|Year : 1983 | Volume
| Issue : 6 | Page : 797-798
RK Maheshwari, RBL Gupta, SK Garg
Gandhi Eye Hospital, Aligarh, India
R K Maheshwari
Gandhi Eye Hospital, Aligarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Maheshwari R K, Gupta R, Garg S K. Scleral wicktrabeculectomy. Indian J Ophthalmol 1983;31:797-8
The failure in trabeculectomy procedure has been attributed to the scarring of the scleral flap of to its bed.
To avoid scarring between scleral flap and its bed a number of procedures have tried in the near past with merits and demerits of their own.
Wick Trabeculectomy is among much methods in which attempted is made to create a permanent filtering fistula with a provision of a wick made out of thin strip of sclera and interposing it between the scleral flap and its bed. Along this wick the aqueous may seep out of the anterior chamber.
Kottow (1979) attempted this procedure, in only 24 eyes with good to excellent results.
The intent of our work is to evaluate the trabeculectomy by scleral wick method in a relatively larger number of cases, also with longer duration of post operative follow up.
| MATERIALS & METHODS|| |
The present series comprised all cases of glaucoma whom we attended during last one year. The cases of congenital glaucoma were not included.
After detailed history, preliminary examination and routine investigations for glaucoma, the patients were put on medical treatment to bring down the intraocular pressure within safe limits. Only those cases were considered for surgery who could not be controlled with the medical treatment.
Routine procedure for trabeculectomy was undertaken and a 5x5 mm. scleral flap was made.
A 2mm wide scleralstrip was cut, leaving attached at its nasal and [Figure 1]b. The scleral strip was dissected free from the underlying uveal tissue. Peripheral iridectomy was performed. The strip was diagonally stitched over the scleral bed with 8/0 silk [Figure 1]c. The scleral flap was now replaced and stitched over the scleral bed with 8/0 interrupted silk sutures. The scleral strip is thus sandwitched between the scleral flap and its bed. The conjunctival flap replaced and stitched with continuous 6/0 silk sutures [Figure 1]d.
Conjuntival stitch was removed after a week and patients were discharged on 10th day with fortnightly follow up for 2 months and then for once a month.
| OBSERVATION & DISCUSSION|| |
Wick trabeculectomy was performed in 121 eyes of 106 patients within the age range of 2580 years of both the sexes. Of these 49 (40.49%) had open angle glaucoma, 46 (38.03%) narrow angle glaucoma, 18 (14.88/) absolute glaucoma and 8 (6.61 %) had aphakic glaucoma [Table - 1].
[Table - 2] shows the average pre and post operative intraocular pressure in different types of glaucoma.
Maximum number of eyes i.e., 118 out of 121 (97.52%) showed an adequate control of intraocular pressure post operatively below 20.0,, Hg. The percentage success rate in different types of glaucoma has also been shown [Table - 3]. Only 3 eyes showed post operative intraocular pressure above .20 mm Hg. and were put on conventional medical therapy.
During post operative followup, the complication were few [Table - 1]
In our relatively larger series of 131 eyes, intraocular pressure was found to be controlled below 20.0mm HG. in 118 eyes (97.52%). It was found to be almost equally effective in primary open angle glaucoma (97.95%), primary narrow angle glaucoma (97.82%), absolute glaucoma (100%). However, its success rate in aphakic glaucoma was slightly less i.e., 87.50% (7 out of 8 eyes). Although it must be admitted that the number of cases in this category were too small to give a firm opinion.
| Summary|| |
A modified procedure of trabeculectomy "Scleral Wick trabeculectomy" was performed in 121 eyes of the 106 patients having different types of glaucoma. The results are very encouraging with very few complication. Post operative followup of these cases upto 45 weeks has been done.
[Table - 1], [Table - 2], [Table - 3], [Table - 4]