- Email: [email protected]
The Development of Lacquer Cracks in Pathologic Myopia
196
February, 1989
AMERICAN JOURNAL OF OPHTHALMOLOGY
Correspondence Correspondence concerning recent articles or other material published in THE JOURNAL should be submitted within six weeks of publication. Correspondence must be typed double-spaced, on 8% x Tl-inch bond paper with Ph-inch margins on all four sides and should be no more than two typewritten pages in length. Every effort will be made to resolve controversies between the correspondents and the authors of the article before publication.
Management of Anterior and Posterior Proliferative Vitreoretinopathy XLV Edward Jackson Memorial Lecture
retinal membranes. The incision should be parallel to the nerve fiber layer to minimize damage to the axons. I agree that initially the membrane is drawn into the vitreous cavity (as was shown in Figure 8). However, once the membrane is partially mobilized, I find the membrane can best be stripped free of these subretinal attachments with as little enlargement of the retinotomy as possible by pulling tangential to the retinal surface. If continued traction is perpendicular to the retina, the residual attachments subretinally fixate the membrane and the vector force at the retinotomy site serving to enlarge the opening. THOMAS M. AABERG, M.D.
Atlanta, Georgia
EDITOR:
In the article "Management of anterior and posterior proliferative vitreoretinopathy. XLV Edward Jackson Memorial Lecture" (Am. J. Ophthalmol. 106:519, November 1988) by T. M. Aaberg, the author gives some cogent advice regarding management of subretinal proliferation. In cases in which retinal reattachment may be precluded by subretinal proliferative membranes, one possible approach is to remove the membranes by grasping them with a hook and pulling them anteriorly through a retinotomy. The retinotomy should be made perpendicular to the direction of the subretinal strand for most efficient removal with the smallest chance of damaging the retina or unduly enlarging the retinotomy site. For removal of these membranes, Dr. Aaberg recommended exerting traction tangentially to the retinal surface. I believe that it would be preferable to exert this traction at an angle normal to the retinal surface rather than tangential. Normal to the retinal surface is the only force vector at which there is no component parallel to the retinal surface that could tear or enlarge the retinotomy. ROBERT J. SCHECHTER, M.D.
Los Angeles, California
_ _ _ _ _ _ _ Reply EDITOR:
_
I appreciate the thoughtful correspondence of Dr. Schecter regarding the removal of sub-
The Development of Lacquer Pathologic Myopia
Cracks in
EDITOR:
In the article "The development of lacquer cracks in pathologic myopia" by Richard M. Klein and Stuart Green (Am. J. Ophthalmol. 106:282, September 1988), the authors state that histologic examination of lacquer cracks has not been previously reported. The histopathology of lacquer cracks was reviewed by Green, W. R.: Retina. Myopia. In Spencer, W. H.: Ophthalmic Pathology. An Atlas and Textbook, ed. 3. Philadelphia, W. B. Saunders, 1985, vol. 2, chap. 8, pp. 914-920. WILLIAM W. MILLER, M.D.
San Francisco, California
_ _ _ _ _ _ _ Reply
_
EDITOR:
We would like to thank Dr. Miller for bringing to our attention the reference on the histopathology of lacquer cracks. RICHARD M. KLEIN, M.D.
New York, New York
STUART GREEN, M.D.
Piscataway, New Jersey
February, 1989
AMERICAN JOURNAL OF OPHTHALMOLOGY
Correspondence Correspondence concerning recent articles or other material published in THE JOURNAL should be submitted within six weeks of publication. Correspondence must be typed double-spaced, on 8% x Tl-inch bond paper with Ph-inch margins on all four sides and should be no more than two typewritten pages in length. Every effort will be made to resolve controversies between the correspondents and the authors of the article before publication.
Management of Anterior and Posterior Proliferative Vitreoretinopathy XLV Edward Jackson Memorial Lecture
retinal membranes. The incision should be parallel to the nerve fiber layer to minimize damage to the axons. I agree that initially the membrane is drawn into the vitreous cavity (as was shown in Figure 8). However, once the membrane is partially mobilized, I find the membrane can best be stripped free of these subretinal attachments with as little enlargement of the retinotomy as possible by pulling tangential to the retinal surface. If continued traction is perpendicular to the retina, the residual attachments subretinally fixate the membrane and the vector force at the retinotomy site serving to enlarge the opening. THOMAS M. AABERG, M.D.
Atlanta, Georgia
EDITOR:
In the article "Management of anterior and posterior proliferative vitreoretinopathy. XLV Edward Jackson Memorial Lecture" (Am. J. Ophthalmol. 106:519, November 1988) by T. M. Aaberg, the author gives some cogent advice regarding management of subretinal proliferation. In cases in which retinal reattachment may be precluded by subretinal proliferative membranes, one possible approach is to remove the membranes by grasping them with a hook and pulling them anteriorly through a retinotomy. The retinotomy should be made perpendicular to the direction of the subretinal strand for most efficient removal with the smallest chance of damaging the retina or unduly enlarging the retinotomy site. For removal of these membranes, Dr. Aaberg recommended exerting traction tangentially to the retinal surface. I believe that it would be preferable to exert this traction at an angle normal to the retinal surface rather than tangential. Normal to the retinal surface is the only force vector at which there is no component parallel to the retinal surface that could tear or enlarge the retinotomy. ROBERT J. SCHECHTER, M.D.
Los Angeles, California
_ _ _ _ _ _ _ Reply EDITOR:
_
I appreciate the thoughtful correspondence of Dr. Schecter regarding the removal of sub-
The Development of Lacquer Pathologic Myopia
Cracks in
EDITOR:
In the article "The development of lacquer cracks in pathologic myopia" by Richard M. Klein and Stuart Green (Am. J. Ophthalmol. 106:282, September 1988), the authors state that histologic examination of lacquer cracks has not been previously reported. The histopathology of lacquer cracks was reviewed by Green, W. R.: Retina. Myopia. In Spencer, W. H.: Ophthalmic Pathology. An Atlas and Textbook, ed. 3. Philadelphia, W. B. Saunders, 1985, vol. 2, chap. 8, pp. 914-920. WILLIAM W. MILLER, M.D.
San Francisco, California
_ _ _ _ _ _ _ Reply
_
EDITOR:
We would like to thank Dr. Miller for bringing to our attention the reference on the histopathology of lacquer cracks. RICHARD M. KLEIN, M.D.
New York, New York
STUART GREEN, M.D.
Piscataway, New Jersey