|Year : 1982 | Volume
| Issue : 4 | Page : 285-287
Reconstruction by peymen's vitrophage
AP Shroff, OP Billore
Rotary eye Institute Navsari, Gujarat, India
A P Shroff
Rotary Eye Institute Navsari, Gujarat
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shroff A P, Billore O P. Reconstruction by peymen's vitrophage. Indian J Ophthalmol 1982;30:285-7
Conventional surgical approach in cases when vitreous is present in anterior chamber or is firmly adherent to posterior surface of iris or lens leads to complications like Bullous Keratopathy (due to vitreo corneal adhesions) or Vitreo Retinal Traction Syndrome. Therefore in this series a different approach of
anterior vitrectomy or lensectomy by Peymen's vitrophage through pars plana has been made to study the position of viireous face and response of the eyes to this new surgical method.
| Materials and methods|| |
The age, sex and laterality of the cases in this study is shown in [Table - 1]. Clinical diagnosis in our cases was traumatic cataract in 10 cases, congenital cataract in 4 cases, after cataract in 4 cases, Occlusion-pupillae in I case and dislocated lens in 1 case.
Pre-operative examination of all cases included vision, acceptance, intraocular tension measurement, Slit Lamp Biomicroscopy, Indirect Ophthalmoscopy, Photography and routine biochemical investigations. Surgery was performed either under general or local anaesthesia according to the merit of the case. Peymen's vitrectomy unit modified by Nagpal and Peymen's vitrophage cutter were used for this procedure.
4 mm sclerotomy wound was made 4 mm away from the limbus either in upper or lower temporal quadrant after opening the conjunctiva. The wound was deepened till choroid was visualised. The edges of the wound were diathermised & a nylon mattress suture was packed but was kept loose.
Stab incision through choroid was made by von Graefe's knife in the anterior direction towards the centre of the pupil. Peymen's Vitrectomy consol was checked and suction, infusion and cutter speed were adjusted. Then cutter was introduced and suture was tied to make it airtight. Evacuation process was continued till lens matter as much as possible was removed or adequate pupillary opening in cases of occlusion-pupillae was made. Posterior fundus was examined by indirect ophthalmoscope for any lens matter which may have sunk down and in such a case cutter was directed posteriorily to aspirate it. Peripheral area was avoided so as to prevent damage to the ciliary body or retina. Cutter was withdrawn and wound was secured adequately. Intraocular tension was maintained within normal range throughout the procedure.
Lactated Ringer Solution mixed with Gentamicin Sulphate was used for infusion (80 mgs/500 ml). Post operative dressings with antibiotic and steroid were done and cases were examined for vision acceptance, Slit lamps biomicroscopy, Intraocular tension, Indirect Ophthalmoscopic examination at the time of discharge and after one month. post operative photographs were also recorded.
| Observations|| |
In 18 cases no operative complication were noted while one case had hyphema from vascularised iris and one case had iris prolapse through the corneoscleral wound in recently done cataract surgery & was reposited eventually. Congenital cataract and traumatic cataract in young patients were easily aspirated because of soft consistency while more time was required for sclerosed lens in elder patients. During post operative period the eyes were very quiet and photophobia was minimum. 16 cases had no complication while striate keratitis, mild iritis. hyphema and transient glaucoma in one each case were noted which disappeared after conventional treatment.
In 19 cases vitreous face was quiet posterior to the pupillary level while in only one case it was just at the pupillary aperture. Vision improved in 17 cases while in 3 cases it did not improve further because of posterior fundus pathology [Table - 2].
| Discussion|| |
Conventional surgical techniques in these cases has many problems. Repetition of surgery and disturbance of vitreous face causing vitreous traction etc. are common in congenital cataracts. In after cataracts secondary membrane formation across the pupillary area and in complicated cataract undesirable traction of vitreous causing retinal detachments are common occurance while with this procedure all above complications can be prevented as inadverent shallow anterior vitrectomy keeps the pupillary area free of any scafolding for secondary membrane formation, therefore pupil remains freely mobile. [Figure 1][Figure 2][Figure 3] shows that infusion fluid takes place of the vitrectomy area which is later on replaced by aqueous humour. Therefore posterior synechia or pupillary block glaucoma does not occur. As a result post operative vitreoretinal traction syndrome may be a rarity. Striate keratitis and iritis were because of more handling and transient glaucoma was probably because of release of prostaglandins. Hyphema persisted for 8-10 days in case where it appeared during surgery only. In other series reported earlier is claimed to have 85 to 90% success rate [Table - 3].
| Summary|| |
New approach through Pars Plana using Peymen's Vitrophage in congenital, traumatic, after cataract, dislocated lens and occulusio pupillae not only construct anterior segment but has better results with minimum post operative complications.
[Table - 1], [Table - 2], [Table - 3]