|Year : 1982 | Volume
| Issue : 5 | Page : 433-434
Trabeculectomy combined with anterior vitreous aspiration in aphakic obstructive glaucoma
Deptt. of Ophthlamology, Medical College, Jaipur, India
R G Sharma
, Deptt. of Ophthalmology Medical College, Jaipur (Rajasthan)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma R G. Trabeculectomy combined with anterior vitreous aspiration in aphakic obstructive glaucoma. Indian J Ophthalmol 1982;30:433-4
Aphakic glaucoma has always been a complex and difficult problem for ophthalmic surgeons to manage.
The present study of Trabeculectomy combined with anterior vitreous aspiration sounds promising in that it seeks to open a new filtering channel for the drainage of aqueous with removal of an obstructive tissue (exudative membrane and vitreous etc.).
| Materials and methods|| |
25 cases of aphakic obstructive glaucoma were subjected for Trabeculectomy combined with anterior vitreous aspiration.
Prior to surgery these cases were thoroughly examined including vision, fundus examination, tonometry and slit lamp biomicroscopy and gonioscopy, wherever it could be possible. Due to corneal pathology details of anterior -chamber angle was not visible in majority of the cases. Intraocular pressure was lowered by giving acetazolamide (250 mg. B.D. or T.D.S.), or intravenous Mannitol. Trabeculectomy was performed according to Watson's modification of Cairn's technique. Anterior vitrectomy was accomplished by Vannas scissors and 0.5 to 1.0 ml. of vitreous aspirated from anterior chamber through the same wound by 18 guaze canula attached to 2 c.c. hypodermic syringe, till the chamber was cleared of vitreous and cornea became scaphoid.
Postoperatively diamox was given in those cases in which initial intraocular pressure was very much high. Postoperative dressings were done as that of any other intraocular surgery. Follow up of these cases were 'carried out for a period of 6 months.
| Observations|| |
Out of 25 cases, 18 cases had vitreous in anterior chamber and rest of 7 cases had pupillary block by exudative membrane.
It was observed that initial intraocular pressure is inversely proportional to the depth of anterior chamber with maximum number of cases 12 out of 25 with :ntraocular pressure ranging from 31 to 40 mm of Hg. had shallow anterior chamber. Postoperative response in these patients was very much satisfactory as all the cases achieved normal depth of anterior chamber. [Table - 1]
4 cases had postoperative complication. 3 cases had shallow anterior chamber with vitreous in anterior chamber and one case with flat anterior chamber. One case had hyphaema which absorbed after 5 days. One case had postoperative iridocyclitis which controlled with medical treatment.
Filteration bleb was found healthy in all the cases. The filteration bleb was thin and flat in 23 cases and uniformly thick and raised in 3 cases. None of the blebs in 25 cases were atrophied or showed cystic changes.
Most of the patients had visual acuity reduced to perception of light preoperatively. Post operatively visual acuity improved maximum upto 5/60.
| Discussion|| |
Post operatively in 21 cases intraocular pressure was well controlled i.e., below 20 mm. of Hg suggested thereby the success rates of as 84% success rate in individual group was as follows : in group I of 3 cases (20-30 mm of Hg.) 66.66%; in group 11 of 12 cases (31-40 mm of Hg) 100% and
group III of 8 cases (41 to 50 mm of Hg.) 87.5%, while in group of 2 cases in which initial intraocular pressure was above 51 mm of Hg. the procedure was totally unsuccessful.
In 4 cases, out of 25 cases where surgery was not successful in controlling intraocular pressure might be due to high initial intraocular pressure, long duration and post operative hyphaema, iridocyclitis, vitreous in anterior chamber and flat and shallow anterior chamber.
It seems to be relatively a better surgical procedure in controlling the I.O.P. and being more physiological has a higher success rate with less postoperative complications. It can be therefore, safely advocated in most of the obstructive aphakic glaucoma in relieving the symptoms and partly improving the vision by clearing the cornea and controlling the intraocular pressure.
| Summary|| |
The evaluation of Trabeculectomy combined with anterior vitreous aspiration in aphakic obstructive glaucoma cases was done in 25 cases.
[Table - 1]