Hydrodissection of conjunctival flap during trabeculectomy in eyes with conjunctival scarring caused by trachoma

S. Mitra, A. Ganesh

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND OBJECTIVE: Conjunctival scarring caused by trachoma represents a substantial challenge even to the most experienced cataract/glaucoma surgeon. We describe a simple technique of hydrodissection of conjunctival flap during combined trabeculectomy and phacoemulsification in eyes with conjunctival scarring caused by trachoma, and discuss its impact on surgical outcome. PATIENTS AND METHODS: A prospective study was conducted in 10 Omani patients, aged 48 to 83 who underwent combined trabeculectomy and phacoemulsification with intraocular lens (IOL) implantation. The conjunctival flap was prepared after hydrodissection using a mixture of 1 mL of balanced salt solution (BSS) and 1 mL of lignocaine 2% with 1:200 000 adrenaline. Outcome measures that were evaluated were visual function, intraocular pressure (IOP) and bleb characteristics. Patients were followed-up postoperatively for a minimum period of 6 months. RESULTS: The mean age of patients was 60.4 years (48-83) and a functioning bleb after 6 months was seen in 8 (80%) cases. IOP <20 mm of Hg (applanation tonometry) without antiglaucoma medications was found in 8 cases; 1 case required one antiglaucoma medication and 1 case required more than one antiglaucoma medication for control of IOP. The latter was reoperated for control of IOP. Nonprogression of visual field was found in 8 (80%) cases. CONCLUSION: Preparation of conjunctival flap by hydrodissection was found to be a simple modification of the conventional technique during combined trabeculectomy and phacoemulsification in trachomatous eyes. It reduced conjunctival dissection, use of cautery and possibility of button-holing of the conjunctiva during dissection in scarred eyes. The minimal tissue dissection involved in this procedure reduced wound healing and thereby increased chances of a functioning bleb, control of IOP and nonprogression of visual field compared to combined surgery employing a conventional method (nonhydrodissection method) of conjunctival flap dissection.

Original languageEnglish
Pages (from-to)213-219
Number of pages7
JournalOphthalmic Surgery and Lasers
Volume32
Issue number3
Publication statusPublished - 2001

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Trachoma
Trabeculectomy
Intraocular Pressure
Cicatrix
Phacoemulsification
Dissection
Blister
Visual Fields
Cautery
Intraocular Lens Implantation
Conjunctiva
Manometry
Lidocaine
Glaucoma
Wound Healing
Cataract
Epinephrine
Salts
Outcome Assessment (Health Care)
Prospective Studies

ASJC Scopus subject areas

  • Ophthalmology

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Hydrodissection of conjunctival flap during trabeculectomy in eyes with conjunctival scarring caused by trachoma. / Mitra, S.; Ganesh, A.

In: Ophthalmic Surgery and Lasers, Vol. 32, No. 3, 2001, p. 213-219.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND AND OBJECTIVE: Conjunctival scarring caused by trachoma represents a substantial challenge even to the most experienced cataract/glaucoma surgeon. We describe a simple technique of hydrodissection of conjunctival flap during combined trabeculectomy and phacoemulsification in eyes with conjunctival scarring caused by trachoma, and discuss its impact on surgical outcome. PATIENTS AND METHODS: A prospective study was conducted in 10 Omani patients, aged 48 to 83 who underwent combined trabeculectomy and phacoemulsification with intraocular lens (IOL) implantation. The conjunctival flap was prepared after hydrodissection using a mixture of 1 mL of balanced salt solution (BSS) and 1 mL of lignocaine 2{\%} with 1:200 000 adrenaline. Outcome measures that were evaluated were visual function, intraocular pressure (IOP) and bleb characteristics. Patients were followed-up postoperatively for a minimum period of 6 months. RESULTS: The mean age of patients was 60.4 years (48-83) and a functioning bleb after 6 months was seen in 8 (80{\%}) cases. IOP <20 mm of Hg (applanation tonometry) without antiglaucoma medications was found in 8 cases; 1 case required one antiglaucoma medication and 1 case required more than one antiglaucoma medication for control of IOP. The latter was reoperated for control of IOP. Nonprogression of visual field was found in 8 (80{\%}) cases. CONCLUSION: Preparation of conjunctival flap by hydrodissection was found to be a simple modification of the conventional technique during combined trabeculectomy and phacoemulsification in trachomatous eyes. It reduced conjunctival dissection, use of cautery and possibility of button-holing of the conjunctiva during dissection in scarred eyes. The minimal tissue dissection involved in this procedure reduced wound healing and thereby increased chances of a functioning bleb, control of IOP and nonprogression of visual field compared to combined surgery employing a conventional method (nonhydrodissection method) of conjunctival flap dissection.",
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