|Year : 1969 | Volume
| Issue : 1 | Page : 11-13
Peripheral iridectomy with scleral cautery - a simple technique
Hamida Saiduzzafar, JS Pradhan, R Gogi
Muslim University Institute Of Ophthalmology and Gandhi Eye Hospital, Aligarh, India
|Date of Web Publication||4-Jan-2008|
Muslim University Institute Of Ophthalmology and Gandhi Eye Hospital, Aligarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Saiduzzafar H, Pradhan J S, Gogi R. Peripheral iridectomy with scleral cautery - a simple technique. Indian J Ophthalmol 1969;17:11-3
|How to cite this URL:|
Saiduzzafar H, Pradhan J S, Gogi R. Peripheral iridectomy with scleral cautery - a simple technique. Indian J Ophthalmol [serial online] 1969 [cited 2020 Aug 9];17:11-3. Available from: http://www.ijo.in/text.asp?1969/17/1/11/37573
The technique of using a hot electric cautery to produce a filtering scar was first employed in the surgical treatment of glaucoma by PREZIOSI. He dissected a conjunctival flap down to the limbus, and then, after splitting the cornea for 1.5 mm he applied the red-hot point of a cautery at the limb us directed towards the angle of the anterior chamber. The cautery was applied lightly to the cornea and withdrawn several times till the aqueous flowed out, iridectomy being done only if the iris prolapsed during the operation.
In 1956 Scheie noticed that he obtained a filtering cicatrix following peripheral iridectomy for glaucoma in cases where the Hildreth cautery had been used for haemostasis. He then independently developed the procedure of scleral cautery with peripheral iridectomy and reported its advantages over other filtering operations (SCHEIE,). Later, following the suggestion of GUINAN, Sheie modified his original technique so that the scleral cut was made through an area previously lightly stroked with the cautery, and then the point of the cautery was applied to the lips of the wound before the anterior chamber was finally_ entered with the knife (SCHEIE).
It is a simplification of the latter technique which has recently been employed at this hospital with very good results. In our method, the electric cautery has been replaced by the point of an ordinary pin, heated red-hot in the flame of a spirit-lamp, while held with a suitable needle holder. This device is so simple and inexpensive that it would be eminently suitable for surgeons working in small and rural clinics, where electrical equipment may not be available.
| Material And Method|| |
The present study was undertaken on cases of primary glaucoma seen in the Glaucoma clinic of the Institute of Ophthalmology, Aligarh, and subsequently admitted to the Gandhi Eye Hospital wards for surgery. There were 106 eyes in the series, of which 67 eyes had angle-closure glaucoma and 39 eyes had open angle glaucoma. Detailed assessment of the glaucoma status was made in each case before and after surgery, and all the cases had a minimum follow-up period of six months.
| Surgical Technique|| |
A large flap of conjunctiva and Tenon's capsule is reflected down to the limbus, and all bleeding points lightly cauterized with the red-hot head of the pin. The area of the proposed incision is gently touched over with the heated pin-head to demarcate it clearly. A scleral incision 3-4 mm long and about 1 mm behind the limbus is made with a Bard Parker Knife (No. 15) down to about half the thickness of the sclera. This cut is made perpendicular to the surface of the sclera and is directed towards the root of the iris. The point, of the pin made red-hot in the flame of a spirit-lamp is now applied to the lips of the scleral wound using just enough heat so that shrinkage of the sclera occurs; the cauterization is concentrated more on the posterior lip of the gutter which is being formed. The incision is then deepened with the knife, more applications with the cautery made, and the procedure repeated until the wound shows a bluish tint. At this stage, after a final careful application of the cautery, the sclera is perforated and the anterior chamber entered with the knife. A peripheral iridectomy is done, the deeper strands of the scleral gutter are well freed with an iris repositor, and the conjunctival flap replaced and sutured with a continuous 6-0 silk stitch.
| Observation And Discussion|| |
The final assessment in this series was made six months after surgery. "Control of intra-ocular pressure" was defined as repeated measurements of 21 mm Hg or less, without miotics. "Hypotony" was defined as an intraocular pressure less than 7 mm Hg. Cases where the intra-ocular pressure remained high and could only be controlled with miotic were considered "failures" from the surgical point of view.
Out of the 106 eyes, the intraocular pressure was controlled in 88 eyes (83.0 per cent) while 5 eyes showed hypotony (4.7 per cent) and 13 (12.2 per cent) were failures. Of the two types of glaucoma studied, this operation was found slightly more successful in open-angle glaucoma where successful control was achieved in 34 out of the 38 cases (87 per cent) whereas only 54 out of 67 eyes (81 per cent) with angle closure glaucoma were controlled [Table - 1]. Post-operative complications were as follows:
1. Delayed fort-nation of the anterior chamber which remained shallow for 9 days or longer in 7 eyes, and 14 days or longer in 3 eyes. However, the anterior chamber ultimately re-formed in all these cases without any medical or surgical aid.
2. Hyphaema occurred post-operatively in 3 eyes, but cleared without any sequelae; within about 6 days.
It was interesting to observe that many of the cases, both of open angle and angle-closure glaucoma whose intra-ocular pressures were slightly low on the tenth day after the operation became normotensive within the next two to six months. One the other hand, some cases who were normotensive just after the operation, later developed a raised intraocular pressure. In other words, it was found that the eyes having a slightly lower intra-ocular pressure in the immediate post-operative period seemed to carry a better long term prognosis.
None of the cases with hypotony showed any disc-oedema or deterioration in visual acuity during the period of follow-up. It is, however, of some interest that the overall incidence of hypotony (4.7 per cent) in this series is lower than the 15 per cent reported by SCHEIE who used a special electric cautery with accurate heat control.
| Summary and Conclusions|| |
1. Scleral cautery with iridectomy was performed on 106 eyes of glaucoma using the heated point of an ordinary pin instead of the electric cautery.
2. It is submitted that the results using this simple and inexpensive device were as good as with other techniques.
3. There were hardly any post-operative complications, and the incidence of hypotony was low.
4. It is suggested that the method is very suitable for use in small and rural clinics, where electrical equipment may not always be available.
| References|| |
GUINAN, P. M. (1961), Trans. Ophthal. Soc. U.K., 81, 713.
PREZIOSI, C. L.: Brit. J. Ophthal., 8, 414, (1924).
SCHEIE, H. G.: Amer. J. Ophthal., 45, 220, (1958).
SCHEIE, H. G.: Trans. Ophthal. Soc U.K., 84, 127, (1964).
[Table - 1]