%) were dependents on family income. One hundred and forty-one (24%) had a positive family history. Secondary glaucoma patients had a lower average age (52.6 ± 16.8 years) and higher average intraocular pressure (IOP; 34.23 ± 13 mm) compared to primary glaucoma patients (26.6 ± 9.7 mm) (P < 0.0001). Thirty-three (47.8%) out of 78 secondary glaucoma patients had advanced disease. Seventy-four (12.6%) were first-time diagnosed and 18 had advanced disease. In addition, 161 eyes had one or more glaucoma surgeries done (128 trabeculectomy and 28 phacotrabeculectomy). Ninety-five (16.2%) patients were advised surgery at our centers (46 trab, 26 phacotrab, 15 phaco, five Ahmed glaucoma valve implantation, and three pars plana vitrectomy). Disease progression was noted in 62 patients reporting good compliance to medicines. CONCLUSION: POAG was the most common variant in this study. Secondary glaucoma patients were youngest in age and had the highest IOP. Trabeculectomy was the most performed surgery. A good literacy rate did not prevent late presentations.

Prevalence of glaucoma types, clinical profile and disease severity at presentation: Tertiary Institute based cross-sectional study from South India.

Purpose: To describe the clinical profile and relative prevalence of subtypes of glaucoma presenting to a tertiary care center in India. Methods: This cross-sectional hospital-based study included 6,120 new patients (>16 years) presenting between January 2016 and December 2017. The data were collected using an electronic medical record system. Results: A total of 11,016 eyes of 6,120 new patients were diagnosed with glaucoma. Sixty-one percent were male and 79% had a bilateral affliction. Primary glaucoma was present in 4,352 (71.1%) and secondary glaucoma in 1,063 (17.4%) subjects. Glaucoma was primary open-angle (POAG) in 4,015 (36.4%) eyes and primary angle closure disease (PACD) in 3,806 (34.5%) eyes. Commonest among secondary glaucoma was post-cataract surgery glaucoma (3.1%), neovascular glaucoma (2.4%), pseudoexfoliation glaucoma (PXG) (2.1%), and steroid-induced glaucoma (SIG) (1.4%). Patients with primary glaucoma were older than secondary (56.6 ± 0.2 vs 54.1 ± 0.4; P < 0.0001). Mean IOP was higher in secondary glaucoma compared to primary (26.9 ± 0.3 vs 18.9 ± 0.1; P < 0.0001). Secondary glaucoma had greater mean CDR compared to primary glaucoma (0.77 ± 0.007 vs 0.70 ± 0.003; P < 0.0001). The prevalence of blindness (visual acuity <20/200) was 16.2% of eyes. Mean deviation (MD) 20db or worse was noted in 39.5% of eyes at presentation including 47.8% of PACG, 37.3% of POAG, 51% of JOAG, 58% of PXG, and 45% of SIG, suggesting disease severity. Conclusion: At the presentation to a tertiary care center, 40% of all eyes with glaucoma had advanced disease with MD worse than - 20D. PACG and JOAG had the worse disease among primary; among secondary, PXG and SIG had the worse disease at presentation.

Bleb-related tuberculous endophthalmitis following combined phacoemulsification and trabeculectomy with mitomycin C.

A one-eyed 67-year-old man with 20/400 vision, dense cataract, previously failed trabeculectomy and medically uncontrolled advanced glaucoma underwent a single-site phacoemulsification with repeat trabeculectomy and mitomycin C. One-week postoperatively, vision in the right eye improved to 20/120, good bleb and intraocular pressure (IOP) of 14 mm Hg. By third postoperative week, patient presented to the emergency with diminished vision, pain and redness in right eye of 2 days duration and was diagnosed to have bleb-related endophthalmitis (BRE). Vitreous biopsy, smear from the bleb were taken and underwent pars plana vitrectomy with intraocular antibiotic injection. Smears and cultures were negative however, aqueous DNA-PCR was positive for Mycobacterium tuberculosis Revisited history revealed treated pulmonary tuberculosis 3 years ago with a positive Mantoux test (17 mm) and hilar prominence on chest X-ray. One month after starting anti-tubercular therapy (ATT), the BRE resolved and vision improved to 20/60 with IOP of 14 mm Hg and the ATT was continued.