Year : 1988 | Volume
: 36 | Issue : 4 | Page : 156--157
Combined trabeculectomy and cataract extraction-A retrospective study
VN Prasad, Mool Narain, Grover Sandeep
Department of Ophthalmology, B.R.D. Medical College. Gorakhpur (U.P.)., India
V N Prasad
Department of Ophthalmology, B.R.D. Medical College. Gorakhpur (U.P.).
Ninety six eyes haying senile cataract and associated open-angle glaucoma had been operated upon over a period of seven years by a combined procedure. The advantages of combined operation have been discussed. The results were encouraging.
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Prasad V N, Narain M, Sandeep G. Combined trabeculectomy and cataract extraction-A retrospective study.Indian J Ophthalmol 1988;36:156-157
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Prasad V N, Narain M, Sandeep G. Combined trabeculectomy and cataract extraction-A retrospective study. Indian J Ophthalmol [serial online] 1988 [cited 2020 Apr 9 ];36:156-157
Available from: http://www.ijo.in/text.asp?1988/36/4/156/26122
The relationship between glaucoma and cataract is very close. The combination of glaucoma and cataract in the same patient in ophthalmic practice is not infrequent. Management of co-existing glaucoma and cataract is difficult and controversial ,. Simultaneous glaucoma and cataract in a patient poses the problem of whether to perform the glaucoma and cataract surgeries at the same time, or doing one operation first followed by the second at a later date. Various filtering procedures have been used by different workers for management of these two co-existing entities. Here we are presenting a retrospective study showing the results and advantages of combined trabeculectomy and cataract extraction.
Material and Methods
This study was conducted on patients suffering from senile cataract associated with open angle glaucoma, over the period 1980 - 87, at B.R.D. Medical College, Gorakhpur. A complete ophthalmological examination of each case was done. All the cases were given medical treatment to lower intraocular tension as far as possible. On the morning of the operation the intraocular tension was again recorded. In those cases where tension was not reduced to less than 22.4 mm. Hg. (Schiotz) by medical therapy, 20% Mannitol was given intravenously just before the operation.
Traheculectomy was performed in the same manner as described by Waston  (1970). The incision was extended to 3o'clock and 9o'clock positions with the corneal scissors. Three preplaced corneoscleral sutures of 8-0 silk were applied and pulled out into loops. Next the intracapsular lens extraction was done with a cryoprobe. Air was injected to reform the anterior chamber and the preplaced sutures were tied. The scleral flap was replaced and two 8-0 virgin silk sutures applied. The conjunctival flap was closed with 6-0 silk sutures.
Ninety six eyes, having both cataract and glaucoma, were operated upon. The mean preoperative tension recorded at the time of admission was 48.72 mm. Hg. (Schiotz). The highest tension recorded was 69.3 mm. Hg. (Schiotz) and the lowest was 29.0 mm. Hg. the maximum number of cases (88 cases) were in the range of 29.0 - 59.1 mm. Hg. [Table 1].
The mean postoperative tension after four weeks of operation was 17.93 mm. Hg. The maximum number of cases (75%) were in the range of 12.2 - 17.3 mm. Hg. The operation was considered to be successful when intraocular tension was reduced to less than 20.6 mm. Hg. Out of a total of 96 operated cases, in 88 eyes (91.67%), the intraocular tension was well controlled and in 8 eyes, it was not controlled inspite of medical treatment [Table 2].
Complications observed were hyphaema (8 cases), flat anterior chamber (4 cases), and iritis (8 cases). All these complications disappeared within a week with suitable treatment.
The vision improved after refraction in 87.5% cases [Table 3] 64 cases showed improvement in vision in the range 6/18 - 6/36. In 12 cases vision did not improve - of these 8 cases had optic atrophy and 4 cases had senile macular degeneration.
Several types of combined surgical procedures have been performed (Stewart and Loftis , Dellaporta , Shield and Simmons ). Since the introduction of trabeculectomy by Cairns  (1968), it became popular and is being widely used nowadays.
In the present series, preoperative tension ranged from 29.0 - 69.3 mm. Hg. with a mean tension of 48.72 mm. Hg. Other workers reported the preoperative range from 29.0 - 63.0 mm. Hg. with a mean tension of 42.8 mm. Hg. (Sharma et al ); 20 - 60 mm. Hg. with a mean tension of 33 mm. Hg. (Jerndol & Lundstrom ) and 17 - 52 mm. Hg. with a mean tension of 29 mm. Hg. (Dellaporta ). We considered a postoperative tension of 20.6 or less after four weeks of operation as successful. The success rate was 91.67%. Galin  reported 50% success, Shield & Simmons  78%, Maumenee  66%, Johns et al 12 83.3%, and Sharma et a1  92%.
A filtering belb was seen in 70.8% cases. In 8 cases post-operative tension was not controlled - in them the pre and post operative tension was more and hyphaema was seen in all cases. Blockage of the filtering area by organised blood may be the cause of failure of the operation. In all these cases vision gradually deteriorated. Out of the total successfully operated cases (88 cases), we found improvement of vision in 76 cases (86.36%).
The arguments cited against simultaneous glaucoma and cataract surgery were, higher filtration rate which causes the anterior chamber to remain shallow or flat and the increased incidence of synechiae formation, which results a secondary rise of intra ocular tension. Such complications have not been encountered in the present series.
The advantages of a combined operation are a short stay in the hospital, higher success rate and undergoing surgical insult only once. Moreover, in a two - step procedure, if cataract extraction is done in an already successfully filtering eye, there is higher incidence of belb failure. Also, there is more difficulty in performing a filteration operation in an aphakic eye.
Therefore, the combined glaucoma - cataract operation at the present state does not represent a longer operation than the operation done in two stages and the results are encouraging.
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