Case Stories

Restoring Sight, Renewing Life a Case of Advanced Cataract with Glaucoma in an Octogenarian
- Dr. Harsh Abhishek

HealEYE

Health Insights

Dr. Harsh Abhishek

Faculty
Glaucoma Services

Restoring Sight, Renewing Life a Case of Advanced Cataract with Glaucoma in an Octogenarian

Case History

An 88-year-old woman presented with painless, progressive vision loss in both eyes for over five years. She was diagnosed with advanced brown cataracts complicated by glaucoma. The image includes what appears to be a medical photograph showing an eye exam or surgical view of one of the patient's eyes on the left side.

Treatment

To control intraocular pressure (IOP), we initiated antiglaucoma medication. However, due to significant optic nerve damage and inadequate IOP control, surgical intervention was necessary. Within a month, we performed small-incision cataract surgery with intraocular lens implantation and trabeculectomy with Mitomycin C in both eyes. The surgery was challenging due to her advanced age, fragile conjunctiva, and the difficulty of maintaining a supine position for an extended period.

Result

Both surgeries were successful. Postoperatively, the patient achieved a visual acuity of 20/40 in both eyes, with well-controlled IOP and no need for further antiglaucoma medication. The most gratifying outcome was her renewed independence—she could once again manage household tasks and read her holy scriptures, which she had been unable to do for the past five years. This case underscores that, despite the complexity of cataract surgery in glaucoma patients, meticulous surgical planning can yield excellent results, significantly enhancing the patient's quality of life.

Glaucoma is a chronic opticneuropathy with raised IOP as a key risk factor. Advanced cataracts further compromise aqueous outflow, worsening the condition. Small-incision cataract surgery with trabeculectomy and Mitomycin C is an effective approach for vision rehabilitation in such cases, as phacoemulsification poses a higher risk of complications. Special attention must be given to Mitomycin C concentration and exposure time, particularly in elderly patients with thin conjunctiva.