Dinamic of the molecular marker of intercellular adhesion (ICAM-1) in patients with neovascular glaucoma after transscleral laser cyclocoagulation

Abstract

Factors influencing delayed presentation and its impact on blindness and visual impairment at primary phaco-trabeculectomy for advanced primary glaucomas in central India. Methods Retrospective case series. Subjects undergoing primary combined phaco-trabeculectomy from March 2015 to December 2021 included. Glaucoma defined as per ISGEO criteria. Advanced glaucoma was defined as Mean Deviation > -12dB as based on HAP (Hodapp-Anderson-Parrish) criteria in Humphrey Visual Fields (HVF) if available peri-operatively. If visual fields were not possible an advanced glaucomatous disc damage with decreased visual acuity <6/60 considered diagnostic of advanced glaucoma. Visual Impairment (VI) defined as per WHO for best corrected distance acuity in better eye [Moderate VI (< 6/18–6/60), Severe VI (<6/60–3/60), Moderate-Severe VI (<6/18-3/60), Blindness (<3/60)]. Exclusions were secondary glaucomas, co-morbid retinopathies contributing to decreased acuity or any prior intraocular surgery in either eye ( except cataract surgery in contralateral eye). Age, gender, proximity to hospital, type of glaucoma (POAG, PACG) considered as risk factors. P<0.05 considered significant. Results Total 119 subjects with mean age 61.7±9.1 years included. Males: Females (%)=55: 45; 27(23%) had Moderate-Severe VI and 13(11%) were Blind at presentation. PACG diagnosed in 82 subjects (69%) with 11(13%) blind. POAG diagnosed in 37 subjects (31%) with 2(5%) blind. Nearly half (49%) were newly diagnosed to have glaucoma at presentation for surgery. Mean Cup-disc ratio was 0.87±0.07 and Mean Deviation (MD) in HVF was -25.01±5.8 dB in operated eye. Overall 21% females were blind and an additional equal number (21%) showed moderate-severe visual impairment compared to 3% and 26% in males respectively (p=0.026). Patients from four surrounding districts (outer zones) with greater distance to base hospital were relatively younger and with higher blindness rates. Of the 23 contralateral eyes with pseudophakia, 20 (87%) had advanced glaucoma of which 9(39%) were blind. Majority of these were operated in cataract surgical camps. Conclusions High prevalence of glaucoma related blindness and visual impairment at primary surgery. Females with greater distance to hospital disproportionally affected suggest socio-economic factors affecting late presentation. Lack of comprehensive eye examination and appropriate management at time of cataract surgical camps needs reevaluation.