Year : 1963 | Volume
: 11 | Issue : 1 | Page : 1--3
Glaucoma with cataract
Krishnaswami Mehra, TK Dutta
Gandhi Eye Hospital, Aligarh, India
Gandhi Eye Hospital, Aligarh
|How to cite this article:|
Mehra K, Dutta T K. Glaucoma with cataract.Indian J Ophthalmol 1963;11:1-3
|How to cite this URL:|
Mehra K, Dutta T K. Glaucoma with cataract. Indian J Ophthalmol [serial online] 1963 [cited 2021 Jun 13 ];11:1-3
Available from: https://www.ijo.in/text.asp?1963/11/1/1/38822
Glaucoma has been a problem for ophthalmologists for many decades. Many different operations have been devised for it, but still the situation is confused. When glaucoma is accompanied by lenticular changes, the picture then becomes more complex and leaves the ophthalmologist in a dilemma.
If the lenticular changes are very early and the tension is high, then the treatment is clearly for the raised tension and nothing has to be done for the lenticular changes. When the tension is raised and lenticular changes are marked so that loss of vision can be accounted for by the lenticular changes as well, the treatment should still be towards bringing the tension down first.
When raised tension is due to the lens e.g. a hypermature cataract or exfoliation of lens capsule, then also the aim of the ophthalmologist is to reduce the tension by miotics and acetazolamide, before lens extraction can be done. Vail (rg49) is of the opinion that in such cases, the lens should be removed first, even if the tension is quite high.
A real problem arises when the intraocular tension ranges between 25 to 35 m.m. of Hg. and along with it there are marked lenticular changes. It was our particular endeavour to find out the best line of treatment for such cases.
In our series we took patients who had immature cataract along with raised tension ranging between 25 and 35 m.m. of Hg.
These patients were examined with a slit lamp and gonioscope, and tonometry with aplanation and Schiotz tonometer were done. Out of these, in some patients fundus examination was not possible due to presence of lenticular opacity, while there were others where a glaucomatous cupping could be seen with an ophthalmoscope.
We divided the cases into three groups:
Group 1- If intraocular tension ranged between 25 to 35 m.m. of Hg., then under cover of Diamox and pilocarpine merely an intra capsular extraction along with broad basal iridectomy was done.
Group 2.-If the tension was above 35 m.m. of Hg, then they were put on miotics and Diamox, and their effect was seen for a week. If after a week the tension came down between 25 and 35 m.m. of Hg, then again a lens extraction with broad basal iridectomy was done.
Group 3.-If the intraocular tension persisted in running higher than 35 m.m. of Hg. then first a filtering operation was done.
This paper is a report on fifty patients - out of this thirty-five belonged to group one, while fifteen belonged to group two.
Patients in whom fundus details could not be made out due to presence of lenticular opacity, after the lens extraction showed the presence of glaucomatous cupping. Thus eight out of the fifty patients had glaucomatous cupping.
After doing lens extraction with a broad basal iridectomy the intraocular tension was normalized in 46 patients out of this series of 5o patients, whose intraocular tension before the operation ranged between 25 and 35 m.m. of Hg.
In patients having raised intraocular tension with cataract the majority opinion is in favour of doing first a fistulising operation and a cataract extraction later. This procedure has been followed by Gifford (1943). Guyton (1f)45), who has shown that in 44 eyes of his patients having primary glaucoma and cataract, if the tension did not come under control by miotics, then a fistulising operation was done, but if the tension got controlled by miotics then cataract extraction alone was the operation of choice.
O'Brien (1947) prefers one stage operation in such patients. He does an anterior sclerectomy at the time of cataract operation. Gradle and Sugar (1947) and Vail (1949) have again advocated first a fistulising operation and later on a lens extraction.
Then came the idea of trying lens extraction alone in patients having slightly raised tension along with a cataractous lens. Knapp (1947) in a series of nine patients having raised tension .found that mere lens extraction brought down the tension within normal limits. Pillat (1949) has shown that intracapsular extraction in glaucoma patients does not give any extra hazards. Ramsay (1950) has further confirmed this view that if intra ocular tension is upto 35 m.m. of Hg, then a cataract extraction alone brings down the intraocular tension within normal limits. Lee and Weih (1950) are also of the same opinion, that if the tension is not higher than 35 m.m. of Hg, and a cataract operation is indicated, then the extraction of the lens may be the initial and often the only operation necessary to bring down the intraocular tension within normal limits.
Wennas and Stert Zbach (1955) combine filtration and extraction of lens in one procedure, as a two-stage operation has got its own problem. They have concluded that the combined operation is a good choice of operation for such patients.
How can extraction of lens help in restoring normal intraocular tension in such patients is a surprise. Some like Becker are of the opinion that lens extraction itself starts a reflex action and the secretion of aqueous by ciliary body is diminished. While others are of the view that lens extraction might be increasing the coefficient of aqueous outflow and thus responsible for maintenance of intraocular tension within normal limits.
The danger of having prolapse of vitreous at the time of lens extraction, when the tension is raised, is of course dreaded. We were a bit reluctant to do lens extraction in such patients at first, but we noted to our surprise that the danger of prolapse of vitreous is much exaggerated.
Complications-In our series of 50 patients there was very slight prolapse of vitreous-only in two patients. One patient had vitreous haemorrhage. Two patients had delayed formation of anterior chamber and choroidal detachment. Choroidal detachment disappeared within 20 days of operation.
Summary and Conclusion
Results of operative procedure in patients having cataract with glaucoma are . studied. In a patient, having raised tension and cataractous changes in the lens, if the tension cannot he brought down lower than J5 m.m. by miotics and acetazolamide, a fistulising operation should be done, followed by cataract extraction at a later (late. If the tension of such patients is either between 25 to 35 m.m. Of Hg, or can be brought down to this level by medical treatment, then merely a lens extraction with broad basal iridectomy at one sitting can restore the tension to within normal limits.
In a follow up of one year, the tension in such patients after a cataract extraction with broad basal iridectomy was observed to have remained under control, without use of any supplementary medications.
|1||Becker: Symposium on Glaucoma C. V. Mosby Company, 1959|
|2||Gifford. S, R.: (1943) Amer. J. of Ophthalmology. 26, 437|
|3||Gradle. H. S. and, Sugar. U.S. (1947) Amer. J. of Ophthalmology 30, 12.|
|4||Guyton, J, S.: (1945). Arch. Of Ophthalmology. 33, 265.|
|5||Knapp. A. : (r947) Arch. of Ophthalmology 38, 1.|
|6||Lee, O, S and Weih. J. E.: (1950) Arch. of Ophthalmology 44, 275.|
|7||O'Brian C.: (1947) Arch. of Ophthalmology, 37, 4.|
|8||Pillat, A.: (1949) Arch. of Ophthalmology. 42, 567|
|9||Ramsay. G. A. S.: (1950) Arch. of Ophthalmology. 43, 195.|
|10||Vail. D, Sternberg. P; and Meyer S. J.: (1949) Amer. J. of Ophthalmology, 32, 1954.|
|11||Wenaas. E 1, and Stert Zbach. C. W. (1955). Amer. J. of Ophthalmology. 39, 71.|