Indian Journal of Ophthalmology

LETTER TO EDITOR
Year
: 2002  |  Volume : 50  |  Issue : 3  |  Page : 247--8

Combined extracapsular cataract extraction with Ahmed glaucoma valve implantation in phacomorphic glaucoma


Harinder S Sethi, Harminder K Rai, Vijay B Wagh, M Narvekar 
 

Correspondence Address:
Harinder S Sethi





How to cite this article:
Sethi HS, Rai HK, Wagh VB, Narvekar M. Combined extracapsular cataract extraction with Ahmed glaucoma valve implantation in phacomorphic glaucoma.Indian J Ophthalmol 2002;50:247-8


How to cite this URL:
Sethi HS, Rai HK, Wagh VB, Narvekar M. Combined extracapsular cataract extraction with Ahmed glaucoma valve implantation in phacomorphic glaucoma. Indian J Ophthalmol [serial online] 2002 [cited 2020 Jul 3 ];50:247-8
Available from: http://www.ijo.in/text.asp?2002/50/3/247/14772


Full Text

 Dear Editor,



We read with special interest the article by Das et al.[1] The authors were able to achieve steady control of IOP with minimum anti-glaucoma medication after combined cataract surgery and Ahmed Glaucoma Valve implantation in all cases of phacomorphic glaucoma in their series. We would like to make some observations regarding their surgical procedure. The authors chose to complete glaucoma surgery (Ahmed Glaucoma Valve implantation with tube inserted into the anterior chamber through partial thickness scleral flap) before proceeding to cataract surgery. Phacomorphic eyes have associated crowded anterior chamber (AC), i.e., a very shallow anterior chamber. This may further flatten after entry with 23-G needle. This may make the insertion of Ahmed Glacuoma Valave tube not only difficult but can cause trauma to the endothelium and iris-lens diaphragm, making the creation of a clear corneal incision and anterior chamber entry difficult. This problem may be overcome by injecting a high viscosity viscoelastic like 1.4% sodium hyaluronate. Further, once the tube with a functioning valve is in place, it may prevent deep anterior chamber during capsulotomy, thus increasing the chances of iridocorneal trauma. Ballooning of the conjunctiva (during irrigation and aspiration) especially in the bleb area might compromise the intraoperative visualisation due to unwanted reflexes. In addition, cortical fragments, pigments and inflammatory products might find their way into the tube opening and from there into subconjunctival sac during cataract surgery. Although the authors have achieved good IOP control in all cases this might affect the efficacy of the valve in some cases.

These possible difficulties can be prevented by slightly modifying their technqiue. We can start by making a conjunctival and scleral flap without entering the anterior chamber. The cataract surgery can then be completed through a clear corneal incision. The Ahmed Glaucoma Valve tube is then inserted into the anterior chamber through the scleral bed. The insertion of the tube at this stage is relatively easy and precludes trauma due to a deep anterior chamber. This also prevents the egress of cortical remnants and pigments through the tube intraoperatively. The scleral and conjunctival flaps are subsequently sutured. Although the purpose of the study was not to evaluate the efficacy of the particular technique and intraoperative timing of Ahmed Glacuoma Valve insertion, we would like to use this article as a platform to suggest these modifications to enhance intraoperative ease of insertion and decrease the chances of trauma to the ocular tissues.

References

1Das CJ, Chaudhary Z, Bhomaj S, Sharma P, Gupta R, Chauhan D. Combined extracapsular cataract extraction with Ahmed Glaucoma Valve implantation in phacomorphic glaucoma. Indian J Ophthalmol 2002;50:25-28.