|Year : 1984 | Volume
| Issue : 6 | Page : 504-505
Ambulatory intraocular lens implant surgery
Deptt. of Ophthalmology, Medical College, Amritsar, India
Deptt. of Ophthalmology, Medical College, Amritsar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh D. Ambulatory intraocular lens implant surgery. Indian J Ophthalmol 1984;32:504-5
Ambulatory cataract surgery is not new. It is being practised sporadically all over the world. However, ambulatory intraocular implant surgery is practised much less often, even in the most advanced countries.
We have been practicing ambulatory intraocular lens surgery during the last four years, cautiously at first, and more frequently with experience.
| Material methods and observations|| |
Presented here is our experience with 323 patients who were treated on an ambulatory basis. They included 205 males and 118 females. The patients belonged to the various age groups as follows :
The patient as a rule came a day before surgery for examination and advice. The aim of pre-operative examination was to assess basic refractive error, presence or absence of local complicating factors and to exclude the presence of conjunctival infection. He was advised local antibiotic drops every 1/2 an hour on the day before surgery. Diabetic patients were prescribed Suganril tablets 3 times a day. On the day of surgery the patient was advised to take normal breakfast and to take 2 tablets of Diamox, 500 mg of Chloromycetin and 40 mg of prednisolone (not for diabetics).
No pre medication was given. The skin around the eye is cleaned and painted with Betadine. The conjunctival sac is thoroughly washed. A drop of phenyl nephrin and a drop of homatropine is put and ocular compression at 30 mm Hg given for 30 minutes.
A mixture of Xylocaine and Marcaine is used for local anaesthesia. The anaesthesia is allowed to take effect for 10-15 minutes before starting surgery.
The surgery for intraocular lens implantation involves routine extracapsular surgery, Singh-Worst Iris Claw lens implantation and closure of incision line with 9-13 suture with 50 micron stainless steel. A sub conjunctival injection of 20 mg of Gentamicin and 2 mg of Decadron is given at the end of operation. A 1/2" thick pad of sterilized U-foam is placed on the eye with three strips of sticking plaster keep it in place.
The patient sits up and walks to the recovery room where he relaxes 'for 1 /2 -1 hour and after that he goes to his home by any type of conveyance available to him-a rickshaw, an auto rickshaw or as a pillion rider on a scooter. He is provided a plastic shield for use at night.
The patient visits the hospital next morning. He starts wearing glasses during the day and the plastic shield at night. The protection from injury is essential for 1˝ months. Homatropine is used for 3 days and local corticosteroids for 40 days. He is allowed to move about in the city from third day onwards. He is allowed to do any visual work that his eye be capable of doing. The next visits to the hospital are on 3rd post-operative day, 10th day 25th day and 40th day. Glasses are prescribed on 40th day.
Operative and post-operative complications
In this series there was capsule rupture at the time of surgery in 3 cases. The capsule was pulled out and the lens extraction completed as intracapsular This did not affect lens implantation. Post operatively 4 patients had moderate striate keratitis, 3 patients had severe striate keratitis one of which ended in corneal decompensation while the other two recovered completely. Post operative uveitis occurred in two patients which needed sub conjunctival steroids.
There was no case of hyphaema, iris prolapse or flat anterior chamber. In no case there was any problem with the implant.
The following table shows the visual result achieved
| Discussions|| |
Ambulatory surgery greatly reduces pressure on the hospital staff. Also, it sends the patients back to his familiar home conditions where he feels more comfortable. Ambulatory intraocular lens implantation can be done only in local patients who can easily come as outpatients and can consult on telephone in case of trouble. Our patients belonged to all age groups and all varieties of cataracts. The overall results are quite encouraging and support the idea of ambulatory intraocular lens implant surgery. The important constituents of ambulatory intraocular implant surgery are : clean extracapsular surgery. proper choice of an intraocular lens and adequate closure of the wound.
| References|| |
Singh, D., 1982, Ind. J. Ophthalmol, 30: 457.
[Table - 1], [Table - 2]