|Year : 1973 | Volume
| Issue : 3 | Page : 117-120
Evaluation of scleral cautery with peripheral iridectomy (Scheie's operation) for glaucomas
GN Seal, MK Das
Department of Ophthalmology, Institute of Post-Graduate Medical Education and Research and S.S.K.M. Hospital, Calcutta, India
G N Seal
Department of Ophthalmology, Institute of Post-Graduate Medical Education and Research and S.S.K.M. Hospital, Calcutta
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Seal G N, Das M K. Evaluation of scleral cautery with peripheral iridectomy (Scheie's operation) for glaucomas. Indian J Ophthalmol 1973;21:117-20
|How to cite this URL:|
Seal G N, Das M K. Evaluation of scleral cautery with peripheral iridectomy (Scheie's operation) for glaucomas. Indian J Ophthalmol [serial online] 1973 [cited 2021 May 8];21:117-20. Available from: https://www.ijo.in/text.asp?1973/21/3/117/31397
The procedure was first employed by PREZIOSI.  He used a galvanocautery puncture to enter the anterior chamber at the limbus at 12 o'clock after turning a conjunctival flap down over the cornea as for trephining. The tip of the cautery wire (0.5 mm. diameter) was applied at dull red heat to the limbus with several light quick touches until the anterior chamber was entered obliquely. Peripheral iridectomy was done only in those cases where the iris prolapsed through the puncture.
This method was developed by SCHEIE  when it was noted that a filtering cicatrix occurred following simple iridectomy in a case of early narrow-angle glaucoma in which Hildreth cautery was applied to the incision for haemostasis. The above observation was pursued further and a modern technique of scleral cautery with peripheral iridectomy was described with its advantages over other filtering operations.  Later on, some modification was done so that the scleral cut was made through an area previously lightly stroked with the cautery and then, the lips of the wound were touched with the cautery before the anterior chamber was finally entered with a knife. 
The principle of the procedure is the same as that of the operation of PREZIOSI  but with some differences in details. Here, a much less intense heat is applied and the cautery does not enter the anterior chamber. An iridectomy is always done. The technique is very simple and safe. Little bleeding occurs which is especially advantageous in hyperaemic eyes. The operation leaves the pupil round and the filtering cicatrix is usually flat and diffuse.
This simple procedure has been employed by us in S.S.K.M. Hospital attached to the Institute of PostGraduate Medical Education & Research, Calcutta, for several years. In our technique, the electro-cautery has been replaced by Wordsworth's ballpointed thermo-cautery heated red-hot in the flame of a spirit lamp.
| Materials and Method|| |
The present study was undertaken on all types of glaucoma seen in the glaucoma clinic of our Department of Ophthalmology, from March 1964 to May 1972. There were 55 eyes in the series of which 22 eyes had angleclosure glaucoma, 28 eyes had openangle glaucoma and 5 eyes secondary glaucoma. In each case, detailed assessment was done before surgery and following that, the case was kept under observation for a period of 6-8 months.
OPERATIVE TECHNIQUE: A large flap of Tenon's capsule with conjunctiva was reflected down to the limbus as in trephining. Blunt dissection was done to expose to sclera at the limbus. Before making the scleral incision, the tip of the thermo-cautery was applied to the superficial sclera along the proposed line of the abexterno incision. The proposed horizontal incision of about 5 mm long was then made just adjacent to the clear cornea. It should be made through the cauterized area, perpendicular to the surface of the globe using a Bard-Parker knife with a No. 15 blade. The cautery was applied once or twice within the lips of the scleral wound. The edges of the incision gape upon application of the cautery. Depth of the wound was touched with the tip of the cautery as the incision was deepened with the knife. The anterior chamber was entered with a final sweep of the knife along the whole length of the incision and a peripheral iridectomy done. Following iridectomy, the iris was reposited and the conjunctiva) flap and Tenon's capsule replaced and sutured with a continuous silk stitch. Guttae atropine was instilled and both eyes bandaged. Locally a steroid ointment was applied from the third post-operative day.
| Observation|| |
The intra-ocular tension is said to be controlled when repeated tonometry shows 20 mm Hg or less without miotics during the assessment period (6 to 8 months). When the tension falls below 10 mm Hg, we define it as "hypotony". If the tension remains above 25 mm Hg even with miotics, we consider the case as failure from the surgical point of view.
