Year : 1983 | Volume
: 31 | Issue : 5 | Page : 639--641
A clinical evaluation of scheie's operation with sclerectomy along with lens extraction in lens induced glaucoma
RG Sharma, GL Verma, Brijendra Singhal
S.M.S. Medical College & Hospital Jaipur, India
R G Sharma
S.M.S. Medical College & Hospital Jaipur
|How to cite this article:|
Sharma R G, Verma G L, Singhal B. A clinical evaluation of scheie's operation with sclerectomy along with lens extraction in lens induced glaucoma.Indian J Ophthalmol 1983;31:639-641
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Sharma R G, Verma G L, Singhal B. A clinical evaluation of scheie's operation with sclerectomy along with lens extraction in lens induced glaucoma. Indian J Ophthalmol [serial online] 1983 [cited 2019 Sep 19 ];31:639-641
Available from: http://www.ijo.in/text.asp?1983/31/5/639/36615
In lens induced glaucoma extraction of cataractous lens alone may not be sufficient to lower intraocular tension because of blockage of filtration angle by formation of peripheral anterior synechia. The lens extraction has been combined by various antiglaucoma procedures but the results obtained are variable. Keeping in view the variability and unpredictability of results of antiglaucoma surgery with lens extraction as a one stage procedure, present study has been undertaken to evaluate the simplicity and clinical usefullness of Scheie's operation combined with sclerectomy with extraction of cataractous lens.
Material and Methods
25 cases of various types of lens induced glaucoma were clinically evaluated for the above procedure. A detailed history and clinical examination of the eye including tonometry and biomicroscopy was done. The fellow eyes were examined to rule out association of concomitant primary type of glaucoma by examination of filtration angle, disc changes, visual field charting and intraocular tension.
Various types of lens induced glaucoma were grouped as shown in [Table 1].
The raised intraocular tension was controlled preoperatively by using acetazolamide tab. 250 mg. given 2 stat and thereafter 8 hourly till the time of operation. An hour before surgery intravenous mannitol drip was also used to lower the intraocular tension.
The one stage operation for cataract extraction and glaucoma under total anaesthesia with facial akinesia.
A limbal based conjunctival flap was made. A 5 mm scratch incision was made circumferentially at limbus and the posterior lip of the incision (sparing a small central area for sclerectomy) was cauterised by thermal cautery to cause retraction of the posterior lip of incision by atleast 1 mm. The incision was further deepend by razor blade to open the anterior chamber. A central posterior lip sclerectomy and peripheral button hole iredectomy done at the same site (see [Figure 1]). The limbal section was extended on both sides by scissors and corneo scleral sutures were placed. Lens was removed in most of the cases by intra capsular technique using cryo pencil. Sclerocorneal sutures were tied. Air injection done in anterior chamber. No sutures were applied around the site of sclerectomy and thermal cauterisation. Conjunctiva was closed by continuous 6-0 silk sutures. (see [Figure 2]). Postoperative management was like any other surgery.
Clinical evaluation of the technique
The cases were examined at the time of discharge after 15 days, 1 month, 2 months, 3 months, 6 months and were followed up to 12 months. On each visit departed ocular examination was done.
The assessment of results obtained by surgical management was based on control of intra ocular tension and improvement in visual acuity after 6 weeks of the operation and condition of filteration bleb.
A good control of intra ocular tension (less than 21 mm Hg.) was achieved in 20 cases (80%), fair control (21-25 mm Hg) was obtained in 3 cases (12%) and 2 cases had intraocular tension more than 25 mm Hg.
Visual acuity of 6/12 to 6/6 with normal tension was achieved in 15 cases. 6/18 to 6/60 in 8 cases, poor visual acuity in 2 cases see [Table 2].
The filtration bleb was thin and flat in 12 cases, uniformly thick and raised in 13 cases. No of the bleb in 25 cases was atrophied or showed cystic changes.
5 cases had unplanned extracapsular cataract extraction. These were the cases of phakolytic glaucoma where the lens particulate matter was present in anterior chamber.
Post operative hyphaema in 1 case, vitreous presentation in anterior chamber in 3 cases and vitreous loss occured in 4 cases where initial tension was pretty high.
Shallow anterior chamber in first postoperative week was observed in 4 cases (16%). 2 were due to overfiltration and rest 2 cases had choroidal detachment. Two cases with over filtration were treated with pressure bandage and anterior chamber formed in 3 days. Another 2 cases with choroidal detachment were treated with topical and systemic steroids and anterior chamber formed in 2 weeks time. Postoperative iritis was observed in 5 cases and disappeared at time of discharge except in one cases who had early endophthalmitis due to postoperative intraocular infection.
The added advantage of posterior sclerectomy is Scheie's fistulising operation was to have more hypotensive effect and sustained effective control of intraocular tension.