Managing post acute congestive phase by combined manual small incision cataract surgery and trabeculectomy: a...

The purpose of the study was to evaluate the therapeutic efficacy of manual small incision cataract surgery (SICS) and trabeculectomy as management option for acute angle closure glaucoma. The first 6 cases of 14 cases of acute angle closure glaucoma seen over a period of 18 months underwent surgical peripheral buttonhole iridectomy (PBHI) after their intra-ocular pressure (IOP) was controlled medically. Subsequently 8 cases underwent manual SICS+trabeculectomy as an alternative procedure after their IOP control who needed further surgery and overall patients' comfort. The results showed sustained visual acuity remained 6/9 or better in all the patients of SICS + trabeculectomy group, compared 6/12 or worse in the PBHI group. Mean non-contact tonometry reading at the end of 6 weeks was 10.2 mm Hg in the second group compared to 14.6 in the first group. None of the patients in the second group ever needed surgery in a 4-month follow-up, whereas 3 patients in the first group had to be operated again for cataract or uncomplicated IOP. Manual SICS+ trabeculectomy offers a good, economical and rational therapeutic alternative to traditional PBHI in the postcongestive phase.