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ARTICLE
Year : 1961  |  Volume : 9  |  Issue : 3  |  Page : 63-65

Experiences of intra-capsular cataract extraction without iridectomy and without sclero-corneal stitches


Victoria Hospital, Darjeeling, West Bengal, India

Date of Web Publication7-Apr-2008

Correspondence Address:
A Basu
Victoria Hospital, Darjeeling, West Bengal
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Basu A. Experiences of intra-capsular cataract extraction without iridectomy and without sclero-corneal stitches. Indian J Ophthalmol 1961;9:63-5

How to cite this URL:
Basu A. Experiences of intra-capsular cataract extraction without iridectomy and without sclero-corneal stitches. Indian J Ophthalmol [serial online] 1961 [cited 2021 Mar 6];9:63-5. Available from: https://www.ijo.in/text.asp?1961/9/3/63/40276

Surgical removal of lens is now 215 years old. Daviel, in 1745, in­troduced the operation that remains surprisingly modern today.

He inserted a sort of keratome into the anterior chamber, en­larged the incision with curved scissor and then scratched the capsule and delivered the catar­act extra capsularly by external pressure.

Of course, before Daviel's time, for about 400 years, or longer, couching or reclination of the cataract was universally practised by the Egyptians, Greeks, Romans, Arabians and East Indians and later by Europeans.

So, we see that at the beginning, there was no iridectomy, at least, not mentioned in the literature.

It is presumed that previously there must have been lots of iris prolapses after simple extraction of lenses for which the modern sur­geons have taken resort to Iridec­tomies in cataract operations to prevent iris prolapse.

This fact is so much convincing to modern ophthalmologists that with the exception of a few, they perform not a single but double or even a series of iridectomies and above all they put several types of sclero-corneal stitches, with the same idea of preventing the iris prolapse.

It remains a mystery that in spite of all these precautions, sometimes iris gets prolapsed in a quiet and co-operative patient who behave.. very nicely during operative and post-operative periods. Or the - other hand sometimes no iris prolapse takes place in a mosi non-co-operative patient who be­haves very badly on the table and afterwards sits up, vomits, even walks out and removes bandages; on the same day of the operation. Evidently, iridectomy is not a pre­ventive against iris prolapse.

Moreover, iridectomy is not ad­vocated in a diabetic patient in whom it is advisable to perform an intra-capsular operation. Following such advice, several dia­betic patients were operated by intro-capsular method without iridectomy and in them no iris pro­lapse occurred.

In the series on which our re­marks are based, one hundred intro-capsular cataract operations ­were performed without iridectomy and without sclero-corneal stitches, of whom the first 49 cases were operated in North Suburban hos­pital, Calcutta and the rest in Victoria Hospital, Darjeeling.

The observation was mainly concentrated to number of iris pro­lapses. There were seven iris pro­lapses, of them one patient had enlarged prostate. The result is not discouraging, so that unnecessary trauma to Iris and Cornea can be avoided (both from the pathologi­cal and cosmetic point of view).


  Pre-Operative Measures and the Operation Top


The patients are selected after routine examinations and necessary treatment.

In nervous or non-cooperative type of patients, if detected earlier, are given Largactil and Phenergan, one tablet each once in the early morning and once one hour before operation and sometimes the me­phenesine group (e.g. myanesin etc.) is given as relaxant if required.

Usual pupillary dilatation with Lotio Homatropine 2%, and surface anaesthesia with Lotio aneth­aine are induced and the usual procedures for facial and ciliary block anaesthesia are followed. If the intra-ocular pressure is found high about 0.5 c.c. more of Ligno­caine or Novocaine is injected in retrobulbar space and digital pres­sure is applied over the eye for 3 to 4 minutes. After the tension comes down, the standard incision is made in the sclero-cornea with a Graefe knife.

Lens is removed with intra cap­sular forceps and lens expressor. In hyper mature cataracts, when catching the lower pole with intra­capsular forceps becomes difficult, then the lens is dislocated by Smith's method and catching of upper pole with intra-capsular for­ceps while keeping the pressure at the lower pole constant by K. Sen's method is attempted. If it fails then it is removed by Smith's method by pressure and counter pressure only. Iris is reposited and a drop of 0.5% eserine is dropped and we wait for about 2 minutes. If the pupil is not properly contracted and circular, two more drops of eserine are again dropped. Sometimes light stroking or massaging over closed upper lid makes the pupil contract­ed and round. Air is required to be placed in anterior chamber if there is too much hypotony.

Penicillin, 100,000 units are inject­ed subconjunctivally, Terramycin Eye ointment is applied and both eyes are bandaged.


  Post-Operative Care Top


Dressing is done daily. Both the eyes are kept bandaged till the chamber is formed.

If after 2 days the anterior cham­ber is shallow or not formed, Diamox tab. (1 tab. T.D.S.) is given. It was observed that the anterior chamber formation was delayed more in those cases where the quantity of retrobulbar injection given was 1.5 c.c. or more.

If on first dressing the pupil looks pulled upwards or oval, one drop of eserine 0.5% is put and the eye is bandaged.

If on subsequent days the pupil is seen to be too much contracted or any sign of irregularity is seen, then one drop of Atropine is put and the eye is bandaged.

On the third day patient is allow­ed to sit up.

Usually, there is no, or very little circom-corneal reaction and cortico steroids are rarely required to be used.

Bandage is removed on 6th or 8th day and patient is discharged on 8th or 10th day.[6]


  Summary Top


In view of the fact that in many unruly patients iris prolapse does not take pleace in spite of not do­ing an iridectomy and in some of the highly co-operative type of patients where prolapse takes place in spite of iridectomy, iridectomy does not appear to be a prevention against prolapse. A simple procedure without iridec­tomy and application of suture is described. In 100 consecutive cases, prolapse occurred in 7 cases.


  Acknowledgments Top


Dr. B. N. Basu, Hony. Secretary North Suburban Hospital, Calcutta and Dr. K. R. Sarkar, Superintend­ent, Victoria Hospital, Darjeeling for kindly allowing me to publish the hospital records.

 
  References Top

1.
Agarwal L. P., Sharma, K. & Malik, S. R. K. - Diamox therapy in Flat Chamber. (After intra ocular Surgery) Brit. J. Oph. 1955, 39: 664-666.  Back to cited text no. 1
    
2.
Arruga. H. - Ocular Surgery. McGraw-Hill Book Co. Inc., New York, Toronto, London, 1952.  Back to cited text no. 2
    
3.
Sen K. - Lecture at the Clinical meeting of the Ophthalmological Society of Bengal.  Back to cited text no. 3
    
4.
Stallard, H. B. - Eye Surgery. John Wright & Sons Ltd., Bristol. Simpkin Marshall Ltd., London 1950.  Back to cited text no. 4
    
5.
Vail, Derrick - Symposium on Diseases & Surgery of Lens (Edited by George M. Haik) The + C. V. Mosby Company, St. Louis, 1957.  Back to cited text no. 5
    
6.
Wagle, G. S. - Personal Communications.  Back to cited text no. 6
    




 

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Pre-Operative Me...
Post-Operative Care
Acknowledgments
Summary
References

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