Dr. ARVIND KUMAR MORYA

, Dr.Sulabh Sahu

Abstract

A72Yr old one eyed patient of chronic closure glaucoma(IOP-43mm/Hg),BCVA6/60 withNS-3,generalized corneal haze&small pupil came.Combined phaco+trab with Ologen implant planned after IOP control.On giving PBB,360degree conj.chemosis.Fornix based conj.&limbal based scleral flap made.Scleral flap was triangular, superior&>1/2 thickness.Pupil size was 4mm with deep seated eyeball.On starting rhexis IFIS&shallowACnoted& managed carefully with moderate use of cohesiveOVD.Phaco completed in 3.5mm pupil with direct chop&under low parameters.During cortical removal sudden bradycardia,surgery halted&managed by Anaesthetist.PCIOLin bag placed.Routine trab. done.ACformed withair+BSS.Biodegradable Ologen placed1/2in fornix,1/2over scleral flap.It acts as mechanical spacer&lacking side effects of MMC.Post-op1month fully functional bleb&IOP-9mm/hg with BCVA-6/12without any anti-glaucoma medications.So complicated cases can be well managed by proper planning&patience.