Year : 1983 | Volume
: 31 | Issue : 7 | Page : 920--923
A new of closure of corneo scleral wound in cataract surgery
AP Shroff, OP Billore, RJ Mirza, SO Billore
Rotary Eye Institute Dudhia Talao, Navsari, Gujarat, India
A P Shroff
Rotary Eye Institute Dudhia Talao, Navsari-396 445. Gujarat
|How to cite this article:|
Shroff A P, Billore O P, Mirza R J, Billore S O. A new of closure of corneo scleral wound in cataract surgery.Indian J Ophthalmol 1983;31:920-923
|How to cite this URL:|
Shroff A P, Billore O P, Mirza R J, Billore S O. A new of closure of corneo scleral wound in cataract surgery. Indian J Ophthalmol [serial online] 1983 [cited 2021 Sep 25 ];31:920-923
Available from: https://www.ijo.in/text.asp?1983/31/7/920/29706
Adequate wound closure is desired goal in cataract surgery of the present time. Multiple interrupted sutures or post placed continuous sutures has made it possible, but then it increases post lens delivery operative period and at times one can come across some difficulties when the case is being done under local anaesthesia.
In present series, we have tried to practice Troutman's suture technique with some modifications so as to have advantages of continuous suturing with less post lens delivery operative period.
MATERIALS AND METHODS
This procedure was carried out in 100 cases who had undergone cataract surgery. In all cases intra capsular cataract extraction with cryo technique was aimed at.
Limbal area was cleared by allowing conjunctiva to retract after mild heat cautery near anterior limit of conjunctiva. Half thickness bevelled incision just posterior to the surgical limbus was made by B.P. knife from 2.30 to 9.30 o'clock position.
Stay knots were taken by using 8° Ethilon (monofilament) suture in the conjunctivoscleral tissue about 1 mm away from lower ends of gutter on either side.
Wound was then opened by stab incision and enlarged by corneal scissors. Peripheral iridectomy was done at 12 o'clock position. Then corneal needle of left suture was made to pass through half thickness of corneal and scleral lips of wound by taking atleast 4 bites keeping almost equal distance between each bites and having acute angle at each, corner before it was finally taken out from scleral tip at 12 o'clock position. Similarly right suture was fashioned from opposite direction and finally taken out at 12 o'clock position, keeping minimum distance from the first suture. Loops were retracted on either side in such a way that lens could be delivered by cryo without any difficulty. Corneo scleral wound was closed in upper part immediately by pulling two central sutures, no sooner the lens had been delivered. Then loops were adjusted and fastened to just oppose the wound. If required iris was reposited so as to have round pupil. Chamber was reformed by air. Then sutures were tightened so as to have adequate closurt, of the wound, before tying the two sutures in the centre. Three knots were cut leaving slightly longer ends for easy removal of suture post operatively.
Sutures were removed in toto after 5-6 weeks. Operative and post operative observations and visual improvement with glasses were noted on almost all post operative visits. Glasses in 72 cases were advised after 6-8 weeks and cases were followed up for 3 to 12 months.
Out of 100 cases, 61 were male and 39 were female. 54 right eyes and 46 left eyes were operated. 49 patients were between the age group of 51 to 65 years, while 24 cases were in age group of 66 to 80 years and above [Table 1].
There was accidental extra capsular cataract extraction in 7 cases (almost equal No. in each group). Out of 14 cases those who had vitreous prolapse, 11 cases had fluid vitreous only in Ant. chamber, while two cases had it in the wound and one case had it outside the wound on sclera. [Table 2].
72 cases out of 100, were followed till the final visual acutiy with glasses was tested. 36 cases improved beyond 6/9. 24 cases improved between 6/18 to 6/12 and 10 cases upto 6/24 only, while in 2 cases visual recovery was too less to record on Snellen's chart. All these 12 cases had pre-existing other ocular pathology [Table 3].
[Table 4] reveals very small degree of astigmatism in 38 cases while 21 cases had moderate degree. 13 cases had high degree of astigmatism out of which in 9 cases ,sub stitches were yet to be removed.
Out of anxiety in early few cases we noticed vitreous disturbances but gradually frequency was very less. We do not see any other reason except slight anxiety and over maturity of cataract for accidental extra capsular cataract cases.
Good visual recovery in 60 cases (beyond 6/18) was because of less operative and post operative complications. In 12 cases vision did not improve because of underlying pathology.
We have observed high degree of astigmatism in early post operative period but it reduced rapidly after stitches were removed. High degree of astigmatism persisted in those cases where stitches could not be removed. Therefore, it is felt the removability in this technique is an added advantage.
As the post lens delivery operative period was very less (average 60-100 seconds) corneoscleral-wound could be secured very promptly. It was better managed particularly when vitreous was disturbed, or facial block was fading away or patient was becoming impatient.
We noticed less difficulty in placing the sutures before lens delivery and it was easy to have point to point apposition. Long ends of knots made it easy to cut the knots and remove the suture in toto. Adjusting the loops and make them regularised after lens delivery is tricky by not difficult at all.
The closure of corneo-scleral wound by preplaced continuous sutures (Troutman's type) in 100 cases proved to be prompt and gave accurate point to point apposition of wound edges with easy removability post operatively thereby minimising the astigmatism. Good visual recovery was achieved in more than 80% cases. In remaining cases though good post operative condition, vision did not improve because of pre-existing pathology.