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Equatorial Cataract after Corneo-Scleral Trephining

1954; BMJ; Volume: 38; Issue: 5 Linguagem: Inglês

10.1136/bjo.38.5.279

1468-2079

H. E. Hobbs, R. Smith,

Cerebral Venous Sinus Thrombosis

THE occurrence of cataract in association with glaucoma presents a thera- peutic problem of some magnitude which has attracted a good deal of atten- tion in recent years (Samuels, 1947;Sourdille, 1950;Chandler, 1949;, Fran9ois, 1947;Williamson-Noble, 1953).The difficulties of treatment are not made less by the uncertainty which still exists as to the role played by the glaucomatous process and its treatment in the genesis of the lens opacity.Since the utility of corfieo-scleral trephining was first established after its introduction by Elliot in the early 20th century, the cause of the cataract which may be seen post-operatively in some cases has been a subject of speculation.Elliot (1914) was not convinced that the cataract was due to the operative interference, and although, as experience with the operation has become world-wide, the contrary view has found its advocates, the general opinion appears still to be in agreement with his, provided that direct operative damage to the lens has not taken place (Duke-Elder, 1940; Spaeth, 1941; Arruga, 1952).The association of delayed reformation of the anterior chamber with post-trephine cataract is, however, generally familiar, and this post-operative complication has been assigned a major place in the causation of the lens opacity by Duke-Elder (1940) and by Williamson-Noble (1953).The purpose of this paper is to present four cases which showed lens changes after trephining, and in which the clinical features can be fairly clearly inter- preted in the light of the gonioscopic picture of the site of the operation.This distinguishes them as a type of post-trephine cataract not previously described, and permits the formulation of a possible hypothesis to account for them. Case ReportsCase 1, female, aged 69, was admitted to Moorfields on April 27, 1939, with an acute attack of congestive glaucoma which responded in some degree to medical treatment; although the tension remained high, visual acuity was 6/9; the eye (left) was trephined on May 1, 1939, and the post-operative course appears to have been uneventful.During the succeeding years vision in the left eye gradually failed, and, when she was first examined at the Institute of Ophthalmology on July 12, 1949, was 6/18 withacorrection of-1 *0/-3' 5axis 900.Marked cupping of the disc was noted and the visual field showed' peripheral constriction.The gonioscopic appearance of the operation area at that time showed a basal iridectomy flanked by corneal peripheral anterior synechiae (Fig. 1, overleaf).The trephine was well- sited on the limbus; but was largely filled by a tube of opacifying lens capsule which could *