Year : 1983 | Volume
: 31 | Issue : 7 | Page : 839--841
Management of pupiliary block glaucoma in early post operative period by a simple technique
AP Shroff, OP Billore, CB Patel, SO Billore
Rotary Eye Institute, Navsari, Gujarat, India
A P Shroff
Rotary Eye Institute, Navsari, Gujarat
|How to cite this article:|
Shroff A P, Billore O P, Patel C B, Billore S O. Management of pupiliary block glaucoma in early post operative period by a simple technique.Indian J Ophthalmol 1983;31:839-841
|How to cite this URL:|
Shroff A P, Billore O P, Patel C B, Billore S O. Management of pupiliary block glaucoma in early post operative period by a simple technique. Indian J Ophthalmol [serial online] 1983 [cited 2022 Jan 20 ];31:839-841
Available from: https://www.ijo.in/text.asp?1983/31/7/839/29681
Sudden flattening of anterior chamber on 5th to 8th day, by the time usually air is absorbed, after cataract surgery with moderate rise of IOP is the condition of pupillary block glaucoma where aqueous fails to make its way from posterior chamber to anterior chamber because of obstruction at the pupillary or iridectomy level.
Though the cataract surgery was eventless, in few cases aqueous was pooled into the retrovitreal space which was already existing alongwith posterior vitreous detachment pre operativtly. In such cases anterior hyaloid membrane was dense and therefore immediate meausre were taken to make a tunnel between anterior chamber and retrovitreal space through vitreous before persistance rise of IOP would lead to disastrous complications and loss of vision.
MATERIAL & METHOD
In this study 10 patients between the age of 50 to 64 years, where 6 male and 4 female and 3 right eyes and 7 left eyes were subjected to this procedure. All but one had eventless intracapsular cataract surgery 5 to 89 days earlier, while one case had planned extracapsular surgery 10 days earlier. 8 cases had raised IOP between 30-40 mm of Hg. while one had 42 and other had 26 mm of Hg. In later 2 cases continuous sutures was fashioned to close corneoscleral wound. Other 8 cases had multiple interrupted sutures. [Table 1]
All patients had complained of headache since previous night and on routine post operative dressing in the morning, anterior chamber in all cases were found to be flat or very shallow. Immediately patients were subjected to applanation tonometry and slit lamp examination. Acetazolamides in adequate dosage were given to lower IOP. Pupils were dilated as much further as possible but without any significant benefit. All patients were subjected to this surgical procedure as early as possible.
Main surgical procedure included a sepatate small wound in intact temporal limbal region. A straight 20 guage needle with 2 c.c. empty syringe was introduced along the iris plane till the pupillary area was reached. Then the direction of needle was changed to about 90° towards posterior pole. Anterior vitreous face was pierced and needle was pushed backwards towards posterior pole to a safe distance till the trapped aqueous gushed into the syringe. The aqueous was sucked till the cornea became concave (saucer like). Needle was withdrawn and through same limbal wound air was injected to reform anterior chamber. Pupil was kept semidilated and eye was patched.
Post operative period was eventless and chamber remained formed in all cases. IOP has remained between 10 to 16 mm of Hg. Slit lamp examination, Applanation Tonometry and Visual recovery were noted on each visit. The cases were followed from 4 months to 20 months.
Post operatively all cases had normal deep anterior chamber with no other anterior segment abnormality. IOP in all cases was between 10 to 16 mm of Hag. Without any anti hypertensive drugs. Vision improved to 6/9 to 6/6 in 3 cases; 6/24 to 6/12 in 3 cases; 6/60 to 6/36 in 3 cases while in one case it was less than 6/60 with glasses. [Table 2].
In many cases slit lamp examination showed a very tiny hole in the anterior vitreous face but none had vitreous in the anterior chamber till they were last seen. Gonioscopic examination revealed open angle in all cases with good peripheral iridectomy.
N.S.Jaffe has mentioned that most patients have posterior vitreous detechment with collapse and pooling of fluid into retrovitreal space even before cataract surgery. Moreover fluid is equal in volume to what was contained within vitreous, therefore it does not push residual formed vitreous forward keeping IOP at normal level.
But when pupillary block glaucoma arises, it is the pooling of additional aqueous into the retrovitreal space by perfusing through the vitreous causes formed antirior vitreous face to buldge forward and block the pupillary and the iridectomy aperture. Therefore the idea is to make a simple nick into the thickned antirior vitreous face so as to have tunnel from anterior chamber to retrovitreal space through vitreous to relieve the pupillary block.
The procedure is very simple, does not require any sophisticated instruments and doesn't have any significant post operative complication. Moreover it has been very effective in controlling IOP in all patients. Angle examination showed almost open angle in all cases as the pupillary block was relieved as early as possible.
Vision improvement is considerable though there is a danger of subjecting the macula to hypotony twice.
As a new wound is made in fresh area, the orginal corneoscleral wound is not disturbed and therefore healing was quite satisfactory.
We found that needle penetration only once through intact Anterior Vitreous face was enough to make a tunnel and we sucked the fluid from retrovitreal space to confirm that needle had passed through the formed vitreous.
Vision in one case did not improve because of old central chorioretinal scar.
This simple technique of making a small nick in the formed anterior Vitreous face so as to make tunnel has been quite effective method to relieve pupillary block in immediate post operative cataract periods in 10 cases.
|1||Jaffe N.S. 1976 Cataract Surgery and its complications; C V Mosby, 220-232.|