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BRIEF REPORT
Year : 2002  |  Volume : 50  |  Issue : 2  |  Page : 131-132

Argon laser suture lysis using ritch lens following cataract surgery


Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong

Correspondence Address:
Jimmy S Lai
Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong

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Source of Support: None, Conflict of Interest: None


PMID: 12194570

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  Abstract 

Argon laser suture lysis using the Ritch lens provides a safe and effective means for correction of post - ECCE suture - induced astigmatism

Keywords: Suture lysis, Ritch lens, extra capsular cataract extraction


How to cite this article:
Lai JS, Tham CC, Lam DS. Argon laser suture lysis using ritch lens following cataract surgery. Indian J Ophthalmol 2002;50:131-2

How to cite this URL:
Lai JS, Tham CC, Lam DS. Argon laser suture lysis using ritch lens following cataract surgery. Indian J Ophthalmol [serial online] 2002 [cited 2020 Aug 3];50:131-2. Available from: http://www.ijo.in/text.asp?2002/50/2/131/14807

Laser suture lysis is indicated after extracapsular cataract extraction (ECCE) in presence of significant suture-induced astigmatism, the correction of which is expected to improve the visual acuity. Suture lysis is often used after glaucoma surgery to decrease the resistance to outflow under the scleral flap. The technique has been reported without lenses for cataract patients,[1] and with various lenses after glaucoma surgery.[2][3][4] This study describes results of using argon laser and Ritch lens to cut tight sutures after extracapsular cataract surgery.


  Cases Top


Five patients had uncomplicated ECCE with posterior chamber intraocular lens (PCIOL) implantation at the Prince of Wales Hospital, Hong Kong in May and June, 1999. The patients were all female, with a mean age of 76 years (range 70-82 years). The cataract surgeries were performed using corneoscleral limbal wound, and the wound was closed with 10-0 black nylon suture (Ethicon" Ethilon"). Laser suture lysis was performed at a minimum of 6 weeks after the surgery.[2]

One drop of 1% amethocaine was applied to the treated eye before the procedure. The Alcon, BiophysicTM Model 532 laser (Alcon Laboratories, INC., Fort Worth, Texas) was used. The Ritch lens (Ocular Instruments, Inc, Bellevue, Wash.) was placed on to the globe with the tip positioned against the target tight suture. The mean number of argon laser shots per suture was 2.75 (range 1-5 shots per suture). The mean energy setting was 408mW (range, 400-420mW). The mean duration of laser shot was 0.13s (range, 0.05-0.20s). A spot size of 50μm was used. Three sutures were cut, including the tightest suture that coincided with the steepest meridian from manifest refraction and / or keratometry, and the one on each side of the tightest suture. Retraction occurred at both cut ends. Manifest refraction and keratometry were repeated 1-2 weeks after the laser procedure.

The mean pre-laser astigmatism was 5.25D (range, 4.50 to 6.50D), with the steepest meridian at or near the vertical axis in all cases. After the laser suture lysis, astigmatism decreased to mean 2.00D (range 1.75-2.225D). All the cases were at similar meridian. This translated into a 62% reduction in astigmatism.

The mean uncorrected visual acuity in the operated eye before suture lysis was 0.16 (range, 0.10 to 0.30). After the laser suture lysis, the mean uncorrected visual acuity in the operated eye improved to 0.36 (range, 0.20 to 0.50). No complications were encountered.


  Discussion Top


Small incision phacoemulsification is currently the most common method of cataract extraction. However, we still see patients who may be more suitable for conventional ECCE, such as those with dense cataract.

