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Anterior-Chamber Irrigation with Sulfadiazine
NOTES, CASES, INSTRUMENTS The X-ray report, stated, as of October 4, 1941: "The stereoscopic X-ray ex amination of the skull of R. F. shows the sella to be shallow, but the clinoids and its floor are smooth. No abnormal calcifica tions are seen. The cranial bones and brain areas appear negative. Ventriculogram reveals an atrophy at the chiasma. Hence, the lesion is due to a probable old healed arachnoiditis." Visual fields are seen in figures 1 and 2. SUMMARY
A brief review of the literature is given. An additional case is presented, due to a probable arachnoiditis at the chiasma. ANTERIOR-CHAMBER IRRIGA T I O N W I T H SULFADIAZINE JOSEPH LAVAL,
M.D.
New York T h e publication of the successful use of sulfanilamide in the anterior segment of the globe by Igersheimer (this Jour nal, 1943, v. 26, p . 1045) prompted me to report the following case. Mrs. R. S., aged 60 years, a housewife, was admitted to the Mt. Sinai Hospital on September 10, 1943, for a cataract extraction following a preliminary iridectomy that had been performed in July. She was extremely myopic and mildly diabetic. On the operating table an unusual com plication arose. T h e episcleral-limbal su ture which I use had been put in place, and the Graefe section had been per formed, when suddenly the patient vom ited. Before the speculum could be re moved a good deal of the vomitus en tered the cul-de-sac of the eye undergoing operation. T h e suture was drawn snugly and the lids were closed until the pa tient had freed herself of the gastric con tents. Then the field was again prepared
527
sterile and the eyelids opened. T h e vom ited material was flushed from the cul-desac with saline solution. It is considered that the gastric contents are sterile in the absence of achlorhydria but I was fearful of a possible infection even though I had good reason to know that the patient had a normal gastric acidi ty. Accordingly, a vial of 25-percent sodi um sulfadiazine for intravenous use was opened and diluted with physiologic saline to 10-percent strength. A small 2-c.c. hy podermic syringe was filled with the 10percent sodium sulfadiazine and a hypo dermic needle was attached. T h e needle was inserted into the anterior chamber and the latter was irrigated. T h e irriga tion was repeated twice and then the culde-sac was flushed thoroughly with more of the 10-percent sodium sulfadiazine. Following this the cataract extraction was performed without any further com plications. T h e patient was given 15 grains of sulfadiazine by mouth five times daily for the first two postoperative days. Healing and convalescence were entirely uneventful. There was no undue reaction at any time. Apparently the anterior segment of the globe can well tolerate 10-percent sodium sulfadiazine, and irrigation with this chemical is nonirritating. W h e t h e r it pre vented an infection in this case is ques tionable, but the point is that the use of a 10-percent solution of sodium sulfa diazine is safe and entirely innocuous. 136 East Sixty-fourth Street. EYES FROM
AUTOPSIES*
S A M U E L GARTNER,
M.D.,
VIRGINIA LUBKIN,
M.D.
New York W e have been fortunate in obtaining permission for a great many autopsies * From the ophthalmologic Montefiore Hospital.
service
of
A brief review of the literature is given. An additional case is presented, due to a probable arachnoiditis at the chiasma. ANTERIOR-CHAMBER IRRIGA T I O N W I T H SULFADIAZINE JOSEPH LAVAL,
M.D.
New York T h e publication of the successful use of sulfanilamide in the anterior segment of the globe by Igersheimer (this Jour nal, 1943, v. 26, p . 1045) prompted me to report the following case. Mrs. R. S., aged 60 years, a housewife, was admitted to the Mt. Sinai Hospital on September 10, 1943, for a cataract extraction following a preliminary iridectomy that had been performed in July. She was extremely myopic and mildly diabetic. On the operating table an unusual com plication arose. T h e episcleral-limbal su ture which I use had been put in place, and the Graefe section had been per formed, when suddenly the patient vom ited. Before the speculum could be re moved a good deal of the vomitus en tered the cul-de-sac of the eye undergoing operation. T h e suture was drawn snugly and the lids were closed until the pa tient had freed herself of the gastric con tents. Then the field was again prepared
527
sterile and the eyelids opened. T h e vom ited material was flushed from the cul-desac with saline solution. It is considered that the gastric contents are sterile in the absence of achlorhydria but I was fearful of a possible infection even though I had good reason to know that the patient had a normal gastric acidi ty. Accordingly, a vial of 25-percent sodi um sulfadiazine for intravenous use was opened and diluted with physiologic saline to 10-percent strength. A small 2-c.c. hy podermic syringe was filled with the 10percent sodium sulfadiazine and a hypo dermic needle was attached. T h e needle was inserted into the anterior chamber and the latter was irrigated. T h e irriga tion was repeated twice and then the culde-sac was flushed thoroughly with more of the 10-percent sodium sulfadiazine. Following this the cataract extraction was performed without any further com plications. T h e patient was given 15 grains of sulfadiazine by mouth five times daily for the first two postoperative days. Healing and convalescence were entirely uneventful. There was no undue reaction at any time. Apparently the anterior segment of the globe can well tolerate 10-percent sodium sulfadiazine, and irrigation with this chemical is nonirritating. W h e t h e r it pre vented an infection in this case is ques tionable, but the point is that the use of a 10-percent solution of sodium sulfa diazine is safe and entirely innocuous. 136 East Sixty-fourth Street. EYES FROM
AUTOPSIES*
S A M U E L GARTNER,
M.D.,
VIRGINIA LUBKIN,
M.D.
New York W e have been fortunate in obtaining permission for a great many autopsies * From the ophthalmologic Montefiore Hospital.
service
of