Cataract if left untreated, can lead to complications such as lens induced glaucoma and permanent visual loss. The COVID-19 outbreak resulted in movement control orders causing closure and reduction of non-COVID hospital services resulting delayed appointment dates. This study described the side effects of delayed patient appointments due to COVID-19 pandemic. A 70-year-old man presented with right eye (RE) pain and redness. There was gradual reduction in RE vision over the last year but treatment was delayed due to pandemic. In examination, visual acuity on his RE was hand movement and left eye (LE) was 6/12 (ph6/12) and near vision of N5. The right pupil was mid-dilated, reacting sluggishly with presence of relative afferent pupillary defect. Intraocular pressure (IOP) on the RE was 54 mmHg and LE was 16 mmHg. Circumciliary injection of right conjunctiva with central corneal haziness was seen. The anterior chamber was deep with the presence of 3+ cells with whitish lens material at the pupillary axis. A Morgagnian cataract with phacodonesis was present. A diagnosis of lens induced glaucoma was made. Immediate reduction of IOP included topical and systemic medication and pain relief were instituted. Intracapsular cataract extraction with anterior vitrectomy and surgical peripheral iridectomy was performed. This highlights the late presentation of a patient with mature cataract during the COVID-19 pandemic. Patient awareness and education are essential in recognising the complications of mature cataract if it is presented later. A reminder of signs and symptoms of lens induced glaucoma should be conveyed to patient when appointment is delayed.
Lens-induced Glaucoma, a Collateral Damage during COVID-19 Pandemic
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Abstrak
Katarak ialah penyebab utama kebutaan yang boleh dielakkan di dunia. Jika tidak dirawat, ia boleh mengakibatkan komplikasi seperti glaukoma dan kehilangan penglihatan kekal. Pada tahun 2020, World Health Organisation (WHO) telah mengisytiharkan wabak COVID-19 sebagai darurat kesihatan global. Akibat perintah kawalan pergerakan, rawatan pesakit bagi penyakit bukan-COVID-19 dikurangkan, tarikh temujanji dilanjutkan atau ditangguh dan pesakit-pesakit perlu menjalani ujian saringan COVID-19 sebelum menerima rawatan. Kajian ini menunjukkan kesan sampingan penangguhan tarikh temujanji pesakit disebabkan pandemik COVID-19. Pesakit lelaki berumur 70 tahun dengan darah tinggi datang dengan aduan mata kanannya sakit dan merah selama sebulan. Penglihatannya semakin berkurangan selama setahun tetapi beliau menangguhkan rawatan disebabkan pandemik. Pemeriksaan fizikal menunjukkan ketajaman penglihatan bagi mata kanan (RE) hanya pergerakan tangan manakala mata kiri (LE) adalah 6/12 (ph6/12) dan penglihatan jarak dekat N5. Didapati anak mata kanan menunjukkan "relative afferent pupillary defect". Tekanan intraokular (IOP) RE adalah 54 mmHg dan bagi LE adalah 16 mmHg. Diperhatikan juga kemerahan konjunktiva RE dengan kekaburan kanta kornea. "Anterior chamber" didapati sempit dengan kehadiran sel sebanyak 3+, katarak putih dengan nukleus tenggelam. "Phacodonesis" juga dilihat. Hasil diagnosis ialah “lens induced” glaukoma disebabkan oleh katarak matang. Untuk pengurangan IOP dengan segera, ubat topikal dan sistemik dimulakan. Laporan ini menekankan komplikasi kehadiran lewat pesakit dengan katarak matang semasa pandemik COVID-19. Pendidikan kesihatan serta langkah-langkah untuk meningkatkan kesedaran di kalangan pesakit mengenai komplikasi katarak adalah penting. Pesakit patut diingatkan mengenai gejala glaukoma yang disebabkan oleh kanta katarak sekiranya temujanji ditukar atau dilewatkan.
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