|Year : 1981 | Volume
| Issue : 4 | Page : 435-437
Flat anterior chamber following cataract operation
HK Singh, JN Rohatgi, BK Prasad
Department of Ophthalmology, Patna Medical College, Patna, India
H K Singh
Prof Eye Deph. 6. M.C. P W. Patna Medical College Hospital, Patna-800004
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh H K, Rohatgi J N, Prasad B K. Flat anterior chamber following cataract operation. Indian J Ophthalmol 1981;29:435-7
|How to cite this URL:|
Singh H K, Rohatgi J N, Prasad B K. Flat anterior chamber following cataract operation. Indian J Ophthalmol [serial online] 1981 [cited 2020 Jun 3];29:435-7. Available from: http://www.ijo.in/text.asp?1981/29/4/435/30948
A total of 872 cases of senile mature cataract were operated from April, 1976 to March, 1978 in the Eye Hospital of Patna Medical College, Hospital in our unit. An Analysis of the incidence and management of flat anterior chamber in these cases has been made.
A review of the cases as made in [Table - 1] shows that there was no marked difference in the incidence of flat anterior chamber in a intracapsular and extracapsular extraction in these cases.
In those cases where stitches were used to close the wound, over all incidence of flat anterior chamber was 12.2 per cent. So far as the number of stitches are concerned, there was little difference in the incidence of flat anterior chamber between three and five stitches.
Unstitched wound on the other hand showed 23.4 per cent incidence of flat anterior chamber. In these groups, incision along with a conjunctival flap reduced the incidence of flat anterior chamber considerably.
Management of Flat Anterior Chamber in these cases:
Leaking wound and pupillary block were the usual causes of flat anterior chamber. Minor wound leak detected in the first dressing (second post-operative day) had responded to the routine medical treatment (i.e. local atropine, cortisone ointment with firm bandage and oral diamox and oxyphenbutazone tablet).
Ragged wound margin was the commonest cause of the anterior leakage and appeared in the first or second dressing. Sixty one cases (49.5%) showed such an anterior leakage of aqueous humour.
Forty six cases (37.4%) had pupillary block. This was either due to (i) healthy cone of vitreous in the small miotic pupil or (ii) air in the posterior chamber (air given on the table slipping behind the iris). These cases responded to proper pupillary dilatation along with the routine medical treatment as mentioned above. In this series pupillary dilatation with atropine 1% drop given at about five minutes intevral for three times along with mild warm fomentation proved quite satisfactory and anterior chamber formed in four to six days time.
Four cases had anterior choroidal detachment and of these, one settled with routine medical treatment along with oral glycerol for three days with bed rest. In tile rest three cases sub-choroidal fluid was tapped along with cyclodialysis and air injection in the anterior chamber. Visual acuity in two of these cases were 6/12 and in one 6/36.
In twelve cases with flat anterior chamber the cause remained uncertain. And these cases did not respond to the routine medical treatment. Surgical treatment was adopted only when the flat anterior chamber persisted for ten days or more in spite of the routine medical treatment.
In these cases the patient was prepared as for glaucoma operation. During operation Zeigler's knife was introduced just on the corneal side of the limbus followed by a small hypodermic needle and air was injected in the anterior chamber. In three cases this method was tried and anterior chamber formed in all the three cases. But the anterior chamber again became flat after two days. Then in all such cases a small incision was given in the cornea by a keratomex just inside the limbus.
An iris repositor was introduced in the anterior chamber and the iris was separated from the cornea in the angle alround. Where resistance was felt, the repositor was introduced in the angle to cause anterior cyclodialysis. While withdrawing the repositor the iris was gently pushed back. Through a hypodermic needle air was introduced in the anterior chamber and routine medical treatment,was continued along with oral cortisone (Prednisolone-40 mg daily for two days with tapering dose). In nine cases anterior chamber was well formed and vision improved to 6/9 to 6/18. In one case the vision came down to finger count at 5 meter distance, while in two cases it was finger count at one at two meter distance.
These cases needing iris separation were probably the result of iridocyclitis which resulted in peripheral anterior synechiae and resultant flat anterior chamber.
In conclusion we would say that
- Sutures have reduced the incidence of flat anterior chamber from 23.4 to 12 per cent. Such sutures may vary from 3 to 5 corneoscleral stitches.
- An all-round conjunctival flap has definite advantage in reducing the flat anterior chamber in cases without sclerocorneal suture.
- Out of 123 cases of flat anterior chamber, 108 cases (87.8%) responded with medical treatment, while 15 cases (12.2%) needed surgical treatment.
- Iris separation with anterior cyclodialysis along with air injection in anterior chamber was tried in twelve cases and remained effective in reforming the flat anterior chamber.
[Table - 1], [Table - 2], [Table - 3]