The aim of this paper is to suggest that a split scleral flap can be used to provide a protection to the filtering bleb in iridencleisis.
The procedure is carried out under 4 times magnification by the following method:
1. After reflecting the limbal based conjunctival flap 6 mm long and 5 mm high, 1/3 thickness of sclera is reflected similar to the one done for trabeculectomy. The flap is pulled down by sutures passed the corners.
2. 1.5 mm from the limbus, the scleral groove is made to 3/4 thickness of sclera. By this time the dark colour of sclerocorneal tissue is quite apparent. Bleeding points are cauterized. The floor of this groove is lightly cauterized to prevent seepage of blood in A.C.
3. A 5 mm wide anterior chamber entry is made by a curved keratome.
4. One or two pillar iridencleisis is performed. Saline or air is injected in the A.C.
5. The scleral flap is loosely sutured by two 8-0 virgin silk.
The conjunctival would is closed as usual.
We have operated upon 27 cases of absolute glaucoma by now in the last six months. The lowering of intraocular pressure by this surgical procedure has been summerised in [Table - 1],[Table - 2].
In all 19 cases (over 70%) out of 27 showed good response in control of tension. 25,6% showed average tension above 26mmHg. This would be a discouraging figure in usual glaucoma surgery but then we are dealing with absolute glaucoma cases where the success rate is low. It is hoped that when the method is tried in favourable cases the result would be still better.
This paper is a report on an experimental type of surgical technique on a small series. The procedure seems promising and worthy of trial.