|Year : 1983 | Volume
| Issue : 4 | Page : 451-453
How much insult human eye can tolerate
AP Shroff, OP Billore, AK Dubey
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, Dubey A K. How much insult human eye can tolerate. Indian J Ophthalmol 1983;31:451-3
Everybody reacts to any type of insult in a different way, likewise organs of our human body can react to an insult which may be in form of heat, cold, chemicals, stone, knife etc. Human eye does show its reaction to such injuries or insults depending upon its severity.
We have tried to study the response of human eye to an insult which is in form of surgery done more than twice to achieve best visual recovery.
| Materials and methods|| |
It is a fact that different eyes react differently to the same type of insult and hence isolated cases have been taken to understand its behaviour towards different or some kind of surgical procedures carried out on the same eye at intervals. Certain parameters e.g. (best visual acuity ocular motility, TOP, any gross anatomical disintergrity, couspicuous presenting symptoms by patients) have been taken into consideration to know its anatomical and physiological intergrity for all cases.
Case I : Recurrent Pterygium
A male aged 21 years has been operated for pterygium excision at least 5 times within the peliod of 3 1/2 years.
During his last surgery pterygeal tissues were excised thoroughly and bare area was covered by bucal mucosa. Subsequently he had
(1) Slight reduction in vision because of enchrochment by fibrous tissue over the nasal pupillary area.
(2) Slight restriction of lateral movement because of dense fibrosis on medial side resulted in diplopia on dextroversion.
(3) Pterygium has become stationary for last one year and he is unwilling for any surgery further.
Case 2 : Recurrent Pterygium
34 years old lady has undergone pterygium excision once at somewhere else and twice at our hospital with different techniques within a period of 2 years.
Though it has recurred and as she was not ready to undergo any surgery further, in desperation she was put on local infiltration of heavy dosage of steroids at regular intervals. Afrer 5 such sittings the recurrent tissues has thinned out and no further progress of pterygium has been seen in last 6 months. Patient, too, has become symptom free.
Case : 3
A lady aged 43 years had initially presented with total retinal detachment with horseshoe tear in the upper temporal quadrant. Buckling procedure with cryo coagulation was done. Fluid was drained by catholysis.
After few days it was noticed that retina was elevated in the lower part because of one small hole left uncovered. Cryo application, adjustment of plombe and catholysis were done but retina redetached after few weeks with some elements of vitreous traction.
Air was infected intravitreally with placement of local plombe to counteract vitreous traction. Retina went back in position but subsequently patient developed complicated cataract. IOP and occular motility was maintained but interpalpebral fissure had become narrow and eye appeared to be deep seated.
Conventional extra capsular cataract extraction was done after 3 months and subsequently
(1) Patient has normal IOP (16mm of Hg)
(2) Slightly restricted ocular motility.
(3) Retina well placed in its position and vision is 6, 1sub 36 with glasses.
Case : 4
A boy aged 8 years has sustained injury before 3 years and had undergone following surgeries
(I) Repair of corneal wounds-twice.
(2) Anti glaucoma surgery
(3) Lens extraction
(5) Anterior Synechiotomy and Air Injection
At present his IOP is 20mm of Hg. Graft is slightly hazy, full ocular movements and vision is about FC 2 M with Masses
| Discussion|| |
Repeatition of one or the other surgical procedure on the same eye is required at times to retain best possible visual acuity and anatomical integrity till you are forced to evscerate the eye. It arises one question. How many attempts one should make on the delicate tender eye, keeping its normal anatomical integrity ? Many diseases are likely to recurre and when one should stop doing any more surgical intervention so as to save the counter of the eye.
From our observations we feel one should make as many attempts as possible with more and more precautions till you achieve your goal. Every next time one must keep in mind that the eye has already undergone surgery for a few times. And if you can be precise in your surgery with minimum handling of tissue than we believe, that there is no harm doing multiple surgeries on the same eye.
| Conclusion|| |
Many attempts can be made
(1) If area of surgery is different like conjunctiva for Pterygium, cornea for Keratoplasty, sclera for retinal work etc.
(2) If the goal is different like control of IOP, removed of cataract, repair of retinal detachment etc.
(3) If enough time interval is kept between two surgeries.
(4) If enough medications are given to have minimal fibrosis.
(5) If a specific surgery is done without any major complication e.g.
(i) cataract surgery without severe vitreous loss.
(ii) Retinal detachment surgery without
(6) If excessive instrumentation or surgical procedure is avoided e.g.
-excessive cryo, diathermy or heat cautery
-excessive wash of anterior chamber for removal of capsules etc.
-excessive handling of corneal endolthelium
(7) It IOP is kept within normal limits at the end of each surgical procedure by avoiding excessive tying of encircling band etc.
| Summary|| |
Few cases those who have undergone multiple surgeries on the same eye to retain best possible visual acuity and normal anatomical integrity have been discussed and few guidelines have been suggested.