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A Simple Method of Photocoagulation Through the Goldmann Contact Glass
540
AMERICAN JOURNAL OF OPHTHALMOLOGY
SEPTEMBER, 1974
SUMMARY
An 18-year-old man was hit over the left eye with a baseball bat. Surgical interven tion was performed on the ninth day after the injury to repair a large fracture of the mid-posterior orbital floor. On the third postoperative day, orbital hemorrhage oc curred without the usual warning symptom of pain, resulting in blindness from oc clusion of the central retinal artery. On the basis of this and other studies, we urge that blow-out fractures be repaired only when there is a demonstrated fracture with in carceration of extraocular muscle tissue, which causes significant diplopia that per sists for as long as two weeks after the injury. REFERENCES
1. Nicholson, D. H., and Guzak, S. V.: Visual loss complicating repair of orbital floor fractures. Arch. Ophthalmol. 86:369, 1971. 2. Bleeker, G. M.: Miscellanea. In Bleeker, G. M., and Lyle, T. K. (eds.): Fractures of the Orbit. Baltimore, Williams and Wilkins, 1970, p. 229. 3. Emery, J. M., von Noorden, G. K., and Schlernitzauer, D. A.: Orbital floor fractures. Long-term follow-up of cases with and without surgical repair. Trans. Am. Acad. Ophthalmol. Otolaryngol. 75:802, 1971. 4. Putterman, A. M., Stevens, T., and Urist, M. J.: Nonsurgical management of blow-out frac tures of the orbital floor. Am. J. Ophthalmol. 77:232, 1974.
A SIMPLE M E T H O D O F P H O T O COAGULATION THROUGH T H E GOLDMANN CONTACT GLASS PEKKA E. J. POHJANPELTO,
M.D.
Lahti, Finland Fankhauser and Lotmar 1 described an optical system that permits photocoagulation of the retina through the Goldmann contact glass. T h e required apparatus, howFrom the Eye Department, Regional Hospital, Lahti, Finland. Reprint requests to P. E. J. Pohjanpelto, M.D., Honkapirtintie, 15900 Lahti 90, Finland.
Figure (Pohjanpelto). The beam of light is focused onto the retina with a planoconvex lens.
ever, may not be available to all who per form these operations. Emerson 2 added a convex lens to the Goldmann contact glass to focus the beam of light on the retina and made it possible to perform ophthalmoscopy of the fundus periphery with an ordinary ophthalmoscope. I have used this method for photocoagulation with a xenon coagulator (Zeiss, Oberkochen). A planoconvex lens of + 2 0 diopters with the same diameter as the flat face of the Goldmann glass is used. The contact glass is inserted with the patient in the recumbent position. A drop of plain water is placed on the contact glass, and the accessory lens is pressed on the surface of the contact glass (Figure). It is then possible to carry out ordinary ophthalmoscopy and photocoagulation through the contact glass. Because the contact glass eliminates the collecting power of the cornea and the dioptric power of the accessory lens is smaller than that of the cornea, the magnifi cation of the retinal image observed is de creased. The reduction occurs in the ratio between the focal lengths of the eye and the existing image-forming system, which is about 0.4. In the same manner, the image diameter of the photocoagulator appears on the retina at a higher field angle. Multi plying the given field angles of the photo coagulator by 2.5 gives approximately the field angles obtained with this system. One of the greatest advantages of the optical system of Fankhauser and Lotmar compared with the method described is the
NOTES, CASES, INSTRUMENTS
VOL. 78, NO. 3
possibility of correcting the focus by mov ing the apparatus back and forth relative to the retina. In the present method this is achieved only T)y changing the dioptric power of the planoconvex. If, however, the equipment of Fankhauser and Lotmar is not available, photocoagulation of the fundus periphery with the Goldmann contact glass is possible with simple instrumentation. SUMMARY
Ordinary ophthalmoscopy and photoco agulation can be accomplished through the Goldmann contact glass with an accessory planoconvex lens of + 2 0 diopters. REFERENCES
541
This newly devised technique to secure the intraocular lens in place fixes the lens to the iris root, leaving the pupillary region free. T h e new model is called extrapupil lary iris lens. A most straightforward way to realize the principle of the extrapupillary iris lens is simply to suture the lens to the iris. It is quite possible, but technically not very convenient. A new design of the lens had to be developed to make the approach more practical and elegant. T h e basic idea was to support the lens by minute prongs ex tending to the iris periphery. T h e original version 3 has three such prongs (made of tantalum alloy) attached to the optical por tion of the lens (methylmethacrylate).
1. Fankhauser, F., and Lotmar, W.: Photoco agulation through the Goldmann contact glass. Arch. Ophthalmol. 77:320, 1967. 2. Emerson, E.: A method of peripheral fundus examination. Am. J. Ophthalmol. 48:100, 1959.
EXTRAPUPILLARY IRIS LENS IN APHAKTA M.
M.
KRASNOV,
M.D.
Moscow, U.S.S.R. A number of surgeons have achieved satisfactory results fixing intraocular lenses with the iris-clip technique. 1 ' 2 Although the iris seems to tolerate contact with a foreign substance, pupillary reactions, and the size and form of the pupil are changed. T h e constriction of the pupil is upset. Its dila tation makes the position of the lens inside the pupillary aperture unstable. Sometimes it moves as the eye (or the head) moves, and may even dislocate. I n the process of insertion of an iris-clip lens, the hyaloid membrane may rupture. From the State Institute for Eye Diseases, Moscow, U.S.S.R. Reprint requests to M. M. Krasnov, M.D., Di rector, State Institute for Eye Diseases, 5, Pogodinka ul., Moscow, U.S.S.R.
Fig. 1 (Krasnov). Position of extrapupillary iris lens in the eye. Three-prong version.
