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   Table of Contents      
ARTICLE
Year : 1966  |  Volume : 14  |  Issue : 1  |  Page : 21-25

Two pillar iridencleisodialysis with cataract extraction in cataract with glaucoma


M. U. Institute of Ophthalmology & Gandhi Eye Hospital, Aligarh, India

Date of Web Publication12-Jan-2008

Correspondence Address:
K Nath
M. U. Institute of Ophthalmology & Gandhi Eye Hospital, Aligarh
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Nath K, Shukla B R. Two pillar iridencleisodialysis with cataract extraction in cataract with glaucoma. Indian J Ophthalmol 1966;14:21-5

How to cite this URL:
Nath K, Shukla B R. Two pillar iridencleisodialysis with cataract extraction in cataract with glaucoma. Indian J Ophthalmol [serial online] 1966 [cited 2019 Aug 24];14:21-5. Available from: http://www.ijo.in/text.asp?1966/14/1/21/38560

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Cataracts are often associated with glaucoma and frequently result as its complication. In such patients the problem is whether the glaucoma and cataract should be dealt with separately in two stages or should be operated simultaneously in one sit­ting. Duke Elder, (1940) Spaeth, (1945) and Sternberg and Meyer (1950) expressed their opinion in fav­our of the former. On the contrary Guyton (1949), Berge (1954), Wen­nas and Stertzberg (1955), Tamler and Maumenee (1955) prefered that the two should be tackled simultane­ously so as to shorten the duration of convalescence and improve the results. In the one stage procedure, cataract extraction may be combined with anterior sclerotomy (O'Brian, 1947), one pillar iridencleisis (Birge, 1954; Wennas and Stertzberg, 1955) two pillar iris incarceration, broad iridectomy (Troutman, 1956; Madan Copal, 1958). Our experience with these combinations is not encourag­ing, because the cases often report with raised intraocular tension sub­sequently. The present study of dealing with the two conditions si­multaneously was therefore under­taken to evaluate the results of a newer technique which provides a more permanent drainage of the aqueous humour. The operation comprises of iridodialysis, two pillar iridencleisis along with cataract ex­traction.


  Material and Methods Top


Between July 1963 and December 1964, 41 cases of glaucomatous cata­racts, ranging between 39 to 72 years, were selected from the indoor sec­tion of the Gandhi Eye Hospital, Aligarh. Tonometery and gonios­copy was undertaken and the cases were divided into two groups; (1) closed angle (17 cases) and (2) open angle (24 cases) glaucomas. The ini­tial tension in 17 cases was found to be high (above 3.5 mm Hg) and was controlled by medical treatment before operation [Table - 1] Secondary angle-closure glaucomas due to intu­mescence of lens were excluded from this series.

These cases were operated and treated over a period of 17 months. All the cases were followed in the hospital for one month although they could be discharged much earlier. Only 23 cases could be followed up for 3-8 months after surgery.

Technique -

As soon as the tension after medi­cal treatment was near normal (20-30 mm Hg Schiotz) the case was con­sidered for surgery. After the usual preparation and the routine local anesthesia, digital pressure was ap­plied to the eye to lower the tension as much as possible. (25-30). Often glycerol had to be administered pre­operatively.

After a traction stitch through the superior rectus a limbal based 6 mm broad conjunctival flap was prepar­ed and was reflected on the cornea. The bleeding points were cauterised and a scleral groove was made from 10 O'clock to 2 O'clock [Figure - 1]. Two preplaced corneoscleral sutures (to be left buried) were placed at 11 O'clock and 1 O'clock. A keratome section was made at 12 O'clock and enlarged from 9 to 3 O'clock [Figure - 2].

In cases of angle closure glaucoma, the iris root was separated from the corneo-sclera by sweeping the angle radially with the tip of an iris repo­sitor all round. This step was omit­ted in cases of open angle glau­coma. Next, the iris was picked up near the sphincter and cut radially upto its root in the 12 O'clock meri­dian. [Figure - 2]. Each cut pillar was then pulled separately towards the centre of the pupil in order to tear it from its true root in between 1 and 11 O'clock positions [Figure - 3]. The two pillars were everted sidewards and the cataractous lens was slided by the upper pole. The two pillars were then spread between I and 11 O'clock meridians with pigment epithelium outwards [Figure - 3],[Figure - 4]. The preplaced sutures were tied. Ad­ditional sutures were given where required. A bubble of sterile air was left in the anterior chamber [Figure - 5],[Figure - 6].

Results -

In all the 41 cases excepting one, the tension remained within normal limits at the end of the first month after operation. 2 cases developed minor complications during the ope­ration, [Table - 2] and majority of the patients recovered good visual acuity [Table - 3]. Only 23 cases could re­port for a follow up examination after an interval of 3-17 months and one of them had elevated tension. [Table - 4] gives comparative status of tension and visual acuity amongst them.

In this operation, the section is rather perpendicular because a groove is made prior to insertion of sutures. Both iris pillars are in­carcerated and hence the chances of establishment of a fistula are im­proved and the dialysis of iris from 1 to 11 O'clock opens the angle at least partly whereby the aqueous outflow may be improved. Thus this procedure gives the advantage of broad iridectomy as well as that of an iris incarceration. In angle clo­sure glaucoma with cataract, the sweeping of the angle with iris re­positor is helpful in breaking the gonio-synechia formed due to contact of iris with cornea.

The results show that out of 17 cases of angle closure glaucoma with cataract, at the end of one month after the operation, the tension was normal in 14 cases while out of 24 cases of cataracts associated with open angle glaucoma the tension was normal in 22 cases. This series did not show any extraordinary imme­diate or remote complication.


  Summary Top


Iridencleisodialysis was performed with cataract extraction in 17 cases of angle closure and 24 cases of open angle glaucomas with cataract. Nor­mal tension was observed in 14 and 22 cases respectively without any extraordinary post operative compli­cations. The technique adopted has been described.[11]

 
  References Top

1.
Birge, H. L. (1954), Amer. J. Ophthal., 36, 925.  Back to cited text no. 1
    
2.
Duke-Elder, W. S. (1940), Text Book of Ophthalmology Vol. III, p. 3,309, Kimpton, London.  Back to cited text no. 2
    
3.
Guyton, J. S., (1945), Arch. Ophthal. (Chi­cago)., 33, 265.  Back to cited text no. 3
    
4.
Madan Gopal (1958-1959) Proc. All. Ind. Ophth. Soc. 18, 8:3.  Back to cited text no. 4
    
5.
O'Brian, C.S., (1947), Arch. Ophthal. (Chi­cago), 37, 4.  Back to cited text no. 5
    
6.
Spaeth, E, B. (1944), The principles and practice of Ophthalmic Surgery, p. 593., Kimpton London.  Back to cited text no. 6
    
7.
Sternberg, P. and Meyer, S. J. (1950), Amer. J. Ophthal., 33, 763.  Back to cited text no. 7
    
8.
Tamber, E. and Maumenee, A. E. (1955), Arch. Ophthal., 54, 816.  Back to cited text no. 8
    
9.
Troutman R. C., (1955), Acta XVII Int. Cong., 2, 674.  Back to cited text no. 9
    
10.
Veil, D., (1949), Amer. J. Ophthal., 32, 1754.  Back to cited text no. 10
    
11.
Wannas, E.J. and Stertzberg, C. , W., (1955), Amer. J. Ophthal., 39, 71.  Back to cited text no. 11
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]
 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]



 

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