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ARTICLES
Year : 1983  |  Volume : 31  |  Issue : 7  |  Page : 839-841

Management of pupiliary block glaucoma in early post operative period by a simple technique


Rotary Eye Institute, Navsari, Gujarat, India

Correspondence Address:
A P Shroff
Rotary Eye Institute, Navsari, Gujarat
India
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Source of Support: None, Conflict of Interest: None


PMID: 6544266

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How to cite this article:
Shroff A P, Billore O P, Patel C B, Billore S O. Management of pupiliary block glaucoma in early post operative period by a simple technique. Indian J Ophthalmol 1983;31, Suppl S1:839-41

How to cite this URL:
Shroff A P, Billore O P, Patel C B, Billore S O. Management of pupiliary block glaucoma in early post operative period by a simple technique. Indian J Ophthalmol [serial online] 1983 [cited 2020 May 26];31, Suppl S1:839-41. Available from: http://www.ijo.in/text.asp?1983/31/7/839/29681

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Table 1

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Table 1

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Sudden flattening of anterior chamber on 5th to 8th day, by the time usually air is ab­sorbed, after cataract surgery with moderate rise of IOP is the condition of pupillary block glaucoma where aqueous fails to make its way from posterior chamber to anterior chamber because of obstruction at the pupillary or iridectomy level.

Though the cataract surgery was eventless, in few cases aqueous was pooled into the retro­vitreal space which was already existing alongwith posterior vitreous detachment pre operativtly. In such cases anterior hyaloid membrane was dense and therefore im­mediate meausre were taken to make a tunnel between anterior chamber and retrovitreal space through vitreous before persistance rise of IOP would lead to disastrous complications and loss of vision.


  MATERIAL & METHOD Top


In this study 10 patients between the age of 50 to 64 years, where 6 male and 4 female and 3 right eyes and 7 left eyes were subjected to this procedure. All but one had eventless in­tracapsular cataract surgery 5 to 89 days ear­lier, while one case had planned extracapsular surgery 10 days earlier. 8 cases had raised IOP between 30-40 mm of Hg. while one had 42 and other had 26 mm of Hg. In later 2 cases continuous sutures was fashioned to close cor­neoscleral wound. Other 8 cases had multiple interrupted sutures. [Table - 1]

All patients had complained of headache since previous night and on routine post operative dressing in the morning, anterior chamber in all cases were found to be flat or very shallow. Immediately patients were subjected to applanation tonometry and slit lamp examination. Acetazolamides in adequate dosage were given to lower IOP. Pupils were dilated as much further as possible but without any significant benefit. All patients were sub­jected to this surgical procedure as early as possible.

Main surgical procedure included a sepatate small wound in intact temporal limbal region. A straight 20 guage needle with 2 c.c. empty syringe was introduced along the iris plane till the pupillary area was reached. Then the di­rection of needle was changed to about 90° to­wards posterior pole. Anterior vitreous face was pierced and needle was pushed backwards towards posterior pole to a safe distance till the trapped aqueous gushed into the syringe. The aqueous was sucked till the cornea be­came concave (saucer like). Needle was with­drawn and through same limbal wound air was injected to reform anterior chamber. Pupil was kept semidilated and eye was patched.

Post operative period was eventless and chamber remained formed in all cases. IOP has remained between 10 to 16 mm of Hg. Slit lamp examination, Applanation Tonometry and Visual recovery were noted on each visit. The cases were followed from 4 months to 20 months.


  Observations Top
­

Post operatively all cases had normal deep anterior chamber with no other anterior seg­ment abnormality. IOP in all cases was bet­ween 10 to 16 mm of Hag. Without any anti hypertensive drugs. Vision improved to 6/9 to 6/6 in 3 cases; 6/24 to 6/12 in 3 cases; 6/60 to 6/36 in 3 cases while in one case it was less than 6/60 with glasses. [Table - 2].

In many cases slit lamp examination showed a very tiny hole in the anterior vitreous face but none had vitreous in the anterior chamber till they were last seen. Gonioscopic examina­tion revealed open angle in all cases with good peripheral iridectomy.


  Discussion Top
­

N.S.Jaffe has mentioned that most patients have posterior vitreous detechment with col­lapse and pooling of fluid into retrovitreal space even before cataract surgery. Moreover fluid is equal in volume to what was contained within vitreous, therefore it does not push re­sidual formed vitreous forward keeping IOP at normal level.

But when pupillary block glaucoma arises, it is the pooling of additional aqueous into the retrovitreal space by perfusing through the vit­reous causes formed antirior vitreous face to buldge forward and block the pupillary and the iridectomy aperture. Therefore the idea is to make a simple nick into the thickned an­tirior vitreous face so as to have tunnel from anterior chamber to retrovitreal space through vitreous to relieve the pupillary block.

The procedure is very simple, does not re­quire any sophisticated instruments and doesn't have any significant post operative complication. Moreover it has been very effec­tive in controlling IOP in all patients. Angle examination showed almost open angle in all cases as the pupillary block was relieved as early as possible.

Vision improvement is considerable though there is a danger of subjecting the macula to hypotony twice.

As a new wound is made in fresh area, the orginal corneoscleral wound is not disturbed and therefore healing was quite satisfactory.

We found that needle penetration only once through intact Anterior Vitreous face was enough to make a tunnel and we sucked the fluid from retrovitreal space to confirm that needle had passed through the formed vitre­ous.

Vision in one case did not improve because of old central chorioretinal scar.


  Summary Top


This simple technique of making a small nick in the formed anterior Vitreous face so as to make tunnel has been quite effective method to relieve pupillary block in im­mediate post operative cataract periods in 10 cases.[1]

 
  References Top

1.
Jaffe N.S. 1976 Cataract Surgery and its complications; C V Mosby, 220-232.  Back to cited text no. 1
    



 
 
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