|Year : 1981 | Volume
| Issue : 4 | Page : 427-429
Preliminary report of our experiences in trabeculectomy
Chhotubhai K Patel, Anil K Bavishi
C.H. Nagari Municipal Eye Hospital. Ahmedabad, India
Chhotubhai K Patel
Ushakiran, A-1, first floor, Opp. Khanpur Gate, Ahmedabad-380001, Gujarat
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Patel CK, Bavishi AK. Preliminary report of our experiences in trabeculectomy. Indian J Ophthalmol 1981;29:427-9
Trabeculectomy and Iridencleisis is a well known operation. This study has been conducted to compare the results of trabeculectomy, transposition of Scleral Flap and iridencleisis.
| Materials and methods|| |
The main criteria observed in our study is postoperative control of tension. In our series, there was no choice of age, sex and types of Glaucoma [Table - 1].
| Operation procedure|| |
Steps of trabeculectomy operations and iridenclesis are well known.
In aphakic glaucoma, central open sky vitrectomy is performed with aspiration of ½ to 3/4 ml of vitreous; and synechiae at the angle is broken slowly by Iris repositor and saline jet.
The scleral flap is stitched and air injected through previous paracentesis, and conjunctival flap sutured.
Postoperative complications were studied [Table - 2]
2. Scleral Flap Transportation
Limbal based 6 to 8 mm conjunctive-tenons flap raised; 3x3 mm one third thickness of scleral flap is raised, hinged on the fornix side. The middle flap of one third thickness hinged on the limbal side is dissected, 2x2 mm window from the remaining one third thickness dissected as in trabeculectomy. The superficial flap is introduced into anterior Chamber and the middle flap brought out covering the outer one. Conjunctiva and tenons sutured. Saline or air in anterior chamber is optional.
3. Iridencleisis as usual two pillars
Post-operative tension has been recorded upto 3 weeks, weekly and followed onward and compared with the preoperative tension as shown in [Table - 3].
| Discussion|| |
Trabeculectomy and Russian Scleral Flap transposition, both having a scleral protection and the bleb is diffuse, thin, little away from the limbus, as opposed to Iridencleisis, which is overhanging the cornea in many cases. Heavy vascularisation is noted when heavy cauterisation was done in both trabeculectomy and Russian operation especially in congestive glaucoma cases.
Both operations, Trabeculectomy and Russian can be done at any place around the limbus and can be repeated. Iridencleisis is usually done at 12 O'clock and rarely at 6 o'clock. Cosmetically, Iridencleisis is not accepted. Trabeculectomy and Russian operation are more physiological as we do not disturb any other structures.
We have noted that increasing lens opacity more common after Iridencleisis in our series in 12%, and not a single case has been noted in the other operation. Could be due to disturbed lens metabolism and touching of Iris pillars on the upper pole of the lens.
Russian Operation is more cumbersome and time consuming without much super added advantage over Trabeculectomy. Iridencleisis is a simple procedure with much more complication and may not be effective in all cases. We confirm that Trabeculectomy is safer, simple and applicable in many cases and a physiological approach without any complications.
Four cases of aphakic glaucoma with anterior Synechiae and membrane formation, who came for enucleation were given a chance with Trabeculectomy as described above. Two of them had 6/36 and one had 6/60 vision. This procedure is worth trying in aphakic glaucoma cases.
We have not compared our results of this series with any other but we put before the house our humble opinion that may be beneficial to humanity. We are continuing our series and shall report our experiences at a later date.
| Summary|| |
Observations of 225 cases of glaucoma following various antiglaucoma operations have been evaluated. We conclude that both Trabeculectomy and Scleral Flap Transposition works nearly by filtration as opposed to previous views.
[Table - 1], [Table - 2], [Table - 3]