Suture lysis by laser is superior to surgical suturotomy. Serious complications such as endophthalmitis,[5] epithelial defect, flat anterior chamber, subconjunctival haemorrhage, and hyphaema[6] can occur after surgical suturotomy. In laser suture lysis, the overlying conjunctiva is not breached. It is therefore painless. The middle of the three cut sutures, being the tightest, retracts by the greatest amount [Figure - 1]. Additionally, bleeding from conjunctival vessels that may obscure view for further suturotomy can be avoided ([Figure - 2] and [Figure - 3]). The risk of infection and conjunctival scarring are minimised. Strict aseptic techniques are not necessarily required. Topical antibiotics or corticosteroid are not required after laser suture lysis. The cutting of the suture is precise and accurate. The disadvantages with laser suture lysis are burns and perforations.[7],[8] The risk of such complications is higher if the conjunctiva is pigmented. To avoid these complications, no more than a few laser applications should be delivered over the same area of the conjunctiva. In addition there is a basic cost factor of laser machine. It needs not to say that the procedure requires specialist skills.

The argon laser is ideal for suture lysis. There is minimal laser effect on the surrounding tissues as the blue-green light of the argon laser is barely absorbed by the translucent conjunctiva and the white sclera. Even blood vessels once blanched by the Ritch lens, do not significantly absorb visible light energy.

The choice of location for suture disruption is important. A location away far from the cornea avoids any refractive effect from scarring, and avoids direct disruption of the wound. A location too near the suture entry through the sclera is not good because the subsequent retraction of the cut suture into the sclera may result in the cut end of the suture pointing perpendicularly out of the sclera. This will cause irritation to the overlying conjunctiva. With all these considerations, the sutures are best cut at a distance of about 1mm from their entry site into the sclera.

The advantages of using a laser lens are numerous. It stabilizes the eye and helps keep the upper lid out of the way. It spreads and thins the overlying conjunctiva. Also, it blanches conjunctival vessels and provides a magnified view of individual suture. Furthermore, it helps focus the laser beam sharply on to the suture. It may even have a heat-sink effect, sparing the conjunctiva from thermal damage.

The Ritch lens[4] has certain specific advantages. The convexity and small surface area of its contact surface provides superb compression of the conjunctiva. A flange holds back the upper lid more effectively. A knurled cap protects the anterior lens surface and facilitates handholding of the lens. The magnification allows a more accurate placement of laser spots. The Ritch lens usually allows visualization of 2 to 3 sutures at a time, and thus, to some extent, helps avoid losing the orientation of the surgical site and cutting the wrong suture.

In summary, we found argon laser suture lysis using the Ritch lens safe and effective. This technique is highly recommended for the postoperative management of extra capsular cataract extraction patients who have significant suture-induced astigmatism.

 
  References Top

1.
Sachdev MS, Kumar H, Dada VK, Mehta MR, Jain AK. Argon laser suturotomy: A technique for the correction of surgically induced astigmatism. Ophthalmic Surg 1990;21:277-81.  Back to cited text no. 1
[PUBMED]    
2.
Hoskins HD Jr, Migliazzo C. Management of failing filtering blebs with the Argon laser. Ophthalmic Surg 1984;15:731-33.  Back to cited text no. 2
[PUBMED]    
3.
Chopra H, Goldenfeld M, Krupin T, Rosenberg LF. Early postoperative titration of bleb function: Argon laser suture lysis and removable sutures in trabeculectomy. J Glaucoma 1992;1:54-7.  Back to cited text no. 3
    
4.
Ritch R, Potash SD, Liebmann JM. A new lens for argon laser suture lysis. Ophthalmic Surg 1994;25:126-27.  Back to cited text no. 4
[PUBMED]    
5.
Gelender H. Bacterial endophthalmitis following cutting of sutures after cataract surgery. Am J Ophthalmol 1982;94:528-33.  Back to cited text no. 5
[PUBMED]    
6.
Jaffe NS. Postoperative corneal astigmatism. In Jaffe NS (editor) Cataract Surgery and its Complications. 4th ed. St. Louis: CV Mosby Company;1984. p.479.  Back to cited text no. 6
    
7.
Savage JA, Condon GP, Lytle RA, Simmons RJ. Laser suture lysis after trabeculectomy. Ophthalmology 1988;95:1631-38.  Back to cited text no. 7
[PUBMED]    
8.
Schwartz AL, Weiss HS. Bleb leak with hypotony after laser suture lysis and trabeculectomy with mitomycin C. Arch Ophthalmol 1992;110:1049.  Back to cited text no. 8
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]


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