|Year : 1964 | Volume
| Issue : 3 | Page : 119-122
Hyphaema after cataract operation
KN Mathur, P Awasthy, JS Mathur
Department of Ophthalmology, S. N. Medical College, Agra, India
K N Mathur
Department of Ophthalmology, S. N. Medical College, Agra
|How to cite this article:|
Mathur K N, Awasthy P, Mathur J S. Hyphaema after cataract operation. Indian J Ophthalmol 1964;12:119-22
The incidence of post-operative hyphema as a post operative complication has been reported by several authors, as varying from 1.25% to 18.7%.
The hyphaema in cases of Owens and Hughes (1947) appeared between the 2nd and the 6th day. Arruga (1952) reported it between the 2nd and the 8th day and Phillips and Forster (1961) reported the same between the 2nd and the 4th day. Different authors have attributed different causes to post-operative hyphaema.
Owens and Hughes (1946) reported hyphaema in diabetics as 12.4% and as 9.2% in those without diabetes.
Knapps (1869), Wheeler (1916), Vail (Jr) (1933), Bellows (1944), Neff (1945), reported trauma to be the major cause of hyphaema, while Meyer (1929), Turner (1935), Goar (1938), emphasize a defective bleeding and coagulation time.
Williams (1869), Stallard (1938), Leech and Sugar (1939), McLean (1940), Philips (1940), Owens and Hughes (1947) and many others have found that the application of stitches has reduced the incidence of hyphema.
Stallard (1958), Arruga (1952) and many others emphasise the value of proper dressings and protectors to reduce post-operation hyphaema.
| Material and Method|| |
To determine the total incidence of hyphaema, and its probable causes, and to evaluate measures for its prevention, 774 cases of cataract extraction were studied at the S.N. Hospital, Agra. Systemic and local examinations of the eye were done in all these cases. Urine and blood pressure were checked. In cases of doubt, blood sugar was examined. In diabetics, proper treatment was given. Bleeding and coagulation time were examined in patients who gave history of abnormal bleeding.
After proper anesthesia, the incision was given by a cataract knife. Out of 774 eyes studied, 599 were given a limbal incision, 74 eyes had corneal incision and in 101 eyes the section was cleral. Peripheral button-hole iridectomy was done in every eye. No stitch was applied in 301 eyes, whereas 473 eyes were given one preplaced corneoscleral stitch.
Intra-capsular extraction was done in 622 eyes (80.36%) and extra-capsular extraction in 152 eyes (19.6%).
The following tables show the incidence of haemorrhage according to the day on which it appeared [Table - 1] and the cause of hemorrhage in [Table - 2].
The type of extraction of the lens showed very little difference. [Table - 3]
It was found in this series that in the eyes which were given a corneoscleral stitch, the incidence of hyphaema was much less. [Table - 4]
It has been observed in these eyes that the type of suture taken played no distinct role in post operative hyphaema.
In the early study of post operative hyphaema, it was realised that trauma was one of the major causes of hyphaema. A group of 320 cases was divided into two equal sub-groups of 160 patients each. One group of patients was dressed with a perforated aluminium shield over an eye pad of suitable thickness so that the margin of the shield rested on the bony prominences of the nose and forehead. The shield was fixed with the help of two strips of adhesive plaster. The shield was changed daily along with the dressing.
The eyes which were protected with the shield, showed hyphaema in 5 cases (3.1%). One patient gave the history of trauma and in the rest no cause could be detected.
The other group of 160 operated eyes was dressed with pad and bandage. In this group 8 eyes had postoperative hyphaema (5.1%). All of them had a history of trauma. In five out of these 8 patients, the bandage had slipped during the night, when the patient had turned on his side.
| Discussion|| |
It has been seen in this study of 774 cataract extractions that the major cause of hyphaema is trauma. The next cause of hyphaema is indirect trauma like coughing, sneezing, vomiting, getting out of bed etc., and squeezing of the eye during dressing. [Table - 2] gives the complete range of causes. It can be seen that corneo scleral stitch has definitely reduced the incidence of hyphaema. [Table - 3]
Type of incision, age and sex play no role in determining post-operative hyphaema.
A protective aluminium shield dressing has minimised the incidence of post operative hyphaema in comparison to a simple pad and bandage.
It has also been noticed that there is a slightly higher incidence of hyphaema in cases of intra-capsular extraction than in extra-capsular extraction.
It has been observed that hyphaema is more common between the 3rd to 6th days, being highest on the fifth day after the operation. It is the time when new blood vessels are forming and the slightest trauma or strain to the eye is likely to lead to hyphaema.
It can be concluded from this study that to avoid the post operative complication of hyphaema, it is necessary that apposition of wound margins must be accurate and firm which can be acquired by proper stitching of the wound. The dressing of these eyes should be protected by a shield.
Squeezing of the eye and straining can be avoided by properly instructing the patient. The drops and ointment used, should be at body temperature. The base of the eye ointment should be such that it does not form a lump in the eye, which may make the patient uncomfortable and inclined to squeeze.
There are four eyes in the series where the cause could not be detected. In these, it might be possible that either the patient had injured his eye during sleep, or were cases of phacouveitis as suggested by Cooper and Rohatgi.
It is concluded that post-operative hyphaema could be greatly reduced if a proper corneo-scleral stitch with protective shield dressing is applied.
| Summary|| |
774 cases of cataract have been studied. Post operative hyphaema in 31 cases has been analysed and commented upon.
| References|| |
|1.||Arruga (1952) Ocular Surgery 3rd Ed. pp. 54-56 and 516-517 (Mc. Graw Hill). |
|2.||Bellows (1944) Cataract and Anomalies of the lens pp. 567-569, (Henry Kimpton). |
|3.||Cooper S. N. (1961) Proc. All-India Ophthal. Soc. 19, 147. |
|4.||Goar. E. L. 1938, Am. J. Surg. 42, 62. |
|5.||Hassig (1941) Cited by Vail in 18. |
|6.||Knapps H. (1869) Arch f. Ophth. 1, 103. |
|7.||Leech V. M. and Sugar H. S. (1939) Arch. of Ophthal. 21, 966. |
|8.||McLean J. M. (1940) Arch. Ophth. 23, 554. |
|9.||Meyer F. (1929) Klin Mon. F. Augenh, 102, 479. |
|10.||Neff. E. B. (1945) Arch. of Ophth. 33. 192-198. |
|11.||Owens, W. C., Hughes W. F. (1947), Arch. of Ophth. 37, 561-571. |
|12.||Phillips A. S. (1940) Brit. J. Ophth. 24. 122. |
|13.||Phillips & Forster (1961) Ophthalmic Operations 2nd Ed., 15 (Ballier Tindall and Cox). |
|14.||Rohatgi J. N. (1961) Proc. All-India Ophthal. Soc. 19, 194. |
|15.||Stallard, H.B. (1958) Eye Surgery- 3rd Ed., p. 52-53. |
|16.||Stallard, H. B. (1938) Brit. J. Ophth. 22, 269. |
|17.||Turner H. H. (1938) Pennsylvania Med. J. 38, 840. |
|18.||Vail D. T. (Jr.) (1933) Trans Am. Ophth. Soc. 31, 496. |
|19.||Williams H. W. (1869) Arch. Ophth. 1. 98. |
|20.||Wheeler J. M. (1916) J. Am. Ophth. Soc. 14, 742. |
[Table - 1], [Table - 2], [Table - 3], [Table - 4]