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ARTICLE
Year : 1983  |  Volume : 31  |  Issue : 5  |  Page : 680-682

A comparative study of sub-episcleral iredenclesis and trabeculectomy


Medical College, Jabalpur, (M.P.), India

Correspondence Address:
R K Mishra
Professor of Ophthalmology, Medical College, Jabalpur, (M.P.)
India
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Source of Support: None, Conflict of Interest: None


PMID: 6671790

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How to cite this article:
Mishra R K. A comparative study of sub-episcleral iredenclesis and trabeculectomy. Indian J Ophthalmol 1983;31:680-2

How to cite this URL:
Mishra R K. A comparative study of sub-episcleral iredenclesis and trabeculectomy. Indian J Ophthalmol [serial online] 1983 [cited 2019 Dec 15];31:680-2. Available from: http://www.ijo.in/text.asp?1983/31/5/680/36631

Table 2

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Table 2

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Table 1

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Table 1

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The modified iredenclesis named "Sub Episcleral Iredenclesis" is practised as follows:­

1. Under usual akinesia and subconjunctival infilteration of Xylocain with Adreneline fornix based or limbal based conjunctival flap is fashioned exposing right up to insertion of superior rectus muscle posteriorly and true limbus anteriorly. Sclera is exposed between 10 to 1 O'clock position. Bleeders are lightly touched by heated probe or contained by aderneline swab.

2. 6 mm x 5 mm, ½ scleral thickness flap is reflected with base at the true limbus. A 5 mm long scleral groove is marked at the true limbus and the bleeders are cauterised. The floor of the groove is also cauterised along with the posterior lip. The temporal end of the groove so made is deepened to make an entry in the a.c. by a 67 Beaver blade or a Bard Parker blade. A curved bistury is introduced into the incision and the floor of the groove is cut from depth outwards. This eliminates risk of injury to iris or lens. Iris usually presents out at this stage or else it could be brought out by a gentle pressure at the posterior lip. The iris is seized with a fine iris forceps and pulled out till the pupillary margin is visible. Margin to root cut is made by a curved iris scissors while the nasal end is held by the iris forceps and left incarcerated and the temporal end is stroked back in to the Ant. chamber. If the anterior chamber is lost then it may be reformed by an sterile air buble.

3. The conjunctival wound is carefully closed. Good suturing prevents subsequent gaping and fibrosis.

The eye is dressed with sub-conjunctival decadron and garamycin, atropin and an antibiotic ointment. The eye is bandaged for 5 to 6 days. For the first three days atropin is used along with antibiotic, subsequently antibiotic with corticosteroid are contined for 2 to 3 weeks.

The procedure does not require use of a microscope. Two to four magnification of a loupe is enough.

Trabeculectomy

The procedure followed has been the one described by Cairns. While excising the deep scleral flap along with the trabecular tissue 16 x magnification of operating microscope has been used to locate the scleral spur. This is the vital step for a successful surgery. The sides of the square is cut by Vannas scissors, a small iridectomy is made and outer scleral flap loosely sutured to the bed by 8 zero virgin silk. Air buble is introduced if the A.C. has been completely lost.

Dressing is done as described in case of Iredenclesis. In all 107 case of modified ireden­clesis and 49 cases of trabeculectomy has been performed and compared in this series. Minimum follow up of cases included in this series has been 6 months with a maximum follow up of 5 years.

Criteria for taking a case for surgery has been when pilocarpine failed to control the tension with 2% T.D.S. or when the patient could not be depended upon to continue the therapy on long time basis.


  Type of cases Top


In all 156 cases have been included in this work.

Assessment of Surgical Results:­

Successful : When the postoperative tension remained under 20 mm Hg after 3 months of surgery.

Partial success: When a maximum of 1% pilocar TDS was required to keep the tension under 20 mm Hg. after 3 months of surgery.

Failure : When the tension remained above 20 mm Hg even after use of Pilo. l % TDS after 3 months.


  Discussion Top


Results of the two series as performed by us is comparable. Trabeculectomy has a slightly better result and is a little more difficult procedure requiring use of operating micro­scope. It can be repeated in the event of having failed once. The round shape of the pupil is not lost. The Sub Episcleral iredenclesis is a much simpler operation which does not require high magnifaction. The pupillary distortion is gross though the patient does not loose much out of it. May be in early cataracts it is helpful. Having failed once it can not be repeated again. The modification eliminates the major disadvantage of iredenclesis namely weak filtering bleb protection.



 
 
    Tables

  [Table - 1], [Table - 2]



 

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