INTRODUCTION Glaucoma is the second leading cause of blindness globally as well as in
most regions , with the prevalence of over 76 million people affected ( 2010
-2020) 1 Glaucoma is defined as a multifactorial optic neuropathy, which is
characterised by progressive damage of retinal ganglion cells and axons, and a
thinning of nerve fibre layer and neuroretinal rim.When a related or identifiable ophthalmic condition is known
to be present , it is secondary glaucoma, i.e., glaucomas that occur as a side
effect or secondary to another underlying medical condition or trauma.This
differs from primary glaucoma where there is no identifiable cause for glaucoma
to develop. Previous studies have shown that secondary glaucoma occurred more in men
than women in the age group of 51-60 years, commonly unilateral with
intraocular pressure =/> 30 mmHg, most common lens induced glaucoma followed
by steroid induced glaucoma 1.Other causes being neovascular
glaucoma,traumatic , pseudoexfoliation, post vitrectomy. Some studies also noted younger patients affected by secondary glaucoma
and presentation with higher IOP, severe disc damage and visual field defects .
2 The management in secondary glaucoma differs from primary, as in
secondary variety if the primary pathology is detected and treated at the
earliest , glaucomatous damage can be prevented . 3 Need for the study Six million people are affected by secondary glaucoma globally compared
to 67 million of primary glaucoma.The prevalence varies from 6-22% globally and
0.7 -6 % in India with varied etiologies. 4 The various causes of secondary glaucoma include ocular and systemic
conditions , lens pathologies,trauma, neovascularization,steroid
–induced,inflammation , previous surgery, and others which poses formidable
diagnostic and management challenge. 5 For each of these conditions,understanding the clinical profile of
patients, mechanism of raise of intraocular pressure (IOP) helps us to focus on
the underlying condition and plan
accordingly. As secondary glaucoma is an important cause of visual morbidity , early
diagnosis and appropriate treatment can help in prevention of irreversible
visual loss. Hence , this study is undertaken to investigate the characteristics of
secondary glaucoma patients at a tertiary care hospital in Bangalore. Objective of the study To study the demography,underlying etiology,clinical characteristics and
disease severity of secondary glaucomas. MATERIALS AND METHODS Source of data Patients attending out patient department (OPD) of Nethradhadama
superspeciality hospital , Glaucoma block, Bengaluru,Karnataka, India . Inclusion criteria 1.
Patients
of either gender aged < 70 years, U/L or B/L , IOP >21 mm Hg, with or
without glaucomatous disc damage with ; 2.
Lens
induced changes 3.
Pseudoexfoliation
syndrome 4.
Steroid
usage 5.
Ocular
trauma 6.
Ocular
inflammation 7.
Neovascularizartion
of eye 8.
Retinal
pathology / vitreo retinal surgery,previous ocular surgeries. Exclusion criteria 1.
Not
willing to participate 2.
Primary
open –angle glaucoma (POAG) , primary angle closure glaucoma (PACG ), Congenital
glaucoma 3.
Corneal
opacity, degeneration,dystrophy or infections , which precludes IOP measurement
by Goldmann applanation tonometer (GAT). Study design: Cross-sectional descriptive study Sample size: 60 consecutive patients In India, the reported prevalence of secondary glaucoma
ranged between 0.7 to 6.72%.
Considering 3.7% prevalence with 5% error
sample needed to conduct this study
is 55 cases. 60
cases will be selected. Place
of study: OPD, Glaucoma block , Nethradhama superspeciality hospital,
Bengaluru, Karnataka. Method
of collection of data Consecutive
patients diagnosed as secondary glaucoma will be explained about the procedure
and informed consent will be taken. A
detailed ophthalmic evaluation which includes the following: 1. Visual
acuity – both uncorrected and best corrected using Snellens chart and Jaegers
chart for near vision. 2. Refraction
with streak retinoscope or auto refractometer. 3. Detailed
slit lamp examination of anterior segment. 4. IOP
measurement by GAT. 5. Posterior
segment evaluation by slit lamp fundus biomicroscopy using a +90D lens or
Indirect ophthalmoscopy. 6. Gonioscopy
using 4 mirror gonio lens. 7. Visual
field examination by HFA 3 ( CZ Meditech ) and Optical coherence tomography
(OCT) for optic nerve head and peripapillary retinal nerve fibre layer analysis
. Statistical
Analysis Categorical data will be represented in the form of
frequency and percentage. Association
between variables will be assessed with
Chi Square Test. Quantitative data will
be represented as Mean & Sd. Comparison will be done with
Independent t test.A P value of <0.05 will be considered statistically significant.Data was
analyzed with IBM SPSS Version 28 for windows. References 1.
Komaratih, E.,
Rindiastuti, Y., & Primitasari, Y. (2020). Profile of Secondary Glaucoma at
a Tertiary Hospital in East Java. Folia Medica Indonesiana, 56(1), 56–59. 2. Seth PK, Senthil S, Das AV, Garudadri C.
Prevalence of glaucoma types, clinical profile and disease severity at
presentation: Tertiary Institute based cross-sectional study from South India.
Indian J Ophthalmol. 2023 Oct;71(10):3305-3312. 3.
Gadia R,
Sihota R, Dada T, Gupta V. Current profile of secondary glaucomas. Indian J
Ophthalmol. 2008 Jul-Aug;56(4):285-9. 4.
Partha Chakma , Debal Kisor Pal , Amar
Kanti Chakma.A Clinical Study of Secondary Glaucoma with Special Reference to
Its Proportion, Causes and Its Risk Factors in a Tertiary Care Hospital - A
Cross Sectional Study . J Evid Based Med Healthc, 2021 Jan ;eISSN - 2349-2570
5.
Gurung J,
Sitoula RP, Singh AK. Profile of Secondary Glaucoma in a Tertiary Eye Hospital
of Eastern Nepal. Nepal J Ophthalmol. 2021 Jan;13(25):98-103. |