Miotics or mydriatics for atony of the ciliary muscle with delayed re-formation of anterior chamber after cataract extraction with complete iridectomy.

Abstract

In cases of delayed formation of the anterior chamber after intracapsular extraction of senile cataract, the cause must be searched for:(I) The incision should be carefully examined for leakage, a procedure aided by the instillation of fluorescein. If there is a leak the ocular tension will be low. A tiny subconjunctival leak may be difficult to diagnose.(2) The fundus must be examined for the presence of choroidal detachment, a condition also accompanied by hypotony.(3) The eye must be examined with the slit-lamp for pupillary block by vitreous. Chandler (I954) described four types of pupillary block:A ring synechia of the pupil to an intact vitreous face; A plug of vitreous occluding the pupillary aperture or any iridectomy that may be present; The formation of a pupillary membrane; Blocking by vitreous of a gap in the pupillary membrane after an extracapsular extraction. In such cases the ocular tension is usually raised and the condition may be treated by mydriatics or complete iridectomy and air injection into the anterior chamber.In all the above three instances the iris diaphragm is in contact with the posterior surface of the cornea with a risk of peripheral anterior synechiae and secondary glaucoma.The three conditions (wound leak, choroidal detachment, and pupillary block) may form a vicious circle. A leaking wound, lowering the ocular pressure, may favour dilatation of the choroidal vessels, giving suprachoroidal exudation and detachment of the choroid, and the latter will push the vitreous forwards giving rise to vitreous pupillary block. Choroidal vascular engorgement may push the vitreous forwards increasing the pressure in the anterior chamber on the healing wound, giving rise to a wound leak and loss of the anterior chamber.In the following I 00 cases ofintracapsular extraction ofsenile cataract using the multiplemethods technique (Mortada, I 963, I 965), all the causes of delayed formation of the anterior chamber were prophylactically treated, preoperatively, operatively, and postoperatively. Even so in four cases the re-formation of the anterior chamber was delayed for 4 days without clinical evidence of a leaking wound, choroidal detachment, or pupillary block The effect ofmiotics and mydriatics on the quickness ofre-formation on the anterior chamber was studied.