Surgical outcome of safe surgery system trabeculectomy combined with cataract extraction.

PURPOSE: To determine the efficacy of safe surgery system trabeculectomy combined with manual small incision cataract surgery/phacoemulsification in primary glaucoma coexistent with cataract. METHODS: This is a retrospective analysis of 105 cases who underwent single-site combined surgery between January 2008 and December 2009. Safe surgery system trabeculectomy with diffuse and posterior application of mitomycin C was performed in all cases. Cataract extraction was done either by Manual Small Incision Cataract Surgery (MSICS) or phacoemulsification. Main outcome measures were success rate of trabeculectomy, as determined by four different IOP goals and incidence of postoperative complications. Analysis was performed using R-2.15, and the significance was tested at 5% level. RESULTS: The minimum follow-up period was 12 months. The overall success rates (with or without medication) when safe surgery system trabeculectomy was combined with MSICS were 91, 70, and 51% for IOP ≤18, ≤15, and ≤12 mm Hg, respectively, and target IOP was achieved in 72% cases. The mean IOP reduction was 43.8% with MSICS and 42.08% with phacoemulsification. The surgical outcome was not significantly different for both techniques. Postoperative complications were infrequent and comparable. CONCLUSION: The Safe Surgery System Trabeculectomy combined with cataract surgery offers excellent IOP control with minimal postoperative complications. It offers an effective and improved solution for primary glaucoma coexistent with cataract found in developing countries.

Suture supported P C IOL in a homocystinuric child.

A homocystinuric child presented with a secondary pupillary block glaucoma due to anteriorly subluxated lens. After removal of the subluxated lens, a suture supported posterior chamber IOL was implanted. Postoperative complication of cerebral venous thrombosis following general anaesthesia was managed with high doses of pyridoxine special diet and drugs.

EPIDURAL ANALGESIA FOR LABOUR IN ARMED FORCES HOSPITALS: A PRELIMINARY STUDY TO ASSESS FEASIBILITY AND ACCEPTANCE.

A pilot project to assess the feasibility of using epidural analgesia for labour was undertaken in an Armed Forces hospital. Effectiveness of the technique, acceptability by patients and nursing staff was assessed. Forty parturients were offered labour analgesia after explaining the procedure. A single-use 16 G Romson epidural catheter was placed in L2-3 or L3-4 space. Injection bupivacaine (0.25%) 10-14 mL was used as an initial dose. An hourly dose of 0.125% bupivacaine (10-12 mL) was given till the onset of second stage. Good to excellent analgesia during first stage was experienced by 34 patients. Marginal second stage prolongation was noticed but without any adverse neonatal effects. Analgesia was unsatisfactory during second stage in 25% patients. Instrumental delivery was required in 17% patients (LSCS - 10% and vacuum extraction - 7%). Procedure was accepted very well by 37 patients and they were satisfied with the pain relief.

Fraser's syndrome.

A full term female baby at birth showed the features of Fraser's syndrome viz. upper lid coloboma, cryptophthalmos, abnormal groove over temporal region, dysmorphic facies, hypospadias and bilateral syndactyly. On ultrasound examination of the abdomen and left orbit, maldeveloped kidney and eyeball were found. Other siblings were not affected. The child died at the age of 3 months.