|Year : 1967 | Volume
| Issue : 1 | Page : 26-28
Making and closing of cataract section
RK Mishra, PK Mukerji
Reader in ophthalmology, Medical College, Jabalpur, India
|Date of Web Publication||18-Jan-2008|
R K Mishra
Reader in ophthalmology, Medical College, Jabalpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mishra R K, Mukerji P K. Making and closing of cataract section. Indian J Ophthalmol 1967;15:26-8
In this short paper we are presenting our experience on 150 cases of cataract operated with a technique just going to be described and in the end we have contrasted the relevant complications with our own series operated in a different way.
Here we are strictly limiting ourselves with the sole topic of making and closing of the wound. The various steps of the technique are already well known. We have attempted to adapt them in a particular combination so as to reduce surgery to the minimum, compatible with adequate security.
The following are the steps of surgery:
1. Fornix based conjunctival flap.
2. Limbal gutter.
3. Preplaced corneoscleral stitch.
4. Section by knife.
5. Closing of the wound, tying the suture and pulling down the conjunctival hood over the section.
Fornix based conjunctival flap
The conjunctival attachment on the cornea is dissected off from 3-9- clock position. The conjunctival area is undermined. There is a little bleeding from the scleral and the conjunctival vessels. The conjunctival vessels stop bleeding soon but the scleral vessels have to be cauterized by heat. The conjunctiva so separated retracts away from the limbus exposing a surprisingly wide area of cornea and the true limbus. [Figure - 1]
Bevers 67 knife is used to make the gutter between 2-10 clock position.
Attempt is made to make the entire length in one sweep going about two-thirds the depth of the limbus tissue.
At the 12 o'clock position, a 4 mm Greishaber needle mounted on 7 zero silk is passed from the corneal lip of the gutter, across the gutter and through the scleral lip in one sweep. A wide loop is made and kept on the nasal side while making the section.
The section is started in the usual 3-9 o'clock position by a cataract knife and as it reaches the beginning of the gutter care is taken to guide the knife point in the gutter. While completing the section at 12 o'clock position care is taken of the suture and if requited, the watchful assistant moves the thread out of the way.
Closing of the wound
After the iris is reposed and the wound margin stroked in place and air injected, the suture is tied by a double knot. The conjunctival flap is pulled down like a hood over the corneal wound and is anchored at 3 and 9 o'clock positions by simple conjunctival stitches [Figure - 2]
| Discussion|| |
This has been our attempt to find the minimum essential surgery to provide adequate security in making and closing of the wound.
The fornix based conjunctival flap besides being the most logical way of exposing the limbus has the following advantages:
A. Full exposure of the actual area of operation.
B. No troublesome bleeding to be reckoned with at the time of actual delivery of the lens.
C. Protection and even support of the wound by the pulled down conjunctival flap. The corneal suture is fully covered by the flap till it retracts -this takes about 4 weeks.
The gutter is made in the true limbus, which provides for a very stable suture and also a path of least resistance for the knife during the section. When the stitch is passed through the tough cornea and scleral lips without the encumbrance of the loose conjunctiva, the suture is very firm indeed. The advantages of the multiple stitches cannot be denied but if properly placed in a good knife section, one stitch is enough. The stitch gets exposed in about 4 weeks time when the flap retracts. This is a very safe time for the stitch to be removed.
In cataract surgery the knife section has greater advantage of giving a clean and uniform wound, so helpful for exact apposition and quick healing. Taking the section at 3 to 9 o'clock position with the knife, instead of enlarging it after making a 2-10 o'clock section again ensures a regular section, though it presents a small problem and a little care of guiding the knife point into the gutter as it reaches the opposite end for counter-puncture. Again, in the course of the present series we have come to believe that if the section is made after making a gutter, the verticle nature of the section prevents the presentation of the iris in the wound on completing the section as the aqueous escapes, or after the delivery of the lens.
In the following table we are comparing the complications pertinent to the topic of the paper, encountered in this series with our own previous series in which we made the usual 3-9 knife section at the limbus with a triangular conjunctival flap with post placed sutures in the flap and the bulbar conjunctiva.[Table - 1]
| Conclusion|| |
It is our impression that the following are the advantages of the procedure described above.
I. Very clear view of the actual site of operation.
2. Firm preplaced suture ensuring security and then remaining deeply buried for about 4 weeks, after which it becomes exposed by the retracted conjunctiva. At this stage it can be removed without any difficulty.
3. The corneal section is being provided with an extra support by the conjunctival hood.
4. Advantage of the gutter and the section by knife.
| Acknowledgement|| |
We are very thankful to Dr. Ronald I.owe. F.R.C.S.. F.R.A.C.S. D.O. (Director Glaucoma Research Institute). Melbourne, who demonstrated to one of us (Dr. R. K. Mishra) the procedure and the advantages of the fornix based conjunctival flap.
[Figure - 1], [Figure - 2]
[Table - 1]