Year : 1983 | Volume
: 31 | Issue : 7 | Page : 886--887
Use of vitrophage in management of accidental extra capsular extraction of senile cataract in immediate post-operative period
AP Shroff, OP Billore, AK Dubey
Rotary Eye Institute, Navsari, Gujarat, India
A P Shroff
Rotary Eye Institute, Navsari, Gujarat
|How to cite this article:|
Shroff A P, Billore O P, Dubey A K. Use of vitrophage in management of accidental extra capsular extraction of senile cataract in immediate post-operative period.Indian J Ophthalmol 1983;31:886-887
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Shroff A P, Billore O P, Dubey A K. Use of vitrophage in management of accidental extra capsular extraction of senile cataract in immediate post-operative period. Indian J Ophthalmol [serial online] 1983 [cited 2020 Jul 7 ];31:886-887
Available from: http://www.ijo.in/text.asp?1983/31/7/886/29694
Cataract extraction by cryo technique had reduced the chances of accidental rupture of lens capsule. Still a surgeon has to face this situation at times, and to manage such a situation is rather difficult than planned extra capsular cataract extraction.
Conventional way of giving thorough wash or use of instruments involves the risk of corneal endothelial damage and too energetic efforts to remove the lens matter may precipitate even a vitreous loss, a more disastrous complication.
Therefore, the idea of using vitrophage to remove the residual dense lens matter in another sitting in early post operative period has been thought of and is practised in our short series of 15 cases. This is not in anyway, to annoy an expert extra capsular surgeon but to have same finish in accidental rupture of capsule where some major complications are feared.
MATERIAL AND METHODS
Over 4 months duration in 15 cases there was accidental rupture of capsule and subsequent procedure concluded removal of nucleus and only free lens matter because of fear of corneal endothelial damage and vitreous loss.
9 males and 6 females, varying from 55 years to 70 years in this series, where 11 were right eyes and only 4 were left eyes, were subjected to this procedure of evacuation of lens matter by Peyman's vitrophage cutter immediately 4-5 days after initial surgery.
Main procedure included 3.5 to 4 mm sclerotomy wound at about 4 mm away form limbus either in upper or lower temporal quadrant Edges were lightly diathermised and nylon stay suture was placed. Stab incision was made by van Grafe's knife. After checking the vitrophage console Peyman's vitrophage cutter was introduced. As much lens matter as possible was removed making the pupillary area absolutely clear and shallow anterior vitrectomy was performed too.
IOP during the procedure was maintained at a lower level so as to save gaping of corneoscleral wound which has been closed only in recent past with either multiple interrupted or continuous sutures.
Post operative care included routine patching with antibiotics, steroids and a tropine. Patients were discharged after 6-7 days (i.e. in all about 11-12 days). Glasses were advised after 6-8 weeks. Follow up for about 48 months at intervals included tonometry, slit lamp examination and indirect Ophthalmoscopic examination.
All 15 cases were discharged after 11-12 days, when pupillary area was free of any lens material with deep and clear anterior chamber and minimum signs of inflammations. Final visual recovery in 12 cases was between 6/24 to 6/9. While in 3 cases it improved upto 6/36 to 6/24.
Slit lamp examination revealed cornea and chamber clear. Anterior vitreous face could not be seen in immediate posterior plane of iris/pupil.
Applanation tonometry revealed IOP within normal range. Indirect ophthalmoscopic examination revealed posterior fundus pathology in 3 cases where vision improved only to 6/36 to 6/24.
Initially it is difficult to convince patients but when they could not count fingers easily because of dense lens material present in pupillary area they agreed to it. Therefore, chances of patients loosing confidence and our loosing patients for second surgery at a later date are minimum.Untoward complications like endothelial corneal damage and vitreous loss could be averted during previous surgery.As we had not made adequate preparations beforehand for this procedure and patients consent was not obtained for this skillful manouvering, it was thought to have done after few days.It has increased the hospitalization by 4-5 days more.Post operative finish was very good and visual recovery was satisfactory.Post operative inflammation was very less and therefore heavy dosage of steroids and antiflaugestics could be avoided.No major complications were noted.Removal of lens material was very easy as it was done before firm adhesions could have taken place or a dense membrane could have formed.
15 cases who had accidental extra capsular cataract extraction were subjected to a second surgical intervention of removal of lens material by vitrophage in immediate post operative period when dense left over lens capsule was noticed in pupillary area which could not be cleared during first surgery for fear of corneal endothelial damage and vitreous loss.