Indian Journal of Ophthalmology

ARTICLES
Year
: 1981  |  Volume : 29  |  Issue : 4  |  Page : 335--337

Intra scleral diathermy in the management of proliferative retinopathy and vitreous haemorrhage


AK Paul, DC Kushwaha 
 Nehru Institute of Ophthalmology and Research, Eye Hospital, Sitapur, India

Correspondence Address:
A K Paul
Nehru Institute of Ophthalmology and Research, Eye Hospital, Sitapur
India




How to cite this article:
Paul A K, Kushwaha D C. Intra scleral diathermy in the management of proliferative retinopathy and vitreous haemorrhage.Indian J Ophthalmol 1981;29:335-337


How to cite this URL:
Paul A K, Kushwaha D C. Intra scleral diathermy in the management of proliferative retinopathy and vitreous haemorrhage. Indian J Ophthalmol [serial online] 1981 [cited 2021 Jan 18 ];29:335-337
Available from: https://www.ijo.in/text.asp?1981/29/4/335/30926


Full Text

The management of proliferative retino­pathy and vitreous haemorrhage, whatever etiology may be, is a great problem for ophthalmologists. There are no effective treat­ment either medical or surgical for this con­dition.

The transperancy of vitreous gel is so essen­tial that any disturbance in the vitreous gel may cause permanent visual disability. The natural resolution of vitreous haemorrhage varies from weeks to year leaving behind some residual changes. The complication of long standing cases of vitreous haemorrhage like retinitis proliferance, retinal detachment, glaucoma etc., are well known.

The growth of new vessel with proliferative changes in the retina and vitreous is seen in number of pathological condition of the retina, commonly as Eales' disease, diabetic retino­pathy, venous occlusion etc. and occasionally become difficult to treat them. Medical treatment is beneficial in early stage. Photo­coagulation has great role in early cases where the media is clear and the changes i.e. new vessel formation are at the level of the retina. The hazy media with long standing cases of proliferative retinopathy and vitreous haemorrhage treatment of any form is difficult, vitrectomv, vitreous replacement etc. are recent advancements in vitreous surgery but with varied results.

 MATERIAL AND METHOD



An attempt has been made in 52 cases of longstanding proliferative retinopathy and vitreous haemorrhage of different etiology to see the effect of intrascleral diathermy operation. In all the cases intrascleral diathermy was done on the lateral aspect. The cases which did not respond to the conventional treatment are taken for the study. Routine examination like slit lamp, tonometry was done. In all the cases media was hazy and the visual acuity was light perception or hand movement only. Time amplitude ultrasonography was perfor­med in all the cases to rule out any retinal detachment. The treatment was carried out in only one eye in the present series.

 OPERATIVE PROCEDURE



Under local anaesthesia limbal based con­junctival flap was made. The laternal rectus muscle was divided 2mm. from the insertion and reflected laterally after putting two 4-0 catgut suture. About 12-14mm. scleral sur­face was exposed. 13-14mm. from the limbus a parallel incision is made and lamellar flap was made about 3 mm. wide. The length of the flap may be 12-14 mm. The scleral flap was reflected from medial to lateral side. Surface diathermy with 2 mm. terminal was applied in two rows from 2-3 sec. in each spot with 50 60 MA current. The scieral flap was closed by fine supramid suture. The cut edge of the lateral rectus was placed in position and two matters sutures are tied. The conjunctiva was closed by continuous black silk sutures.

 OBSERVATION



Routine examination of patient was made after the operation like slit lamp examination, fundus examination etc. The response of the treatment were based on improvement of vision and clearity of the media. All the cases could be followed up on 10th days, 1 months 3 months and 6 months to 1 year period after operation.

 DISCUSSION



The intrascleral diathermy operation in proliferative retinopathy and vitreous haemorrhage cases was tried as the technique is simple and diathermy apparatus is easily available in many centres and post operative complications are almost nil. The hazards of Eales disease with recurrent haemorrhage in healthy young age group of people are well known to all of us. Similarly proliferative cases of diabetic retinopathy. In all these cases where nothing is expected by other treatment, simple diathermy treatment can be tried.

In our series of 52 cases, 20 cases showed some degree of visual improvement after 3 months. 6 cases showed improvement of vision upto 6/18, 6/24 and 6/60 after 6 months to 1 year.

It is not clear that how the procedure helps in clearing the vitreous or improvement of vision but is believed to help by an absorption of the haemorrhage, proliferative bands and the new formation of vessels by heating effect of the diathermy. The permeable new vessels become attenuated and shunk which clear the visibility of the fundus glow.

At present diathermy was done in lateral aspect of the eye but it can be repeated on the medial aspect as well if the first operation is not of any success.

 SUMMARY



52 cases of proliferative and vitreous haemorrhage of different etiology were treated by intrascleral diathermy and the results were evaluated.