Year : 1983 | Volume
: 31 | Issue : 7 | Page : 836--838
Combined trabeculectomy and cataract extraction
Nalanda Medical College Hospital, Patna, India
Nalanda Medical College Hospital, Patna
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Sinha A. Combined trabeculectomy and cataract extraction.Indian J Ophthalmol 1983;31:836-838
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Sinha A. Combined trabeculectomy and cataract extraction. Indian J Ophthalmol [serial online] 1983 [cited 2021 Sep 28 ];31:836-838
Available from: https://www.ijo.in/text.asp?1983/31/7/836/29680
Lens Induced Glaucoma is a surgical emergency. Removal of the lens after controlling the intraocular pressure is the treatment of choice. The intraocular pressure pre-operatiyely is controlled by Acetazolamide. The pressure may or not be fully controlled by acetazolamide and hence lens extraction is always done under mannitol 10% infusion. In some of these cases inspite of successful removal of lens the cases did not maintain a normal intraocular pressure and passed into absolute glaucoma gradually. For this reason it was thought to do a filteration operation along with lens extraction. 102 cases were done with combined trabeculectomy lens extraction. Their results have been satisfactory and they are presented below.
MATERIALS AND METHODS
All cases of lens induced glaucoma had thorough clinical examination with special reference to duration of the disease, the I.O.P. and gonioscopic finding. Preoperatively they were put on Diamox (1000 mg. daily) and chloromphenical drops. No miotics or mydriatics were used in these cases. For 24/48 hours they were kept under observation and then subjected to combined trabeculectomy catract extraction. Preoperatively on the operation table the tension was measured every 15 mts. while the mannitol transfusion (a 90 drops per minute were given. If even after 30/45 minutes the tension did not come below 30 mm Hg. in to cases it was decided to do Trabeculectomy only and lens extraction later,but in these cases when I.O.P. controlled below 30 mm Hg. trabeculectomy lens extractions was carried on.
Removal of the lens in cases of lens induced glaucoma has to be planned at the earliest within 24/48 hours. During that period the I.O.P. has to be controlled by Diamox. The problem of side reactions to actazolamide has rarely to interfere in these cases as this has to be used for a very short period. Along with actazolamide the lens extraction is done under mannitol 10 % infusion within I to 2 days. The earlier it is done better are the results with visual acuity point of view. It was also observed that the cases with shorter duration of the diseases has very good visual acuity recovery where as those with more than 5 days duration did not have such a good prognosis. Longer the duration of the disease changes in the endothelium took place. Element of uveitis were more and more and PAS developed.
The notable observations were that lens induced glaucoma never occured below the age of 40 years and surprisingly it was noted that the incidence of this condition is double among the females compared to that of males.
In surgery first trabeculectomy is done with slow release of aqueous and then the edges of the trabeculectomy hole is extended with corneal scissors on both sides. Utmost care of the lens to be taken so that the lens is not damaged as the AC is very shallow. In these cases the suspensory ligament are very weak, hence lens delivery is never a problem provided the I.O.P. has been well controlled during surgery. Inspite of all the care to keep the I.O.P. well within normal some of the cases did not show very settled I.O.P. to proceed for combined surgery.
Six cases in the series showed vitreous loss on the table inspite of all the precautions.
The post operative complications were as usual, Hyphaema, shallow AC, Uveitis, infection, vitreous loss and persistant raised I.O.P. They were tackled on usual lines and recovery was smooth. The cases with raised post operative I.O.P. were kept on diamox which did not behave well on long follow up and 3 of these cases passed into absolute glaucoma.