|Year : 1961 | Volume
| 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 Publication||7-Apr-2008|
Victoria Hospital, Darjeeling, West Bengal
Source of Support: None, Conflict of Interest: None
|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|| |
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|| |
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.
| Summary|| |
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|| |
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|| |
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.
Arruga. H. - Ocular Surgery. McGraw-Hill Book Co. Inc., New York, Toronto, London, 1952.
Sen K. - Lecture at the Clinical meeting of the Ophthalmological Society of Bengal.
Stallard, H. B. - Eye Surgery. John Wright & Sons Ltd., Bristol. Simpkin Marshall Ltd., London 1950.
Vail, Derrick - Symposium on Diseases & Surgery of Lens (Edited by George M. Haik) The + C. V. Mosby Company, St. Louis, 1957.
Wagle, G. S. - Personal Communications.