|Year : 1984 | Volume
| Issue : 2 | Page : 65-68
Gonio-punch in glaucoma
IP Singh Parmar, RC Nagpal, VS Lodha
Department of Ophthalmology, Medical College Rohtak, India
I P Singh Parmar
Department of Ophthalmology, Medical College, Rohtak
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh Parmar I P, Nagpal R C, Lodha V S. Gonio-punch in glaucoma. Indian J Ophthalmol 1984;32:65-8
Since its introduction by Cairns, the trabeculectomy and its various modifications have become widely accepted and favourite methods of surgical management of glaucoma by most of the ophthalmic surgeons. A number of reports have confirmed that trabeculectomy is a safe and reliable technique with minimum complications and it gives a high success rate in various types of glaucoma, though it was originally introduced for chronic simple glaucoma. This report presents results of Gonio-punch a modified trabeculectomy performed for various types of glaucoma.
| Material and methods|| |
A total of 325 patients (411 eyes) suffering form various types of glaucoma (from March 1978 to December, 1982) have been included in the present study. The distribution of various types of glaucoma are shown in [Table - 1].
Gonio-punch was performed with a modified trabeculectomy technique. A limbus based conjunctival flap was made and the superficial scleral vessels were cauterized. A rectangular or triangular limbus based scleral flap of 2/3rd thickness and 5x5 mm in dimensions was made at 12 O'clock position. A stab incision was made approximately in the anterior part of the trabecular zone at 12 0' clock position. An iris repositor was used to separate the scleral bed from the ciliary body. Apiece of trabecular meshwork was taken out by using Holth's scleral punch forceps. Peripheral button hole iridectomy was done in all the cases except for secondary glaucoma cases due to uveitis in which a broad iridectomy was performed. The scleral flap was sutured back in position by applying 2-4 interrupted 8-0 virgin silk sutures. The conjunctival incision was closed by continuous running/key pattern sutures 4 6-0 silk.
Intra ocular pressure was recorded at the end of first postoperative week and thereafter on regular follow up visits for six months. The cases were in I.O.P. was found to he raised above 21 mmHg (Schiotz) were managed by topical instillation of pilocarpine and oral acetazolamide was administered, if required.
| Observations|| |
Results and complications of the present study are shown in [Table - 3][Table - 4] respectively. The total success rate of surgery alone was 82.5 percent and in an additional 8.8 percent eyes 1.0. P. could be controlled with drugs postoperatively. Most of the complications resolved within 3 weeks of postoperative period except for shallow A.C. and hypotony which persisted in 5.1 and 3.9 percent cases respectively.
| Discussion|| |
The intraocular pressure was controlled (< mmHg Sch.) by Gonio-punch alone in 85.7 percent of eyes suffering from chronic simple glaucoma. The I.O.P. was normalised in another 9.3 percent eyes of this group with addition of topical drugs after surgery. Thus a total success rate of 95 percent was achieved in our series, which is similar to those reported,, a but higher than the results observed by Ridgway et a1 and Mills
In chronic congestive glaucoma group the success rate was 79.4 percent including 14.7 percent eyes which required topical drugs postoperatively. The results reported by Ridgway are higher for the similar group.
Gonio-punch alone normalised I.O.P. in 80 percent eyes with secondary glaucoma while in additional 10 percent I.O.P. was brought under control with topical and oral drugs after surgery.
In aphakic glaucoma group only 8 eyes (42.1 percent) responded favourably to Gonio punch alone and in additional 4 eyes I.O.P. was brought to normal range by administration of topical and oral drugs after surgery. The failure rate in this group has been significantly higher (36.8 percent) than reported by Mills.
The I.O.P. could be controlled by Gonio punch in 6 eyes (75 percent) suffering from congenital glaucoma but the remaining two eyes did not respond favourably even to topical drugs postoperatively.
The combined procedure (Gonio-punch and cataract extraction) normalised I.O.P. in 91.7 percent cases. This success rate is similar to the results observed by other authors. But in the series reported by mills 38.9 percent eyes required additional therapy postoperatively to control I.O.P. whereas in our series 8.3 percept eyes remained uncontrolled even after topical and oral drugs-and other measures like cyclodialysis and cyclocryotherapy were required to reduce I.O.P.
Complications of the surgery have been very few in the present series. Hyphaema occurred in 4.9 percent eyes but it resolved in all cases during the first postoperative week. The incidence of shallow A.C. was 11.2 percent during early postoperative period (1-3 weeks). Out of above the A.C. returned to normal depth in 6.1 percent eyes within first 3, weeks of postoperative period. Two eyes developed malignant glaucoma after Gonio-punch, one from chronic simple glaucoma group and another was from chronic congestive glaucoma group. These were managed successfully by topical cycloplegics and Diamox orally. Mild to moderate anterior uveitis occurred in 17 eyes (4.14 percent) after surgery but it could be controlled in all cases by steroids and cycloplegics. None of the eyes developed uveitis in the late postoperative period (>3 weeks). Hypotony (I.O.P. < mmHg) occurred in 6.3 percent eyes and was diagnosed within first postoperative week. The I.O.P. gradually returned to normal range in 2.4 percent eyes within first three months of postoperative period. In the remaining cases hypotony persisted despite treatment with steroids. However, visual prognosis remained good in all of these cases.
| Summary|| |
Results of the Gonio-punch done in 411 eyes suffering from different types of glaucoma are reviewed in the present report. A modified procedure of trabeculectomy as a Gonio-punch was adopted. The operation proved to be a simple, safe and effective technique for almost all types of glaucoma.
The incidence of operative and postoperative complications was very low which is an important consideration for the selection of any surgical procedure.
| References|| |
Cairns, J.E., 1968. Amer J. Ophthalmol.. 66:673.
Maskati, B.T. and Bakshir, K.K.: 1974. Proceedings of All Ind. Ophthalmol. Vol. XXXI1 : 013.
Singha, S.S., 1974, East Arch. Ophthalmol.. 2:18.
Watson, G.P., 1977, Traheculectomy : Controversy in Ophthalmology, p. 191-199, W.B. Saunders Comp. - N.Y.
Ridgway, A.E.A., 1974, Brit. J. Ophthahnol.. 58: 680.
Mills. K.B., 1981, Brit. J. Ophthalmol.. 65:790.
[Table - 1], [Table - 2], [Table - 3], [Table - 4]