|Year : 1984 | Volume
| Issue : 2 | Page : 73-75
Trepano-trabeculectomy (a combined operation for glaucoma)
VN Prasad, M Narain, HK Bist, MM Khan
Department of Ophthalmology, BRD. Medical College, Gorakhpur, India
V N Prasad
Department of Ophthalmology, B.RD. Medical College, Gorakhpur (U.P.).
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Prasad V N, Narain M, Bist H K, Khan M M. Trepano-trabeculectomy (a combined operation for glaucoma). Indian J Ophthalmol 1984;32:73-5
|How to cite this URL:|
Prasad V N, Narain M, Bist H K, Khan M M. Trepano-trabeculectomy (a combined operation for glaucoma). Indian J Ophthalmol [serial online] 1984 [cited 2021 Jan 21];32:73-5. Available from: https://www.ijo.in/text.asp?1984/32/2/73/27374
Various conflicting results have been obtained by different authors with trabeculectomy Singha 13 observed 96%, Maskati 90%, Mehta 85.97%, Cairns 100%, David (1977) 73.4%.
Various modifications of the procedure have appeared in the literature from time to time. Watson (1910 & 1975), Nestror (1972) and Welsh (1972).
As a consequence of many encouraging reports trabeculectomy is assuming increasing importance in the management of glaucoma. Now trabeculectomy is considered as a primary line treatment. Having this development in mind, we perform a trabeculectomy combined with trephine, an old filtering operation for glaucoma. Particular emphasis is given not only to control the intraocular pressure but also on operative and post operative complications.
| Material and methods|| |
71 eyes of 61 patients were selected for the study.
They were divided according to various groups according to types of glaucoma [Table - 1]. All cases were investigated and intraocular pressure was recorded preoperatively at first, secondly post operatively on the 8th day, at the time of discharge and thirdly after 15 days, then after one month and after that at three months interval.
| Surgical technique|| |
After giving the proper local anaesthesia a deep conjunctival flap is made 7 mm. above from the limbus extending from 10 to 2 O'clock. A complete haemostasis is obtained by cauterizing the bleeders. A scleral flap of partial thickness of size of 5X4mm is made extending upto limbus. Cornea is splitted in two layers by tooke's knife of about 2 mm. Now with the help of 1.5 mm size Elliot's trephine, putting it half on the corneal side and half on scleral side a opening is made at limbus. Prolapsed iris is cut & reposited. Scleral flap is stitched by 10 zero mono filament suture. These are burried suture and need not to be removed. Conjunctival flap is stitched by continuous sutures.
| Observations|| |
Present study was conducted in over 71 eyes of 61 patients of various types of glaucoma. [Table - 1]. Their preoperative intraocular tension was recorded by the Schiotz tonometer. These cases were divided in to 3 groups. First having the intraocular tension from 26.6 to 35.8 mm of Hg. Second group having intraocular tension from 35.8 to 59.1 mm Hg. and third group from 59.1 mm of Hg and above [Table - 2]. Maximum number of eyes had tension from 36 to 56 mm. of Hg.
It was considered to be successful when the intraocular tension was reduced to 19 mm of Hg or less, with or without additional medication for the total followup period.
There was no complications during surgery. In the first three days after operation three eyes (4.2%) had hyphaema in the anterior chamber and two eyes (2.8%) had iritis [Table - 4]. These complications resolved with in a week. But two out of total shows flat bleb after six weeks. After tonometry it was observed that tension was raised in both eyes. In remaining cases the bleb was diffuse and working properly with out any complication. Total follow up period ranged from a minimum of three months to a maximum of two years. 36 eyes (50.7%) being followed up for more than one years. Five cases required additional medication to control intraocular tension after surgery. Among these one was of congestive type and four were chronic simple type glaucoma.
| Discussion|| |
Cairns who first introduced the trabeculectomy for the management of chronic simple glaucoma, consists of removal of trabecular mesh work, with a part of Schlemm's. canal thus enabling the aqueous to reach the canal of Schlemm and flow in the episcleral veins in the normal way Duke-Elder Suggested that in advanced cases of glaucoma, canal of Schlemm may be entirely obliterated. So drainage through the cut end was out of question. But, now it is thought that the Sub conjunctival drainage is the main factor in trabeculectomy like any other fistulizing operation. We are agreed with Richardson, Watson and Nestror that the mechanism is through sub conjunctival drainage and partially through cyclodialysis. Our 97.2% success rate is in favour of Sub conjunctival drainage and thus giving the better results.
The study shows, the better results than Mehta 85.9%, Maskati 90%, Singha 96%, Maria 93.3%, Maselli 96.7%, in cases of chronic simple glaucoma and also shows better in cases of absolute glaucoma in comparison to Malik and Mehta.
No complication was noticed during the surgery as was also observed by Watson Singha, Dutta and Maria. Post operative complications were also minimum. Hyphaema was observed in 3 eyes (4.2%) and iritis in two eyes (2.8%), in comparison to Maria hyphaema 4 eyes (8.9%), Iritis 3 eyes (6.6%) Maseli and Singha.
Gangwar reported two cases of complications of trepano trabeculectomy in form of flat bleb due to adhesion of Scleral flap to its bed. In present study two cases of flat bleb were also reported, the cause might be the adhesion of scleral flap to its bed, but both were not reoperated.
| Summary|| |
The modified technique, of trabeculectomy with trephine of glaucoma operation was performed on 71 eyes. This combined operation gives the better results in comparison to single operation i.e. trabeculectomy. Post operative complications were also minimal.
| References|| |
Cairns, J.E. 1968, Amer. J. Ophthalmol. 66:673.
Duke-Elder S., 1969, System of Ophthalmology Vol. II, diseases of lens and viteous, glaucoma and hypotony. Henrey Kimptom, London.
Richardson, KT. 1968, Invest, Ophthalmol, 7:137.
Watson, P.G., 1975, Amer. J. Ophthalmol. 79:831.
Mehta, KR., 1974, Indian J. Ohthalmol. 22:9.
Maskati, B.T. 1974, Proc. Indian Ophthalmological society Vol. 31:32.
Mills, KB. 1981, Br. J. Ophthalmol. 65:790.7. Singha, S.S. 1974. East. Arch, Ophthalmol, 2:18.
Maria, D.L. and Kachole Vidya, 1980. Ind. J.Ophthalmol. 28:81.
Maselli E. Galautino G., Pruneri, F. and Sirllini, M.1977, Br. J. Ophthalmol. 61:675.
Malik, S.R.K. 1976, Proc. 5th Afro Asian Confress of Ophthalmolgy.
Dutta, L.C. 1974, Proceedings of all India Ophthalmological society Vol. 31.
Gangwar, D.W., Bansal, S.C., Jain, I.S. and murthy, G.V. 1982, Ind. J. Ophthalmol. 31.
[Table - 1], [Table - 2], [Table - 3], [Table - 4]