|Year : 1966 | Volume
| Issue : 1 | Page : 40-43
Cataract extraction following glaucoma surgery- assessment of 100 cases
Department of Ophthalmology, King George's Medical College, Lucknow, India
|Date of Web Publication||12-Jan-2008|
K K Bisaria
Department of Ophthalmology, King George's Medical College, Lucknow
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bisaria K K. Cataract extraction following glaucoma surgery- assessment of 100 cases. Indian J Ophthalmol 1966;14:40-3
Cataract extraction in operated cases of glaucoma presents a number of problems. Degenerative changes like fluid vitreous and iris atrophy make the response of the eye to the operative trauma unpredictable. Besides this, the changes that may have occurred as a result of glaucomatous process, may be responsible for variable degree of visual loss after a successful cataract operation.
It is controversial whether cataract follows its usual course of development as in senile cataract or its formation is hastened after filtering operations. Nano and his co-workers (1960) believe that 35 percent of patients who have undergone such operations develop nuclear cataract. Arruga (1952) believes that the incidence of cataract formation is the same in operated and unoperated cases. Kirby (1949) suggests that cataract formation may follow operations where the tension is suddenly reduced and the anterior chamber remains collapsed. Under such circumstances the lens capsule remains in contact with corneal endothelium and subsequently its nutrition suffers. However, the early precipitation of cataract formation following a filtering operation could be due to lens damage occurring during the operation while late formation may be as a result of some disturbance in lens metabolism.
The problem of incision is of paramount importance in cataract surgery specially following a filtering operation where the bleb comes in the way. The cases of glaucoma where iridectomy or cyclodialysis have been performed hardly present any difficulty as here the usual limbal incision can be made. The same state can be created by doing Holth's iridencleisis posteriorly, about 4 m.m. from the limbus (Agarwal 1958). The following sites for incision in the presence of a filtering bleb have been suggested.
i) Through the bleb.
ii) Through the clear cornea anterior to bleb
iii) Superiorly above the bleb. It is not practical, as filtration will be lost.
iv) At the limbus laterally and/or inferiorly.
Each of these approaches have been favoured by different groups of surgeons of repute, which makes choice of surgery confusing.
| Analysis of Cases|| |
The present study is carried out in 100 cases of operated glaucoma.
I. Age and sex
The age ranged from 26 to 68 years. Out of 100 cases, 65 were males and the rest females.
II. Time interval between glaucoma operation and cataract extraction varied from 3 weeks to 2½ years.
III. Type of cataract
Out of 100 cases, 60 eyes had immature lens opacities. In 25 the cataract was mature and in the rest 15 hypermature.
IV. Type of glaucoma operation performed.
i) Broad iridectomy was present in 40 cases.
ii) Filtering operations were noted in 60 cases, of which in 5 trepanation and in 55 iridencleisis had been performed.
(i) Cases with broad iridectomy
The eyes where broad iridectomy had been performed the usual incision at superior limbus was taken. The various complications encountered in this group are shown in [Table - 1].
(ii) Cases with filtering blebs-
Out of 60 cases, in 50 the incision was made anterior to the bleb, in 6 through the bleb and in 4 in the temporal region. In the first and third groups 3 corneal stitches as shown in figure A.B.C., were taken, whereas in the second group corneo scleral stitches as shown in figure D.E.F. were applied [Figure - 1]. The various complications noted in these cases are shown in [Table - 2].
V. Visual results
The fundus was not visible after cataract surgery in a total of 9 cases clue to various causes mentioned in [Table - 3].
In 91 cases the fundus was clearly visible and the various lesions that were observed are enumerated in "[Table - 4].
The pre-existing anomalies in the eye along with operative complications produced great variation in visual improvement. [Table - 5] shows the number of cases with variable degree of improvement in visual acuity tested after extraction of the lens.
The cases where broad iridectomv had been performed earlier, did not present much difficulty specially as regard to the site of the incision. In all such cases the usual superior limbal incision was made. The presence of posterior synechiae as a result of iridocyclitis following glaucoma surgery in such eyes did not allow a smooth delivery of lens. In 3 such cases, the lens extraction was extra capsular. The other complications were as common as in other cases of ordinary cataract extraction.
The real problem was with the site of incision in cases having filtering blebs, such cases were 60. The cases where the incision was made anterior to the bleb showed higher incidence of gaping wound, delayed reformation of anterior chamber and opacification of cornea but hyphaemia was altogether absent. This latter advantage is due to the section going through avascular portion of the cornea. The eyes where incisions were performed through the bleb and those in the temporal region did not given much information as the number of cases were very small.
Scheie (1956) stated that perpendicular corneal incision gives satisfactory results as against those where the incision is bevelled. Alston Callahan (1952) prefers the lateroinferior section because with this the functioning bleb is altogether avoided but adds that in some cases there may be derangement of corneal metabolism. Elton Yasuna (1964) in his series of cataract extraction with incision through the bleb in 26 eyes following iridencleisis operation observed some lowering of intraocular tension in 18 eyes (10%) while 3 eyes (12%) showed elevated tension and in the remaining 5 it remained unchanged. He emphasized that this technique is simple and safe.
The present study gives more information regarding the results of incision made anterior to the bleb. In view of the difficulty in delivering the lens from temporal or inferior sites on one hand and the dangers of elevation of intraocular tension and postoperative iridocyctitis of "bleb" incision, we prefer to stick to the making of incision anterior to the bleb. The perpendicular incision at the completion of section with proper stitches minimises the complications usually encountered with in this technique.
| Summary|| |
A series of 100 cases where cataract extraction was performed following glaucoma surgery has been reported.
An evaluation of three sites of incisions has been attempted particularly in those cases where it is made anterior to the bleb.
Complications of wound gaping and delayed formation of anterior chamber can be minimised by appropriate stitching.
The corneal incision anterior to bleb in this paper has given satisfactory results. "Bleb" incisions and infero-lateral incisions have not been performed in sufficient numbers for a fair comparison of results.
| References|| |
Agaiwal, L. P. (1958), Ophthalmologica, 135, 91-94.
Callahan, A, (1952) A. M. A. Arch of Ophth. 47, 132-140.
Gifford, S. R., (1943) Amer. J. Ophthal. 26, 468-473.
Kirby, D. B. (1941) A. M. A. Arch of Ophthal. 25, 866-901.
McLean. J. (1942) Amer. J. Ophthal. 25, 192-193.
Scheie, N. G. (1956) A. M. A. Arch of Ophthal. 55, 818-829.
Spaeth, E. (1954) Amer. J. Ophthal. 37, 120.
Williamson-Noble, FA; (1953) Trans, Ophthal. Soc. U.K. 78, 585-595.
Yasuna, E, (1964) Amer. J. Ophthal. 57, 258-261.
[Figure - 1]
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]