|Year : 1982 | Volume
| Issue : 6 | Page : 627-630
Difficulties, complications & results of parsplana surgery
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. Difficulties, complications & results of parsplana surgery. Indian J Ophthalmol 1982;30:627-30
Parsplana Surgery has given a new dimension to the surgery of eye and changed the prognosis of many a hitherto untreatable disorders and improved the outcome of many other complicated situations. One is able to continue manipulations within the eye without causing a collapse of the eyeball, thereby giving more scope for alterations. The procedure when combined with microscopic vision and endoillumination gives useful results until now not thought of.
In the last 3 years I have done 402 parsplana surgeries for many variety of indications.
| Materials and methods|| |
402 eyes in the same number of patients are the subjects of the study. A majority (391) was treated by Peyman's Vitreophage employing the locally made modified console to operate it. The remaining 11 cases were treated by my own portable instruments.
The variety of indications subjected to the procedure are tabulated below
In general for the purpose of framing the results, I have divided the indications into two major heads. One for posterior segment disorders consisting mainly of vitreous haemorrhage and endophthalmitis and the second for anterior segment reconstructions. The procedure followed is the same as detailed earlier except that in the last 320 cases the incistion in conjunctiva was given after hooking all the four recti. When dealing with anterior segment reconstruction only superior and lateral recti were hooked. The incision on sclera was made 4 mm from. limbus and of about 4 mm in length. The infusion fluid used was Normal saline and only 0.5 cc of garamycin was added to a bottle of 300 cc. When dealing with endophthalmitis and other inflammatory situations, 2 cc of Decadron injection was also added to the bottle of infusion fluid.
| Difficulties and complications|| |
The difficulties and complications encountered in this surgery are tabulated as under :
| Results and discussions|| |
Parsplana surgery though less forgiving of surgical errors because of accuracies involved is going to stay for it gives an opportunity of continued manipulations within the eye. It helps restore vision in many desperate situations. Non-absorbing vitreous haemorrhage and endophthalmitis are examples of such situations.
Of the 402 cases subjected to parsplana surgery, 188 cases were for vitreous haemorrhage. The possible etiologies of vitreous haemorrhage considered for vitrectomy are tabulated below :
The result of 188 cases subjected to parsplana surgery are tabulated below
Many of these haemorrhages cleared within a week to ten days of the procedure but 17 cases cleared after 6 to 8 weeks. These were cases where reshuffling of the vitreous and drawing the attention of the natural scavenging forces possibly helped the clearing of vitreous [Table - 5].
Endophthalmitis was another indication where parsplana surgery was used and found effective in 7 of the 11 cases [Table - 6]
In endophthalmitis it is very essential that the surgery must be decided as early as possible. The presence of good projection is always a favourable feature. 2 of the cleared cases developed retinal detachment in 3 weeks to 6 weeks interval and responded to the carefully done conventional retinal surgery.
The 4 cases of massive vitreous retraction subjected to this procedure totally failed and in all I punched holes in retina.
Giant tears are another good indications when wanting to incarcerate the overturned flap of the tear. This could be easily achieved in all the five cases by putting the cutter off and only sucking the edge of flap and slowly dragging it out and incarcerating it.
Results of the 199 cases of anterior segment reconstruction were more dramatic than that of posterior segment. They are tabulated as under:
Moreover the job done in reconstructing the anterior segment was superior to the conventional procedures until now employed. In perforating traumas involving lens, vitreous disturbances the prognosis is very much altered for the lens matter etc. can be well cleaned.
The toxic effect of the combination of lens matter, blood, vitreous and toxins from perforating articles can be removed and the problem of vitreous incarceration in the wound taken care of.
| Summary|| |
Results of 402 cases of closed parsplana vitrectomy done by Peyman's vitreophage and Nagpal's portable vitreophage are presented, The difficulties faced and complications encountered are put forward and discussed.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7]