|Year : 1985 | Volume
| Issue : 3 | Page : 163-166
Scheie's operation-a retrospective study
BS Jain, SR Soni, AN Mehrotra
Department of Ophthalmology, M.L.B. Medical College Jhansi, India
B S Jain
Department of Ophthalmology, M.L.B. Medical College Jhansi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain B S, Soni S R, Mehrotra A N. Scheie's operation-a retrospective study. Indian J Ophthalmol 1985;33:163-6
It was Schie who suggested a very simple effective and convenient method of thermocautery of limbal incision wound lips, instead of original electrocoagulation method of Preziosi. This procedure has been in wide use however, this procedure is not free of operative and post operative complications. The study was undertaken to look into the complications in relation to the controlled tension after Scheie's operation.
| Material and methods|| |
A total number of 76 glaucomatous eyes of 61 patients were treated with Scheie's procedure and followed a period of four years from January, 1979 to December, 1983.
All these eyes were subjected to the detailed clinical examinations and various investigations including slit lamp examination, visual acuity, visual field (as and when feasible), Schiotz, tonometry, fundoscopy and gonioscopy etc.
The eyes were operated by standard Scheie's procedure under local anaesthesia. The data were complied and analysed on the completion of the study.
| Observations|| |
Age of all the 61 patients was ranging between 30-66 years. Age and sex distribubution shows more involvement of females (M:F = 1 : 2) and most of the patients were belonging to the age groups of 30-40 years and 41-50 years [Table - 1]. Thus total 76 glaucomatous eyes, constituting chronic simple glaucoma (43.9%), chronic angle closure (27.06%), Acute congestive (22.37%) and mixed variety (6.5%); were subjected to Scheie's operation.
Prior to the operation 51 eyes (the maximum) were having the raised tension in range of 31-40 mm Hg, whereas the visual acuity 6/18-6/36 was found in maximum of eyes [Table - 2].
During the operation the complications were minimal. The blood surging from iris and/or corneoscleral wound edges caused hyphaema and the accidental button holing of conjunctiva was seen in a few. The delay in the anterior chamber reformation which took place by 2-5 days in most of cases [Table - 4]. However, none of these eyes needed surgical intervention for reformation of anterior chamber. The other complications like iritis of mild/moderate severity, progress in the opacification of lens and closure of surgical cleft were noted as well.
Lasting hypotony (tension < 10 min Hg) was exhibited by 16 eyes at 1 month follow up, later the tension got build up in 13 eyes and only 3 remained hypotonic throughout the follow up. However, the intra ocular tension raised above 21 mm Hg in 13 eyes (out of 57 observed) and the acuity of vision was found in the range of 6/18-6/36 in maximum 46 eyes [Table - 2].
Thus the over all control of IOP [Table - 3] have seen to be 81.15% at the end of follow up period of four years. One eye which had a controlled intra ocular tension ( < 21 mm Hg) till 36 month's follow up showed an obvious rise in the intra ocular tension afterwards and thus it was excluded from the list of successfully controlled cases though later controlled with the administration of 2% pilocar pine eye drops 3 times daily.
There was a formation of filtering bleb in 64 eyes. The maximum 32 (42%) eyes had thin cystic including 4 (5.2%) encroaching cornea. Four of the blebs exhibited imminent scarring.
| Discussion|| |
Scheie's operation even today is quite popular in spite of the introduction of trabeculectomy. Present study was undertaken to see the long term effectiveness and the complications of this operation.
A total of 76 eyes of 61 patients were operated and followed for a maximum of 4 years. The age of patients was ranging from 30 to 70 years with a mean (± standard deviation) of age-45.1 (± 9.3) years and male to female ratio was 1 : 2 [Table - 1]. Previous reports of Viswanathan et a1, Singh et al etc. are similar.
The post operative complications were a few relatively viz. button holing of conjunctiva - 2 eyes, hyphaema-16 (20.9%) eyes which was reabsorbed within 3-5 day without any special treatment. The delay in the anterior chamber formation was seen in 11 (15.7%) eyes, which took 3-5 days for reformation. Similar results were noted by Nadel et a1 in 2%, Bondeu et a1 in 8%, Tyner et a1 in 16.8%, Spaeth et al in 13.8% eyes in which the conjunctival button holing and hyphaema was recorded. This shows the common occurrence of these complications even in best of hands. The reported incidence of shallow anterior chamber way quite common e.g. in 43.3% by Scheie, it 58% eyes by Berson etc.
Our results were quite good, may be as reward of careful handling of the tissue, with controlled intraocular tension in 77.2% (44 out of 57) eyes at the ultimate follow up; however, on an average 81.1% of the eyes were having the controlled tension. These results are well comparable with those of Nadel et a1, 73.6%, Bakker et. a1 74% and Spaeth et a1 75% etc.
The hypotony was seen in 3 (3.9%) eyes which is incidentally similar to Tyner et al and Scheie 7.4% and Nadel 8.6%. Milc to moderate iritis was seen in 31.4% (24; eyes. The workers in past reported ever higher incidence of iritis like Poly Kronako s 58.3% and lower incidence like Natarajan el. This reflects that the incidence varies from worker to worker probably due to indi. vidual susceptibility to operative handling. The opacification of lens was seen in 5 (11.8%) eyes definitely and in 19 eyes doubtfully which can well be compared to the reported incidence by Sugar 18% and Allen 32% etc.
Thus the study shows an excellent control of the intra ocular tension with a few complication, which easily responded to medical treatment alone.
| Summary|| |
A total of 76 eyes of 61 patients operated for glaucoma by Scheie's procedure and followed up for a period of 4 years. The maximum of the patients were from 3rd and 4th decade of age with male to female ratio of 1 : 2. The control in the tension was achieved in 81.1% cases, with a few complications.
| References|| |
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Nadel, A.J. 1966, Amer J. Ophthalmol. 62: 955.
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Tyner, G.S.; Lahey, D D ; Elliff, C.E. and Watts, H A., 1960, Arch. Ophthalmol. 64: 408.
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[Table - 1], [Table - 2], [Table - 3], [Table - 4]