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ARTICLES
Year : 1979  |  Volume : 27  |  Issue : 4  |  Page : 51-52

Complications of corneoscleral wound healing in cataract surgery


Vijaya Hospital, Madras, India

Correspondence Address:
Y Laxmana Rao
Vijaya Hospital, Madras 20
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Rao Y L, Badrinath S S. Complications of corneoscleral wound healing in cataract surgery. Indian J Ophthalmol 1979;27:51-2

How to cite this URL:
Rao Y L, Badrinath S S. Complications of corneoscleral wound healing in cataract surgery. Indian J Ophthalmol [serial online] 1979 [cited 2020 Dec 1];27:51-2. Available from: https://www.ijo.in/text.asp?1979/27/4/51/32574

Inspite of the literature on complications after cataract surgery being very vast, informa­tion on complications such as shallow anterior chamber after suture removal, unintentional filtering blebs, and endophthalmitis after suture removal is very scanty. Our aim is to assess the incidence of these three complications in our series of cases, an attempt to find out the predisposing and etiological factors and make suggestions to reduce their incidence.


  Materials and Methods Top


In a five year period from 1972 to 1977, a total of 645 cataract extractions including those combined with anti-glaucoma surgery have been performed.

All cases were operated under local anaesthesia. After raising the conjunctival flap, the anterior chamber was opened with a blade at the 12 O'clock meridian. The incision was extended with corneoscleral scissors. After iridectomy alpha chymotrypsin was used if indi­cated. Intracapsular cryo cataract extraction was done. Corneoscleral sutures were then placed. Pre-placed sutures were used occasionally.

Post-operatively topical atropine and corticoste­roids were used as a routine. After discharging the patient, he was instructed to report for review once in a week. Sutures were removed at the end of three weeks, under topical xylocaine anaesthesia. A razor blade was used for suture removal.

Available data on the 645 cases has been collected and analysed with reference to the following complica­tions:

  1. Shallow anterior chamber after suture removal.
  2. Unintentional filtering blebs.
  3. Endophthalmitis after suture removal.



  Observations Top


Shallow anterior chamber after suture removal

In a total of 645 cataract extractions, shallow an­terior chamber during suture removal occured in 51 eyes (7.9%). The incidence of shallow anterior chamber following suture removal does not seem to depend on types of corneoscleral incisions, conjunctival flap or type of suture.

However, on comparing a group of 161 cases with 5 sutures and a group of 112 cases with 7 sutures, it was found that incidence of shallow chamber was signi­ficantly lower in the former (4.3%) than the latter group (12.5%). In our experience, 5 corneoscleral sutures are adequate for 160° incision. Keeping the sutures for 4-5 weeks instead of usual 3 weeks seem to reduce the incidence of shallow chamber. All but 4 cases were managed by pressure bandaging for one to four days. The 4 cases were resutured.

Unintentional filtering blebs after cataract surgery

Unintentional filtering blebs were detected in 31 of the 645 cases operated (4.8%). Of the 254 cases in which limbal based flap was used, 15 developed filtering bleb (5.9%). Of the 211 cases in which fornix based flap was used, 9 developed filtering bleb (4.3%). The time lag between the surgery and the development of bleb varied from 6 weeks to 8 months. None of the cases developed filtering bleb before suture removal.

The intraocular pressure ranged from 8 to 16 mm. Hg. despite the presence of filtering bleb. However, in two eyes the ocular pressure was too low to be recorded. One patient with low unrecordable tension had papill­oedema on fundus examination. On gonioscopy, two cases showed internal wound gaping (6.5%), three show­ed iris incarceration (10%) and three showed vitreous incarceration (10%).

45% of the blebs were located in the upper nasal quadrant and 22.5% in the 12 O'clock meridian and only 3% were located in upper temporal quadrant.

The cases were not ordinarily treated. Cryo the­rapy was given in 2 cases. Bleb was excised in 2 cases. In one case diathermy was applied to the bleb and the small gap in the wound was closed with sutures. The bleb disappeared with treatment in all 5 cases. In the case which had hypotony wi h papilloedema, the intra­ocular pressure returned to normal and papilloedema disappeared.

The filtering blebs are associated with defective wound healing. Various predisposing factors have been incriminated by different authors. They are de­fective suturing, tissue incarceration, use of alpha chymotrypsin, bad sections and use of topical corti­costeroids post-operatively, poor wound healing; incar­ceration of iris and vitreous have been contributing factors in our cases.

Post-operative infection

Post-operative infection occured in 8 cases out of the 645 cases operated (1.24%). The interesting feature is that in 7 out of the 8 cases, the infection occured after suture removal. Out of the seven cases of late post­operative infection, six occured within one week after suture removal and the seventh occured It days after removal of corneoscleral sutures. This indicates that the removal of sutures has predisposed in some unknown way to the onest of infection.

The following line of treatment was adhered to in all these cases:

  1. Intensive topical treatment with atropine and corticosteroids.
  2. Intensive systemic antibiotics oral or parenteral.
  3. Massive doses of systemic steroids-starting with 60 mg. of prednisolone or its equivalent dose' of betamethasone or dexamethasone.


The results were gratifying with this line of treat­ment. Five of the seven cases had a final vision of 6/ 12 or better. One case regained 6/36 vision and one was lost to follow-up.




 

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