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Cataract Extraction After Filtering Operations

Cataract Extraction After Filtering Operations Abstract The site of incision for cataract extraction after filtering operations has been a subject of prolonged debate. This presents a serious problem because of the close relationship to delayed reformation of the anterior chamber and failure of the filtering cicatrix with recurrence of glaucoma. The literature was reviewed, and a technique for cataract extraction through a perpendicular incision made superiorly in clear cornea with no conjunctival flap was described by one of us (H.G.S.) in 1956.1 Encouraging results from operating upon 22 eyes were reported. The present paper describes certain modifications of that technique and the results in operating on 65 eyes. These results are compared also with extraction by 2 other methods: (1) a 2-plane incision, as for conventional cataract extraction, made inferiorly with a small conjunctivalcorneal flap; and (2) the same incision made superiorly, the filtering operation having been done inferiorly to permit routine cataract extraction above. References 1. Drawings showing technique for extraction superiorly, through clear cornea: A, Small scratch incision made perpendicularly through clear cornea just within the limbus over the temporal pillar; fixation by scleral pick. Nasal incision avoided because bridge of nose interferes with subsequent insertion of scissors to enlarge incision toward the temporal side. B, Incision extended just within the limbus using corneal scissors cutting at right angles to surface of cornea. Perpendicular incision avoids overhanging ledge. C, Sutures inserted as wound is enlarged to minimize lateral displacement of wound edges. Double-armed appositional mattress suture placed through wound edges, one arm at 11:30 and the other at the 12:30 o'clock meridian. D, Incision enlarged nasally to horizontal meridian. E, Two supplementary sutures placed at 9:30 to 10:30 o'clock. F, Incision enlarged temporally to horizontal meridian. G, Supplementary sutures inserted at 1:30 and 2:30 o'clock. H, Loops of sutures retracted by muscle hook. Free ends of mattress suture at 12:00 o'clock grasped to permit rapid closure of incision upon delivery of lens. I, Lens delivered by tumbling. Traction on ends of mattress suture to close incision. J, Eye protected by mattress suture; supplementary sutures tied. K, Loop of mattress suture pulled downward and divided to provide 2 sutures. L, Divided mattress suture tied. M, Final appearance of eye. 2. Scheie, H. G.: A Method of Cataract Extraction Following Filtering Operations for Glaucoma , A.M.A. Arch. Ophthal. 55:818, 1956.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Cataract Extraction After Filtering Operations

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Publisher
American Medical Association
Copyright
Copyright © 1962 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1962.00960030041009
Publisher site
See Article on Publisher Site

Abstract

Abstract The site of incision for cataract extraction after filtering operations has been a subject of prolonged debate. This presents a serious problem because of the close relationship to delayed reformation of the anterior chamber and failure of the filtering cicatrix with recurrence of glaucoma. The literature was reviewed, and a technique for cataract extraction through a perpendicular incision made superiorly in clear cornea with no conjunctival flap was described by one of us (H.G.S.) in 1956.1 Encouraging results from operating upon 22 eyes were reported. The present paper describes certain modifications of that technique and the results in operating on 65 eyes. These results are compared also with extraction by 2 other methods: (1) a 2-plane incision, as for conventional cataract extraction, made inferiorly with a small conjunctivalcorneal flap; and (2) the same incision made superiorly, the filtering operation having been done inferiorly to permit routine cataract extraction above. References 1. Drawings showing technique for extraction superiorly, through clear cornea: A, Small scratch incision made perpendicularly through clear cornea just within the limbus over the temporal pillar; fixation by scleral pick. Nasal incision avoided because bridge of nose interferes with subsequent insertion of scissors to enlarge incision toward the temporal side. B, Incision extended just within the limbus using corneal scissors cutting at right angles to surface of cornea. Perpendicular incision avoids overhanging ledge. C, Sutures inserted as wound is enlarged to minimize lateral displacement of wound edges. Double-armed appositional mattress suture placed through wound edges, one arm at 11:30 and the other at the 12:30 o'clock meridian. D, Incision enlarged nasally to horizontal meridian. E, Two supplementary sutures placed at 9:30 to 10:30 o'clock. F, Incision enlarged temporally to horizontal meridian. G, Supplementary sutures inserted at 1:30 and 2:30 o'clock. H, Loops of sutures retracted by muscle hook. Free ends of mattress suture at 12:00 o'clock grasped to permit rapid closure of incision upon delivery of lens. I, Lens delivered by tumbling. Traction on ends of mattress suture to close incision. J, Eye protected by mattress suture; supplementary sutures tied. K, Loop of mattress suture pulled downward and divided to provide 2 sutures. L, Divided mattress suture tied. M, Final appearance of eye. 2. Scheie, H. G.: A Method of Cataract Extraction Following Filtering Operations for Glaucoma , A.M.A. Arch. Ophthal. 55:818, 1956.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Jul 1, 1962

References