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| ARTICLE |
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| Year : 1966 | Volume
: 14
| Issue : 1 | Page : 36-39 |
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Different techniques of iridencleisis and their value in glaucoma- a study of 60 cases
SP Gupta, KC Garg, KK Bisaria
Department of Ophthalmology, King George's Medical College, Lucknow, U.P., India
| Date of Web Publication | 12-Jan-2008 |
Correspondence Address:
S P Gupta
Department of Ophthalmology, King George's Medical College, Lucknow, U.P.
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Gupta S P, Garg K C, Bisaria K K. Different techniques of iridencleisis and their value in glaucoma- a study of 60 cases. Indian J Ophthalmol 1966;14:36-9 |
The two common filtering operations for chronic glaucoma are iridencleisis and trephining. The iridencleisis is better due to its easy procedure, less post operative complications and better results. The present study is confined to two techniques of iridencleisis and their value in glaucoma.
Several techniques of achieving incarceration of the iris and thus producing a filtering cicatrix have been described, out of which only two are the most commonly practisedone described by Holth (1930) and the other by Weekers (1948). Several modifications have been described however. The present study is a comparison of the two techniques under identical conditions.
| Weeker's Technique | |  |
In this method the iris which appears as a tiny ball in the scleral wound, is seized with two iris forceps, one on each side. By slight horizontal pull it is torn into two fregments and the conjunctival wound is closed by plain catgut suture.
| Holth's Technique | | |
Here the iris that presents in the wound is caught with iris forceps and is cut in the 12 O'clock meridian from pupillary margin to iris root with iris scissors. The nasal pillar is left in the wound after drawing up a little and temporal one is stroked back in position. The conjunctival incision is closed by a continuous key-pattern suture.
Three factors contribute to the success of the operation viz. (1) an incision perpendicular to the sclera, (2) the length of the innermost part of the incision and (3) preservation intact of the pigment epithelium.
| Complications of Iridencleisis Operation | | |
The following complications are possible.
1. Tearing of the iris on being pulled, if it is very atrophic.
2. The iris recedes into the anterior chamber if corneal section is too large.
3. The pupil may be drawn up if the iris is pulled too much.
4. Iridocyclitis.
5. Hypertension.
The present study was carried out in 70 eyes of 60 cases operated for chronic glaucoma admitted in the Eye Section of Gandhi Memorial and Associated Hospitals from February 1963 to January 1964. Out of these, in 42 eyes, Weeker's technique was followed, whereas in the other 28 eyes, Holth's technique was adopted.
| Age and Sex Incidence | | |
Out of 60 cases, 14 were in the age group of 30 - 40 years, 18 were between 41 - 50 years, 22 were between 51 - 60 years and 6 cases were above 60 years of age. The maximum age was 80 years and minimum 30 years.
Among 60 cases, 38 were males and 22 females.
Visual Acuity:
[Table - 1] shows various vision groups in relation to technique employed. It indicates the comparatively late stage of the condition, when the cases presented themselves for treatment.
Field of Vision:
The field defects have been tabulated in [Table - 2] as early, moderate and marked. In 18 cases the fields were so severely affected that they could not be charted.
Fundus Examination:
[Table - 3] shows various fundus changes met in cases to be operated by the two techniques.
Intra-ocular Tension:
[Table - 4] shows the grouping regarding the tension.
| Post-operative Findings | | |
Filtering Scar:
Out of 70 eyes operated in 66 eyes a filtering scar was well formed. The other features are illustrated by [Table - 5].
Control of Intra-ocular Tension.
The tension was within normal limits in 54 eyes (77.14%) without the use of miotics and with miotics in 10 eyes (14. 29%). It remained elevated in 6 cases (8.87%).
[Table - 6] shows tonometric results in the two techniques employed.
Visual Acuity:
Out of 70 eyes operated, it improved in 44 (62.86%), remained unchanged in 20 eyes (28.57%) and deteriorated in 6 eyes (8.57%). By Weeker's technique the improvement was in 66.67% and in Holth's 57.14%.
Field of vision:
In 42 operated by Weeker's technique, in 26 it improved, in 10 it remained unchanged and in 6 it could not be taken. By Holth's technique 28 eyes operated, showed improvement in 10, 6 showed no change and in 12 it could not be taken.
Post-operative complications:
The only complication noted in Weeker's technique was delayed formation of anterior chamber with hyphmma in 2 cases. In Holth's technique the number of complications observed are shown in [Table - 7].
| Follow up | | |
The period of follow up ranged from 2 weeks to 7 months following operation.
The percentage of success and failure was determined by two factors, viz. intraocular tension and visual acuity.
Considering the criteria of tension, all cases were classified into three categories.
1. Good results - 15 - 20 mm Hg.
2. Border line results - 23 - 25 mm Hg. without the use of miotics.
3. Failures - 28 mm Hg. or above without the use of miotics.
The follow up was possible only in 44 patients as the rest did not turn up for check up. The results as regards tension are summed up in [Table - 8].
Considering the criteria of visual acuity the results in two techniques were as given in [Table - 9].
In the follow up it was clearly established that Weeker's technique gave better results than Holt's.
| Summary and Conclusion | | |
In this series of work, 70 eyes were operated. Weeker's and Holth's were the two techniques employed. The following conclusions are drawn from the above study.
1. Weeker's technique is easier and less time consuming.
2. In Weeker's technique there was spontaneous prolapse of the iris and hence the iris was seized easily.
3. The filtering bleb reformed earlier in Weeker's technique and control of tension was well maintained without the use of miotics in most of the cases.
4. The visual results were better in Weeker's technique.
5. The only complication found in Weeker's technique was delayed formation of anterior chamber with hyphiema in two cases. The Holth's technique included complications like, hyphxcma, iridocyclitis, early precipitation of cataract formation and non-formation of the anterior chamber.[13]
| References | | |
| 1. | Bader, c. (1876) Royal London Ophth. Hosp. Rep. 8: 430.  |
| 2. | Butler, T. H. (1936) Trans. Ophth. Soc. U.K. 56: 194 |
| 3. | Critchett. (1857) Royal London Ophth. Hosp. Rep. 1: 57 |
| 4. | Evans, J.P (1943) Brit. J. Ophthal. 27: 548 |
| 5. | Goar, E. L., and Schultz, J. F. (1939) Arch Ophthal. 22: 10:35 |
| 6. | Holth, S. (1930) Arch. Ophthal, 4: 803 |
| 7. | Lugossy, G. (1960) :Amer. J. Ophthal. 49: 1968 |
| 8. | Lukic, D. (1955) Acta XVII Int. Cong. 2: 1 176 |
| 9. | Lundsgaard, K. K. K. (1930) Acta. Path. et microbiol Scandin. Supp. 3: 269. |
| 10. | Rees. A (1945) Arch. Ophthal. 34: 360 |
| 11. | Stallard, H. B. (1953) Brit. J. Ophthal. 37: 680 |
| 12. | Weekers, L and Weekers, R (1948) Brit. J. Ophthal 32: 904 |
| 13. | Wille, W. A. (1936) Brit. J. Ophthal. 20: 229 |
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7], [Table - 8], [Table - 9]
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