Out of the 55 eyes operated, the intra-ocular tension was controlled in 51 eyes (92.7%) of which 3 eyes developed hypotony (5.417o); 4 eyes (7.3%) did not respond to the procedure and were considered to be failures. The operation was tried in 2 eyes of haemorrhagic glaucoma (following central retinal vein thrombosis) but in both the cases, it was unsuccessful. One aphakic glaucomatous eye was operated upon with success. In both the eyes of a case of juvenile glaucoma, the procedure was successful in controlling the tension. In angle-closure glaucoma, successful control was achieved in 21 out of 22 cases, whereas 27 out of 28 cases with open-angle glaucoma were controlled. Angle-closure group included several cases where the operation was done in the acute congestive phase without any difficulty.
In majority of cases, reformation of the anterior chamber occurred within 3 days. Formation of the anterior chamber was delayed in 8 eyes which remained shallow from 6 to 7 days and in 5 eyes, the chamber did not reform before 2 weeks. In all these eyes, it subsequently reformed without any surgical intervention.
Hyphaema developed in 3 eyes due to seepage of blood through the fistula from flap-bleeding (usually traumatic)., In all these eyes, it was absorbed within few days. In one eye, the iris was herniated through the scleral fistula and came to lie in the subconjunctival tissue producing a prominent round pigmented cicatrix. The filtering cicatrix, however, was quite effective in controlling the tension.
In majority of the eyes, the formation of the filtering bleb occurred between 5 to 7 days. In 4 eyes, it took about 2 to 3 weeks for the bleb to form properly. The bleb was diffuse in nature and had a thick conjunctival covering.
Hypotony which occurred in 3 eyes appeared to be innocuous. No oedema of the disc or retina developed in these eyes. The vision was affected as a direct result of hypotony in one eye where rapid cataractous changes developed within three months.
| Discussion|| |
Scleral cautery with peripheral iridectomy is a simple operative procedure which gives fairly good results. It can be performed whenever a filtration operation is indicated - both close-angle and wide-angle glaucomas. It is more simple and safer than other fistulizing procedures because the incision is made through an area rendered avascular by cauterization. The filtering cicatrix produced in this operation is usually diffuse and thick which probably minimizes the risk of late infection.
The procedure is especially useful in neglected acute congestive glaucoma  and in the eyes where previous surgery has failed to lower the tension. It may also be tried in aphakic glaucoma and in selected cases of congenital glaucoma as a re-operative procedure.
Control of pressure claimed by different ophthalmic surgeons varies from 80 to 90%. HAMIDA SAIDUZZAFAR  et al reported 106 cases of primary glaucoma operated by this procedure and claimed 87.7% success in controlling the tension. Our percentage of success in this series stands at 92.7 (close-angle group 95.4% and wideangle 96.4%). We have come across only 3 cases of hypotony (5.4%) in the series which is much lower than 15% reported by SCHEIE.  We have not encountered any rare complication like malignant glaucoma, late endophthalmitis or vitreous loss through the fistula. Only rare complication which occurred in one eye is the herniation of the iris tissue through the wound with updrawing of the pupil
The operation has several advantages over other fistulizing procedures. They include: (a) Incidence of complications is less, (b) Duration of hospital-stay is less, (c) Bleb is thicker and so the chance of late infection is minimum, (d) No chance of sympathetic ophthalmia since the iris tissue is not incarcerated in the wound, (e) Re-operation can easily be performed if required, (f) Cataract extraction is easier to perform if required.
Our conclusion as regards this procedure is that it is a easier and at the same time, effective method in controlling the intra-ocular tension in different types of glaucoma, especially the primary ones.
| Summary|| |
Scheie's operation was performed on 55 eyes of different types of glaucoma using a ball-pointed thermocautery of Wordsworth instead of an electric one.
The procedure was simple and easier to perform and results were as good as other filtering operations. It can be done in all types of primary glaucoma and is especially useful for eyes with neglected acute narrow-angle glaucoma and for re-operations where other procedures have failed.
Post-operative complications were few and the incidence of hypotony was low. The pressure was controlled in 92.7% of the eyes operated in this series. Its advantages over other procedures and the post-operative complications are discussed.
| References|| |
Hamida Saiduzzafer, J. S. Pradhan & R. Gogi: Peripheral Iridectomy with Scleral Cautery (a simple technique), J.A.I. Ophthal. Soc. 17: 11-13 (1969).
Preziosi, C. L.: The electro-cautery in the treatment of Glaucoma, Brit. J. Ophthal. 8: 414-417, (1924).
Scheie, H. G.: Retraction of scleral wound edges: As a fistulizing procedure for glaucoma. Am. J. Ophthal. 45: 220 (1958).
Scheie, H. G.: Filtering Operations for Glaucoma: A comparative study, Am. J. Ophthal. 53: 571-590 (1962).
Scheie, H. G.: Iridectomy with scleral cautery: Current status. Trans. Ophthal. Soc. U.K. 84: 127137, (1964).
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