|Year : 1970 | Volume
| Issue : 3 | Page : 128-130
Role of diamox (acetazolamide) in cataract surgery
DL Maria, MD Kale
Department of Ophthalmology, Medical College, Aurangabad, India
D L Maria
Department of Ophthalmology, Medical College, Aurangabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Maria D L, Kale M D. Role of diamox (acetazolamide) in cataract surgery. Indian J Ophthalmol 1970;18:128-30
Ocular hypotony forms an important part of preoperative management of cataract surgery to prevent vitreous loss. This percentage of vitreous loss is increased with advent of various new techniques of cataract extraction. Various hypotensive drugs are used preoperatively. According to Hill in addition to sedatives and tranquilizers, retrobulbar injection of suitable anaesthetic agent followed by digital pressure over the globe for 5 minutes will cause sufficient hypotony of the globe. This hypotony can be achieved by osmotic agents such as urea, glycerol and carbonic anhydrase inhibitors such as acetazolamide, Agarwal  , Mody  , Kornblueth.
According to Agarwal and Mody  administration of Diamox along with other preoperative medication with retrobulbar injection of anaesthetic helps to prevent vitreous loss.
Diamox as an ocular hypotensive drug is used since 1954 in ophthalmic practice. Diamox (Acetazolamide) the carbonic anhydrase inhibitor in oral doses of 500 to 1000 mg could produce a fall in intra ocular pressure within 60 to 90 minutes. Maximum fall reaches within 3 to 5 hours. Exact mechanism of action, by which it causes inhibition of carbonic anhydrase is not known.
Shortly after the introduction of Diamox, as an ocular hypotensive agent, it was used to produce hypotony prior to cataract extraction to prevent vitreous loss, Agrawal and Malik  .
Ureets Zavalia Jr  claims that administration of Diamox 15 to 20 mg/ kg body wt/a day for 48 hours before surgery causes hypotony and induces vitreous detergescence. According to him it alters the colloidal state of vitreous by removing water, increasing viscosity and thus diminishing its volume.
Present study was instituted to determine whether the Diamox is of much value along with retrobulbar injection of xylocain 2% with adrenaline 1: 1000 in producing hypotony of the eye ball.
| Material and Method|| |
135 cases of cataract were studied for this purpose. Most of the patients belonged to age group of 40 to 80 and were admitted for routine cataract extraction. There was no other ocular pathology. 65 cases were given Diamox along with preoperative medication, while 70 cases were not given Diamox except for preoperative medication. The cases were taken at random. The study was on double blind trial basis.
Premedication was 1 gr of phenobarb and mist. alba 1 oz at bed time In the morning, half an hour before operation 10 mg of sequil with 100 mg of pethidine I. M. was given. Diamox series received 500 mg Diamox previous night and 500 mg 2 to 3 hours before operation. All the cases were operated after retrobulbar injection 1.5 ml of 2% xylocaine with 1: 1000 adrenaline with digital pressure for 5 minutes.
Tension was recorded with a Schiotz tonometer on previous night before Diamox therapy, before retrobulbar injection and after retrobulbar injection.
Calculations of drop in tension before retrobulbar and after retrobulbar injections were made in percentage, and a table was made according to the age groups, both of control and Diarnox series. Following points were observed : (1) percentage of fall of intraocular pressure before retrobulbar injection. (2) percentage of total fall after retrobulbar injection. (3) Appearance of the anterior chamber after section. (4) Vitreous disturbance or vitreous loss after removal of lens.
| Observations|| |
The table below shows that there is no significant difference in a fall of intraocular pressure after retrobulbar injection in both the series. Average fall of tension in control group is 51.5% while in acetazolamidc series it is 59.4%.
Fall before retrobulbar injection is different in the two groups. In the control group it is 16.7% while in the Acetazolamide group it is 33.6%, showing that Diamox has got hypotensive action even in the presence of normal intra ocular pressure.
Average normal tension came to about 16.3 mm of Hg (Schiotz). Vitreous loss is seen in both the groups. In the control group it is 10.0% while in Diamox series it is 9.2%. There is no significant difference between the two. Vitreous disturbance was observed more in the control group.
In two cases of the control series and three cases of the Diamox series, the tension before retrobulbar injection, was raised instead of coming down, which can be explained, on the basis that these cases might be of a glaucomatous nature.
| Comments|| |
As regards hypotony of the eye ball, Diamox has got no additive effect over the retrobulbar injection with digital compression alone for 5 minutes. Though vitreous loss was seen in both the cases, almost in equal percentage, the anterior vitreous bulge of the vitreous face was almost absent in Diamox series probably due to the detergescence of the vitreous.
| Summary|| |
65 cases using Diamox with retrobulbar injection of xylocain 2% with adrenaline 1: 1000 and digital pressure for 5 minutes were compared with 70 cases with only retrobulbar injection and digital pressure for 5 minutes.
No significant difference in fall of tension was seen after retrobulbar injection between the two series of cases.
There was some difference in tension between these two groups before retrobulbar injection, indicating that Diamox lowers normal intra-ocular pressure.
Vitreous disturbance and anterior vitreous bulge was seen less in Diamox series probably due to detergescent effect of Diamox.
| References|| |
Agarwal, L. P. and Malik, S. R.: Diamox in cataract surgery. Amer. J. Ophth. 56,
933-7, Dec. 63.
Gundizik, J. D. et al.: Use of Diamox and retrobulbar injection to prevent vitreous loss. Amer. J. Ophth. 56, 933-7, Dec. 63.
Hill, H. F. et al.: Effects of retrobulbar anaesthesia upon intra-ocular pressure. Preliminary report on its importance in cataract surgery. Arch Ophth. (Chicago) 70, 178-83, Aug. 63.
Mody, D. G. et al.: Hypotony in cataract surgery. J. All India Ophth. Soc. 19, 26-30, Feb. 66.
Ureet-Zavalia Jr.: Preoperative dehydration of vitreous body. Indications, techniques, critical analysis of the results obtained. Amer. J. Ophth. 56, 933-7, Dec. 63.
W. Korablueth, G. Gombos and B. Traub: Effects of osmotic agents employed before cataract extraction, on the position of vitreous following removal of lens. Amer. J. Ophth. 62, 220-2, Aug. 66.
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