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A comparative study of the influence of preoperative, intracameral viscoelastic agents on post-operative anterior chamber depth and intraocular pressure in trabeculectomy.

The study was carried out on 71 consecutive eyes with primary open angle glaucoma or primary chronic angle closure glaucoma undergoing conventional trabeculectomy to compare the influence of pre-operative intracameral sodium hyaluronate 1% with hydroxypropyl methylcellulose 2% (HPMC2%) on postoperative anterior chamber depth (AC depth) and intraocular pressure (IOP) in trabeculectomy. In all cases balanced salt solution (BSS) (group A) or HPMC2% (group B), or sodium hyaluronate 1% (group C) was left in the anterior chamber at the end of the surgery. All patients were observed serially on days 1,3,5,7 and 14 and months 1,3 and 6 postoperatively. The main outcome measure was restoration of AC depth to preoperative level with IOP of less than 21 mm Hg and no additional antiglaucoma medication or surgery.

The AC depth decreased to a maximum of 2.38[+ or -] 0.61 (20.94% decrease) in group A, 2.84 [+ or -] 0.45 (6.30% decrease in group B on the 3rd postoperative day and 2.82 [+ or -] 0.28 (1.40% decrease) in group C on the 5th postoperative day following which complete restoration of Ac depth occurred by the 3rd month in group A, 1 month in group B and the 14th day in group C. Overall, the IOP decreased to 13.93 [+ or -] 2.25 (54.75% decrease) in group A, 14.01 [+ or -] 2.57 (51.27% decrease) in group B and 14.44 [+ or -] 2.61 (51.40% decrease in group C at 6 months. Three eyes developed flat anterior chamber only in group A. Shallow AC was seen in one eye in group A and three eyes (grade 1) in group B. Complications like choroidal detachment and hyphema were seen only in group A. Initial postoperative elevation (IOP spikes) of IOP (although minimal) was seen in 5 eyes in group C which required frequent monitoring and active intervention. The incidence of late postoperative bleb failure was more in group A and C. Absolute success was maximally achieved in group B.

It was concluded that the efficacy and economical advantages of intracameral injection of HPMC 2% during trabeculectomy are more as compared to BSS and sodium hyaluronate 1%. HPMC 2% helps to maintain AC depth and reduces incidence of complications related to shallow AC and ocular hypotony following trabeculectomy.

Dr. Kaamna Kalra

Dr. (Col.) P.K. Sahoo

Department of Opthalmology

Army Hospital (R&R), Delhi Cantt.

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Title Annotation:ABSTRACTS: Some Research Projects Completed Recently
Author:Kalra, Kaamna; Sahoo, P.K.
Publication:ICMR Bulletin
Article Type:Abstract
Date:Mar 1, 2010
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