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Repair of Descemet's membrane detachment with intracameral injection of 20% sulfur hexafluoride gas
• Repair of Descemet's membrane detachment with intracameral injection of 20% sulfur hexafluoride gas. Gault JA, Raber IM. Cornea 1996; 15:483-489.
D
ETACHMENT OF DESCEMET'S MEMBRANE IS A Po tential risk of anteriorly positioned incisions for cataract extraction. Small, peripheral detachments frequently heal spontaneously and are clinically in consequential. Large detachments may cause visually significant bullous keratopathy. Several techniques have been used to repair detachments of Descemet's membrane, including injection of air or viscoelastic material into the anterior chamber or suturing the membrane after it has been surgically repositioned. This report describes successful descemetopexy in five patients. Injections of 20% sulfur hexafluoride were administered after the detached membrane had been "unscrolled," obviating the need for penetrating keratoplasty.—George B. Bartley •Wills Eye Hospital, 900 Walnut St, Philadelphia, PA 19107.
• Management of dislocated lens fragments after phacoemulsification surgery. Ross WH*. Can J Ophthalmol 1996;31:234-240.
T
HIS REPORT DESCRIBES THE CLINICAL FEATURES
and outcomes of 54 consecutive patients whose phacoemulsification was complicated by the disloca tion of lens nucleus fragments into the vitreous cavity. Findings at initial examination included mod erate or severe corneal edema in 44% of eyes, intraocular pressure greater than 25 mm Hg in 46%, intraocular inflammation in 69%, retinal detachment in 4%, and vitreous hemorrhage in 8%. Six of eight patients who were treated conservatively achieved final visual acuity of 20/40 or better. In the remaining 46 patients who underwent pars plana vitrectomy, ultimate visual acuity was 20/40 or better in 65%, 20/50 to 20/100 in 17%, and 20/200 or worse in 17%. Patients who received an anterior chamber intraocu lar lens at the time of cataract surgery had a signifi
760
cantly worse visual outcome than patients who re ceived a posterior chamber intraocular lens when vitrectomy was performed. The author recommended that "vigorous" attempts to remove dislocated lens fragments be avoided. Rather, an anterior vitrectomy should be performed and a posterior chamber intra ocular lens implanted if adequate capsular support is available.—George B. Bartley
'Department of Ophthalmology, St Paul's Hospital, 1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada.
• Resource management of cataract patients: Can visual rehabilitation be achieved in three visits? Ionides A, Claoué C*. J Cataract Refract Surg 1996;22: 717-120.
P
OTENTIAL ADVANTAGES OF MINIMIZING THE NUM-
ber of visits required for patients undergoing cataract extraction include "rapid visual rehabilitation, . . . minimal interference with patient activities, financial savings to the community, and enhanced job satisfaction for the team delivering care." The authors evaluated the efficacy of a care model comprising a preoperative examination, the surgical episode with a follow-up examination the day after the operation, and an examination 2 weeks postoperatively. The technique of cataract extraction involved a 5-mm diameter scierai tunnel without sutures, phacoemulsification, and implantation of a polymethylmethacrylate intraocular lens. Thirty (88%) of 34 consecutive patients who underwent uncomplicated cataract surgery had good outcomes using the model described. The remaining four pa tients required additional visits to treat persistent intraocular inflammation, which resolved in each instance without permanent sequelae. The average change in spherical equivalent between the examina tion 2 weeks postoperatively and a refraction per formed 6 weeks after surgery was 0.34 diopters, with a mode of 0 diopters. The authors concluded that most patients requiring cataract surgery could be treated with a "three-episode model" with significant finan-
AMERICAN JOURNAL OF OPHTHALMOLOGY
NOVEMBER 1996
D
ETACHMENT OF DESCEMET'S MEMBRANE IS A Po tential risk of anteriorly positioned incisions for cataract extraction. Small, peripheral detachments frequently heal spontaneously and are clinically in consequential. Large detachments may cause visually significant bullous keratopathy. Several techniques have been used to repair detachments of Descemet's membrane, including injection of air or viscoelastic material into the anterior chamber or suturing the membrane after it has been surgically repositioned. This report describes successful descemetopexy in five patients. Injections of 20% sulfur hexafluoride were administered after the detached membrane had been "unscrolled," obviating the need for penetrating keratoplasty.—George B. Bartley •Wills Eye Hospital, 900 Walnut St, Philadelphia, PA 19107.
• Management of dislocated lens fragments after phacoemulsification surgery. Ross WH*. Can J Ophthalmol 1996;31:234-240.
T
HIS REPORT DESCRIBES THE CLINICAL FEATURES
and outcomes of 54 consecutive patients whose phacoemulsification was complicated by the disloca tion of lens nucleus fragments into the vitreous cavity. Findings at initial examination included mod erate or severe corneal edema in 44% of eyes, intraocular pressure greater than 25 mm Hg in 46%, intraocular inflammation in 69%, retinal detachment in 4%, and vitreous hemorrhage in 8%. Six of eight patients who were treated conservatively achieved final visual acuity of 20/40 or better. In the remaining 46 patients who underwent pars plana vitrectomy, ultimate visual acuity was 20/40 or better in 65%, 20/50 to 20/100 in 17%, and 20/200 or worse in 17%. Patients who received an anterior chamber intraocu lar lens at the time of cataract surgery had a signifi
760
cantly worse visual outcome than patients who re ceived a posterior chamber intraocular lens when vitrectomy was performed. The author recommended that "vigorous" attempts to remove dislocated lens fragments be avoided. Rather, an anterior vitrectomy should be performed and a posterior chamber intra ocular lens implanted if adequate capsular support is available.—George B. Bartley
'Department of Ophthalmology, St Paul's Hospital, 1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada.
• Resource management of cataract patients: Can visual rehabilitation be achieved in three visits? Ionides A, Claoué C*. J Cataract Refract Surg 1996;22: 717-120.
P
OTENTIAL ADVANTAGES OF MINIMIZING THE NUM-
ber of visits required for patients undergoing cataract extraction include "rapid visual rehabilitation, . . . minimal interference with patient activities, financial savings to the community, and enhanced job satisfaction for the team delivering care." The authors evaluated the efficacy of a care model comprising a preoperative examination, the surgical episode with a follow-up examination the day after the operation, and an examination 2 weeks postoperatively. The technique of cataract extraction involved a 5-mm diameter scierai tunnel without sutures, phacoemulsification, and implantation of a polymethylmethacrylate intraocular lens. Thirty (88%) of 34 consecutive patients who underwent uncomplicated cataract surgery had good outcomes using the model described. The remaining four pa tients required additional visits to treat persistent intraocular inflammation, which resolved in each instance without permanent sequelae. The average change in spherical equivalent between the examina tion 2 weeks postoperatively and a refraction per formed 6 weeks after surgery was 0.34 diopters, with a mode of 0 diopters. The authors concluded that most patients requiring cataract surgery could be treated with a "three-episode model" with significant finan-
AMERICAN JOURNAL OF OPHTHALMOLOGY
NOVEMBER 1996