|Year : 1966 | Volume
| Issue : 1 | Page : 21-25
Two pillar iridencleisodialysis with cataract extraction in cataract with glaucoma
K Nath, BR Shukla
M. U. Institute of Ophthalmology & Gandhi Eye Hospital, Aligarh, India
|Date of Web Publication||12-Jan-2008|
M. U. Institute of Ophthalmology & Gandhi Eye Hospital, Aligarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nath K, Shukla B R. Two pillar iridencleisodialysis with cataract extraction in cataract with glaucoma. Indian J Ophthalmol 1966;14:21-5
Cataracts are often associated with glaucoma and frequently result as its complication. In such patients the problem is whether the glaucoma and cataract should be dealt with separately in two stages or should be operated simultaneously in one sitting. Duke Elder, (1940) Spaeth, (1945) and Sternberg and Meyer (1950) expressed their opinion in favour of the former. On the contrary Guyton (1949), Berge (1954), Wennas and Stertzberg (1955), Tamler and Maumenee (1955) prefered that the two should be tackled simultaneously so as to shorten the duration of convalescence and improve the results. In the one stage procedure, cataract extraction may be combined with anterior sclerotomy (O'Brian, 1947), one pillar iridencleisis (Birge, 1954; Wennas and Stertzberg, 1955) two pillar iris incarceration, broad iridectomy (Troutman, 1956; Madan Copal, 1958). Our experience with these combinations is not encouraging, because the cases often report with raised intraocular tension subsequently. The present study of dealing with the two conditions simultaneously was therefore undertaken to evaluate the results of a newer technique which provides a more permanent drainage of the aqueous humour. The operation comprises of iridodialysis, two pillar iridencleisis along with cataract extraction.
| Material and Methods|| |
Between July 1963 and December 1964, 41 cases of glaucomatous cataracts, ranging between 39 to 72 years, were selected from the indoor section of the Gandhi Eye Hospital, Aligarh. Tonometery and gonioscopy was undertaken and the cases were divided into two groups; (1) closed angle (17 cases) and (2) open angle (24 cases) glaucomas. The initial tension in 17 cases was found to be high (above 3.5 mm Hg) and was controlled by medical treatment before operation [Table - 1] Secondary angle-closure glaucomas due to intumescence of lens were excluded from this series.
These cases were operated and treated over a period of 17 months. All the cases were followed in the hospital for one month although they could be discharged much earlier. Only 23 cases could be followed up for 3-8 months after surgery.
As soon as the tension after medical treatment was near normal (20-30 mm Hg Schiotz) the case was considered for surgery. After the usual preparation and the routine local anesthesia, digital pressure was applied to the eye to lower the tension as much as possible. (25-30). Often glycerol had to be administered preoperatively.
After a traction stitch through the superior rectus a limbal based 6 mm broad conjunctival flap was prepared and was reflected on the cornea. The bleeding points were cauterised and a scleral groove was made from 10 O'clock to 2 O'clock [Figure - 1]. Two preplaced corneoscleral sutures (to be left buried) were placed at 11 O'clock and 1 O'clock. A keratome section was made at 12 O'clock and enlarged from 9 to 3 O'clock [Figure - 2].
In cases of angle closure glaucoma, the iris root was separated from the corneo-sclera by sweeping the angle radially with the tip of an iris repositor all round. This step was omitted in cases of open angle glaucoma. Next, the iris was picked up near the sphincter and cut radially upto its root in the 12 O'clock meridian. [Figure - 2]. Each cut pillar was then pulled separately towards the centre of the pupil in order to tear it from its true root in between 1 and 11 O'clock positions [Figure - 3]. The two pillars were everted sidewards and the cataractous lens was slided by the upper pole. The two pillars were then spread between I and 11 O'clock meridians with pigment epithelium outwards [Figure - 3],[Figure - 4]. The preplaced sutures were tied. Additional sutures were given where required. A bubble of sterile air was left in the anterior chamber [Figure - 5],[Figure - 6].
In all the 41 cases excepting one, the tension remained within normal limits at the end of the first month after operation. 2 cases developed minor complications during the operation, [Table - 2] and majority of the patients recovered good visual acuity [Table - 3]. Only 23 cases could report for a follow up examination after an interval of 3-17 months and one of them had elevated tension. [Table - 4] gives comparative status of tension and visual acuity amongst them.
In this operation, the section is rather perpendicular because a groove is made prior to insertion of sutures. Both iris pillars are incarcerated and hence the chances of establishment of a fistula are improved and the dialysis of iris from 1 to 11 O'clock opens the angle at least partly whereby the aqueous outflow may be improved. Thus this procedure gives the advantage of broad iridectomy as well as that of an iris incarceration. In angle closure glaucoma with cataract, the sweeping of the angle with iris repositor is helpful in breaking the gonio-synechia formed due to contact of iris with cornea.
The results show that out of 17 cases of angle closure glaucoma with cataract, at the end of one month after the operation, the tension was normal in 14 cases while out of 24 cases of cataracts associated with open angle glaucoma the tension was normal in 22 cases. This series did not show any extraordinary immediate or remote complication.
| Summary|| |
Iridencleisodialysis was performed with cataract extraction in 17 cases of angle closure and 24 cases of open angle glaucomas with cataract. Normal tension was observed in 14 and 22 cases respectively without any extraordinary post operative complications. The technique adopted has been described.
| References|| |
Birge, H. L. (1954), Amer. J. Ophthal., 36, 925.
Duke-Elder, W. S. (1940), Text Book of Ophthalmology Vol. III, p. 3,309, Kimpton, London.
Guyton, J. S., (1945), Arch. Ophthal. (Chicago)., 33, 265.
Madan Gopal (1958-1959) Proc. All. Ind. Ophth. Soc. 18, 8:3.
O'Brian, C.S., (1947), Arch. Ophthal. (Chicago), 37, 4.
Spaeth, E, B. (1944), The principles and practice of Ophthalmic Surgery, p. 593., Kimpton London.
Sternberg, P. and Meyer, S. J. (1950), Amer. J. Ophthal., 33, 763.
Tamber, E. and Maumenee, A. E. (1955), Arch. Ophthal., 54, 816.
Troutman R. C., (1955), Acta XVII Int. Cong., 2, 674.
Veil, D., (1949), Amer. J. Ophthal., 32, 1754.
Wannas, E.J. and Stertzberg, C. , W., (1955), Amer. J. Ophthal., 39, 71.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]
[Table - 1], [Table - 2], [Table - 3], [Table - 4]