Year : 1984 | Volume
: 32 | Issue : 5 | Page : 399--401
Evaluation of combined procedure: Penetrating keratoplasty and anterior vitrectomy by vitrophage
AP Shroff, OP Billore, RJ Mirza, PH Masani
Rotary Eye Institute, Navsari, Dudhia Talao, Navsari, Gujarat, India
A P Shroff
Rotary Eye Institute, Navsari, Dudhia Talao, Navsari 396445, Gujarat
|How to cite this article:|
Shroff A P, Billore O P, Mirza R J, Masani P H. Evaluation of combined procedure: Penetrating keratoplasty and anterior vitrectomy by vitrophage.Indian J Ophthalmol 1984;32:399-401
|How to cite this URL:|
Shroff A P, Billore O P, Mirza R J, Masani P H. Evaluation of combined procedure: Penetrating keratoplasty and anterior vitrectomy by vitrophage. Indian J Ophthalmol [serial online] 1984 [cited 2022 Jul 6 ];32:399-401
Available from: https://www.ijo.in/text.asp?1984/32/5/399/27521
Long term follow up of aphakic cases, in whom vitreous had escaped into the anterior chamber during cataract surgery, mainly present with the problem of bullous keratopathy because of thick vitreo endothelial adhesions.
Before a decade or so, keratoplasty being a complicated and unpredictable surgery, was not frequently recommended in old aphakic patients, but now the matter is different Improvised suture material, excellent magnification devices, vitrectomy, healon etc. have totally changed the outlook in such patients.
MATERIAL AND METHODS
In present series of 15 cases, 11 were male and 4 were female between the age of 25 to 69 years. 9 were left eyes and 6 were right eyes. Cataract surgery was performed 1 year to 3 years prior to this surgery in 11 cases. As majority of cases were operated elsewhere exact details were not available. All cases were given a fair trial of medical therapy over a period of 2 to 3 months. Majority of cases (10) were agreed upon to undergo second surgery as a symptom relieving measure only e.g. pain, off and on watering, photophobia etc, 4 cases had perforated corneal, ulcer following infection.
Initially they were treated by medical line of treatment but ultimately cornea melted or perforated.
Clinical evaluation on slit lamp biomicroscopy, applanation tonometry, indirect ophthalmoscopy to reveal any posterior fundus pathology, retinal visual acuity to assess visual improvement preoperatively on Rodenstock Retinometer were done, alongwith other routine and general investigations in aphakic bullous keratopathy cases.
In aphakic cases 3 mm sclerotomy wound was prepared for anterior vitrectomy in lower outer quadrant. Edges were diathermised and 6° nylon suture was preplaced. 7.5 to 8.5 mm full thickness corneal graft from fresh donor corneas were sutured using 10° nylon or Dermalon suture (13 cases) and 8°,ethilon suture (in 2 cases) in continuous fashion.
During the procedure escaped vitreous was cut away with scissors and fluid vitreous was aspirated from vitreous cavity by 18 gauge straight needle. Corneal wound was adequately secured by tightening the suture at least 2 to 3 times and only one knot was given to keep it secured.
The surgical technique differed in cases of perforated corneal ulcers., where corneal graft . was transplanted first and then the sclerotomy wound was made. Moreover opaque lens was removed on table only.
Anterior vitrectomy by Peyman's vitrophage through pars plana was done as thoroughly as possible to make the anterior chamber free of any residual vitreous. The previous knot was secured further and the procedure was concluded. The procedure was performed under marcaine anaesthesia in 13 and general anaesthesia in 2 cases. Routine post operative dressing done and notes were prepared.
Cases have been followed up for 10 to 16 months.
In group of Bullous keratopathy [Table 2] larger area of cornea gets involved as the time after cataract surgery passes by. Moreover, there is a marked deterioration of vision where more than 8 mm of cornea was involved. Visual improvement was grouped in 3 grades (as shown in [Table 2]) and accordingly pre-operative vision was grouped so as to compare post operative improvement. 2 cases of less than 6 mm corneal involvement who had visual acuity between 3/60 to 6/60 improved to 6/36 to 6/24 with glasses. Graft remained clear even after 12 to 16 months. Out of 5, 3 cases of B group where corneal involvement was 6 to 8 mm, had vision between 3/60 to 6/60, and out of 3 cases graft had remained clear and vision had improved to 6/36 to 6/24 with glasses. In one case, though graft had remained clear, vision neither improved nor deteriorated. 2 cases in whom vision was this series of 15 cases where 11 cases were of aphakic bullous keratopathy and 4 cases of large perforated corneal ulcers or abscess, penetrating keratoplasty with anterior vitrectomy by vitrophage has certainly given encouraging results.