|Year : 1981 | Volume
| Issue : 4 | Page : 431-433
Closed parsplana vitrectomy
Retina Foundation, Ahmedabad, India
P N Nagpal
Retina Foundation, Ahmedabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nagpal P N. Closed parsplana vitrectomy. Indian J Ophthalmol 1981;29:431-3
At the last Conference at Hyderabad, I presented the initial report of our Vitrectomies. In the meantime. I have further used the Peymans Vitreophage wish our self-made console and have done 82 operations. I shall not repeat the procedure adopted and shall go on to describe and discuss my results. The procedure has been elaborately detailed out in my paper read at Hyderabad Conference and appears in the proceedings of the same. The only difference made was in cases of endophthalmitis where Inj. Decadron 2 ml was also added to the infusion fluid (Dextrose Saline 5%).
| Observations and discussion|| |
Indications of the procedure are shown in [Table - 1]. Non-absorbing vitreous haemorrhage formed the main indication i.e. in 77 cases.
The haemorrhages had resulted from, variety of causes such as Eales' disease, Diabetes, Hypertension and Trauma. The period for which the haemorrhagc had remained unabsorbed varied from 3 months to 3½ years. The haemorrhages of less than 3 months duration were not considered for the surgery. The criterion for selection of cases was the presence of good perception and projection of light. Patients with vision more than 3/60 were also not considered for surgery.
Endophthalmitis was an indication in 2 cases. Both of them did not improve in vision although the vitreous in one got cleared to great extent. Membranectomy to form the pupil was done in 2 cases. In one, perforating trauma had led to formation of membrane and in the other it had formed following cataract extraction. Both were successful. One case of massive vitreous retraction with total retinal detachment was also subjected to the procedure unsuccessfully.
27 cases cleared up and showed the fundus. In 25 of them vision improved to varying degree.
The vision in 2 cases did not improve because of the existing optic nerve atrophy. In the remaining 55 cases the vitreous could not be cleared because of repeat haemorrhages or because of low grade inflammation and formation of membranes within vitreous.
The vitreous clearing did not immediately occur in all cases. In 3 cases it cleared up in 6 weeks time. Possibly the vitrectomy has some role to play in restarting the dormant scavenging work of the natural forces.
[Table - 5] shows the list of complications. The one very conspicuous absence in the list of complications is infection. I had feared it and was no doubt careful. Retinal holes were formed in 2 cases. This was because I went very close to the surface of retina while the cutter was on. Retinal detachment occurred in one case, while the other was massive vitreous retraction with total retinal detachment.
Repeat haemorrhages occurred in 5 cases. While the 3 eases in which the haemorrhage occurred in immediate post operative period were possibly due to the procedure, the delayed haemorrhages were due to the disease process responsible for the previously existing haemorrhage. Of the latter, in two cases, a repeat vitrectomy was successfully carried out. It restored partial vision in one of them. Cataract formed in 4 cases. Two of them were those in which the vitreous had been cleared to improve the vision. There was no lens opacity at the time of discharge and in 3 to 6 months time a full mature cataract formed. Removal of cataract in both of them restored the previously achieved vision with correction. Why cataract formed in these cases is not fully understood but can possibly be explained by the absence of vitreous which has some nutritive role to play in lens metabolism. Trauma due to the vitrectomy procedure caused cataract in another two cases. A simultaneous lensectomy was resorted to in both of them successfully.
Closed Parsplana Vitrectomy has a future because its indications are the desperate cases in which any attempt to restore vision is welcome. It is relatively a new procedure and holds promise in the cases where until now no hope exists. Our cases have all been performed with Binocular Indirect Ophthalmoscope and by the Peymans Gullotine type of Vitreophage. I have a feeling that the rotatory or the oscillating type of vitrectomy may have its own indication. In 55 of my cases the vitreous refused to clear, inspite of our continuous washing and cutting. It is possible that if we used internal illumination and endocauterisation, we might have succeeded further.
| Summary|| |
Results of 82 cases of Closed Parsplana. Vitrectomy done by Peymans Vitreophage using a self-made console are discussed.
| References|| |
Nagpal, P.N. 1978, Close Parsplana Vitrectomy Proc. All India Ophthalmological Society Conference Hyderabad.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]