|Year : 1983 | Volume
| Issue : 6 | Page : 769-770
Inducing pre-operative hypotony for intra ocular surgery
S Tony Fernandez, Jayan Thomas
C. B.M. Ophthalmic Institute, Little Flower Hospital, Angamally-Kerala, India
S Tony Fernandez
C.B.M. Ophthalmic Institute, Little Flower Hospital, Angamally, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Fernandez S T, Thomas J. Inducing pre-operative hypotony for intra ocular surgery. Indian J Ophthalmol 1983;31:769-70
Introducting hypotony for intra ocular surgery has become the essential step for any intra ocular surgery especially for cataract extraction and for intra ocular lens implant. Low tension will avoid loss of vitreaous during surgery and retain air bubble in the eye, helping to introduce the intra ocular lens without damaging the ecdothelium. General methods like I.V.Manitol, Diamox etc. were used systemically to reduce the tension. Other local measures described for reducing intra ocular tension are :
1. Finger Pressure Method
2. Paediatric B.P.Cuff Method
Aim of the Study: Our aim is to introduce a new and convenient method of inducing preoperative hypotony. The method was introduced to us by Prof. V.Muller of West Germany. The effective pressure over the globe when measured was found to be about 550 gms. After retrobulbar and facial block, the weight is placed over the eye ball of the patient over an eye pad.
This method is compared with Finger Pressure Method:
1. To study the rapidity of the reduction of the tension in various groups.
2. To study the operative and post operative complications if any.
| MATERIALS & METHODS|| |
200 patients on whom routine cataract surgery or intra ocular lens implant surgery was done were subject to the study. In 100 cases Finger Pressure Method was used and in 100 cases Balanced Weight Method used.
1. Tension was noted after retrobulbar injection was given.
2. Tension was noted 5 minutes after Finger Pressure Method or Balaced Weight Method.
3. 7 minutes later tension was again repeated and noted down.
Tension was taken with Schiotz Tonometer which was previously sterilized in hot air sterilizer. In between, spirit was user to clear the base.
| Observations|| |
Average reduction of tension in these cases was noted as follows:
Complications: There were hardly any significant complications. Slight subluxation of lenses was noted on the, table in 2 cases in each group but did not give rise to any complications on extraction.
Vitreous Loss: In 2 cases in each group fluidvitreous loss was noted. In none of the cases normal vitreous loss were noted.
Post Operative Complications Noted: In one
case a Central Vein Thrombosis was noted. We are not very sure whether this had occured before the operation or during the operation.
The Points Noted Are As Follows:
1. After 5 minutes reduction of tension in both these methods was compartevely low to undertake surgery.
2. Older patients especially those above 55 - 65 years showed more reduction in tension than younger patients.
3. After 2 more minutes of applying the weight, the reduction was more dramatic. In some cases the tension was so low, that it could not be recorded.
Advantage of Balanced Weight Method:
1. Convenient and easy to apply as compared to finger pressure or paediatric cuff method.
2. Time of application was much less as compared to paediatric cuff method.
3. The balanced weight method was labour saving method as compared to finger pressure method, as the doctor does'nt have to attend to the patient after applying the balanced weight.
| Summary|| |
A new and convenient method of inducting pre-operative hypotony. The redution of tension with the balanced weight method is described and in both the methods was comparable but the balanced weight method was more convenient in application. Old aged people showed rapid reduction in tension as compared to younger age group. Vitreous loss was minimal. In 2 cases in each group, slight subluxation of the hypermature lenses occured. Therefore care should be taken in applying this methods in hypermature cataract.
[Table - 1], [Table - 2], [Table - 3]