Year : 1979 | Volume
: 27 | Issue : 4 | Page : 109--110
Gurbax Singh Bhinder, Mohinder Kumar Sanghi
M.A.M. College & Associated Hospital, New Delhi, India
Gurbax Singh Bhinder
Associate Professor of Ophthalmology, M.A.M. College and Associated Hospitals, New Delhi
|How to cite this article:|
Bhinder GS, Sanghi MK. Punch trabeculectomy.Indian J Ophthalmol 1979;27:109-110
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Bhinder GS, Sanghi MK. Punch trabeculectomy. Indian J Ophthalmol [serial online] 1979 [cited 2021 Jan 25 ];27:109-110
Available from: https://www.ijo.in/text.asp?1979/27/4/109/32593
Glaucoma surgery still remains a problem for the ophthalmic surgeons, inspite of a wide variety of surgical techniques described.
The idea of present study is to report the results of consecutive punch-trabeceulectomy in all types of glaucomas in order to evaluate the success of this procedure in Indian patients.
Maierials and Methods
Trabecuiectomy was performed in 80 eyes of different types of glaucoma which were fully investigated pre-operatively. There were 42 males and 38 females and age rarging from 10 years to 80 years. These cases were subjected to a detailed examination of optic disc, intraocular pressure, visual fields, tonography and gonioscopy. The types of glaucoma in which surgery was performed were as follows: chronic simple glaucoma: 37 eyes (46.2%), chronic angle closure: 20 eyes (25%), acute congestive: 9 eyes (11.3%) and secondary glaucoma: 2 eyes (7.5%), absolute: 6 eyes (7.5%), post-operatively: 6 eyes (2.5%).
Trabeculectomy was performed in 75 cases under local anaesthesia using 2% lignocaire hydrochloride and five cases under general anaesthesia. Operating spectacles with x 4.5 magnification were used in 40 eyes, operating microscope in 20 eyes and in rest of 20 eyes no magnification was used during surgery.
Preliminary steps were similar to the classical technique. The half thickness scleral flap 5mm x 5mm was raised while dissecting towards the limbus till 1mm of the clear cornea was seen. The anterior chamber was entered by a horizontal incision with the broken blade. A big peripheral iridectomy was performed. This part of the corneo scleral junction was cut with x 1.5mm Holth punch [Figure 1]: Depending on the preoperative tension, one (less than 40 mmHg) or two (more than 40 mm Hg) punch bites wee taken in the sclera.
These cases were dressed daily in the post-operative period using 1% atropine sulphate and 1% tetracyline hydrochloride ointments. The cases were discharged from the hospital after 4 days on atropine oin meet and 0.1% betamethasone drops. They were followed up in the glaucoma clinic for a period of 6 months to 3 years keeping a complete record of intraocular tension, visual acuity, fields, tonography and gonioscopy.
Punch-trabeculectomy was successful to control intraocular tension at below 21 mm Hg. with (4 eyes=5%) or without miotics in 98.8% of the cases. It was ineffective in 1 case (1.2%).
A 100% success rate was seen in chronic angle closure, acute congestive, absolute, postkeratoplasty and other secondary glaucomas. Cases of chronic simple glaucoma showed a control in 97.3% of cases with or without miotics. One case was not controlled even with miotics.
Drainage bleb was seen in 48% of the eyes which were usually diffuse, well covered by conjunctiva and tenon's flap and were posterior in location [Figure 2]. None of these blebs encroached upon the cornea.
Corrected visual acuity fell by two or more than two lines in 7.5% of eyes while in rest of the cases, there had been either no change in visual acuity or it fell by less than one line on Suellen's chart.
Complications were seen in this study in 23 eyes (28.7%). These complications left behind no permanent stigma [Table 1].
It has been generally considered that trabeculectomy can only be successfully performed with a magnification obtained either with a binocular loupe or an operating microscope. In the present study our results revealed that the success of operation was independent of the magnification used. This is enough evidence that the operation is within the reach of an average ophthalmic surgeon with limited resources.
In this study trabeculectomy was successful in 98.8% of cases in controlling the intraocular tension below 2.1 mm Hg in all types of glaucoma. The complications were relatively fewer and minor.
As such trabeculectomy is probably the best standard surgical procedue for glaucoma.
We feel that intraocular tension tends to be lower (less than 16 mm Hg) in cases having diffuse and uniform bleb than those cases where blebs were localized and shallow (17 mm-21 mm Hg).
Visual acuity was not affected in the present study in 92.6% of cases, a finding which favourably compares with the results of other investigators.
Summary and conclusions
1. Punch trabeculectomy was performed in 80 cases of glaucoma with an overall success rate of 98.8%.
2. Cases were operated using operating microscope, operating spectacles and unaided. It was noted that success rate is independent of the technique used.
3. Study reveals that control of intraocular tension is related to the type of bleb.
4. Complications were transient and few.
5. We feel that punch trabeculectomy is the most ideal operation for Indian population as it is easy to perform, gives mostly 100% success rate and has least post-operative complications.
|1||Cairns, J. E., 1968, Amer. J. Ophthal., 66, 673.|