AMERICAN JOURNAL OF OPHTHALMOLOGY
SEPTEMBER, 1974
SUMMARY
An 18-year-old man was hit over the left eye with a baseball bat. Surgical interven tion was performed on the ninth day after the injury to repair a large fracture of the mid-posterior orbital floor. On the third postoperative day, orbital hemorrhage oc curred without the usual warning symptom of pain, resulting in blindness from oc clusion of the central retinal artery. On the basis of this and other studies, we urge that blow-out fractures be repaired only when there is a demonstrated fracture with in carceration of extraocular muscle tissue, which causes significant diplopia that per sists for as long as two weeks after the injury. REFERENCES
1. Nicholson, D. H., and Guzak, S. V.: Visual loss complicating repair of orbital floor fractures. Arch. Ophthalmol. 86:369, 1971. 2. Bleeker, G. M.: Miscellanea. In Bleeker, G. M., and Lyle, T. K. (eds.): Fractures of the Orbit. Baltimore, Williams and Wilkins, 1970, p. 229. 3. Emery, J. M., von Noorden, G. K., and Schlernitzauer, D. A.: Orbital floor fractures. Long-term follow-up of cases with and without surgical repair. Trans. Am. Acad. Ophthalmol. Otolaryngol. 75:802, 1971. 4. Putterman, A. M., Stevens, T., and Urist, M. J.: Nonsurgical management of blow-out frac tures of the orbital floor. Am. J. Ophthalmol. 77:232, 1974.
A SIMPLE M E T H O D O F P H O T O COAGULATION THROUGH T H E GOLDMANN CONTACT GLASS PEKKA E. J. POHJANPELTO,
M.D.
Lahti, Finland Fankhauser and Lotmar 1 described an optical system that permits photocoagulation of the retina through the Goldmann contact glass. T h e required apparatus, howFrom the Eye Department, Regional Hospital, Lahti, Finland. Reprint requests to P. E. J. Pohjanpelto, M.D., Honkapirtintie, 15900 Lahti 90, Finland.
Figure (Pohjanpelto). The beam of light is focused onto the retina with a planoconvex lens.
ever, may not be available to all who per form these operations. Emerson 2 added a convex lens to the Goldmann contact glass to focus the beam of light on the retina and made it possible to perform ophthalmoscopy of the fundus periphery with an ordinary ophthalmoscope. I have used this method for photocoagulation with a xenon coagulator (Zeiss, Oberkochen). A planoconvex lens of + 2 0 diopters with the same diameter as the flat face of the Goldmann glass is used. The contact glass is inserted with the patient in the recumbent position. A drop of plain water is placed on the contact glass, and the accessory lens is pressed on the surface of the contact glass (Figure). It is then possible to carry out ordinary ophthalmoscopy and photocoagulation through the contact glass. Because the contact glass eliminates the collecting power of the cornea and the dioptric power of the accessory lens is smaller than that of the cornea, the magnifi cation of the retinal image observed is de creased. The reduction occurs in the ratio between the focal lengths of the eye and the existing image-forming system, which is about 0.4. In the same manner, the image diameter of the photocoagulator appears on the retina at a higher field angle. Multi plying the given field angles of the photo coagulator by 2.5 gives approximately the field angles obtained with this system. One of the greatest advantages of the optical system of Fankhauser and Lotmar compared with the method described is the
NOTES, CASES, INSTRUMENTS
VOL. 78, NO. 3
possibility of correcting the focus by mov ing the apparatus back and forth relative to the retina. In the present method this is achieved only T)y changing the dioptric power of the planoconvex. If, however, the equipment of Fankhauser and Lotmar is not available, photocoagulation of the fundus periphery with the Goldmann contact glass is possible with simple instrumentation. SUMMARY
Ordinary ophthalmoscopy and photoco agulation can be accomplished through the Goldmann contact glass with an accessory planoconvex lens of + 2 0 diopters. REFERENCES
541
This newly devised technique to secure the intraocular lens in place fixes the lens to the iris root, leaving the pupillary region free. T h e new model is called extrapupil lary iris lens. A most straightforward way to realize the principle of the extrapupillary iris lens is simply to suture the lens to the iris. It is quite possible, but technically not very convenient. A new design of the lens had to be developed to make the approach more practical and elegant. T h e basic idea was to support the lens by minute prongs ex tending to the iris periphery. T h e original version 3 has three such prongs (made of tantalum alloy) attached to the optical por tion of the lens (methylmethacrylate).
1. Fankhauser, F., and Lotmar, W.: Photoco agulation through the Goldmann contact glass. Arch. Ophthalmol. 77:320, 1967. 2. Emerson, E.: A method of peripheral fundus examination. Am. J. Ophthalmol. 48:100, 1959.
EXTRAPUPILLARY IRIS LENS IN APHAKTA M.
M.
KRASNOV,
M.D.
Moscow, U.S.S.R. A number of surgeons have achieved satisfactory results fixing intraocular lenses with the iris-clip technique. 1 ' 2 Although the iris seems to tolerate contact with a foreign substance, pupillary reactions, and the size and form of the pupil are changed. T h e constriction of the pupil is upset. Its dila tation makes the position of the lens inside the pupillary aperture unstable. Sometimes it moves as the eye (or the head) moves, and may even dislocate. I n the process of insertion of an iris-clip lens, the hyaloid membrane may rupture. From the State Institute for Eye Diseases, Moscow, U.S.S.R. Reprint requests to M. M. Krasnov, M.D., Di rector, State Institute for Eye Diseases, 5, Pogodinka ul., Moscow, U.S.S.R.
Fig. 1 (Krasnov). Position of extrapupillary iris lens in the eye. Three-prong version.