- Email: [email protected]
Bilateral Pupillary Block
a shallow anterior chamber after intracapsular cataract extraction and positive posterior pressure with vitreous bulge causing air to escape (a situation for which some would use a Sheets glide). Either sodium hyaluronate or 2% methylcellulose will restore anterior chamber volume and coat the lens. However, the 2% methylcellulose solution is slightly less viscous than sodium hyaluronate and can be more easily diluted out of the eye at the end of the procedure. In view of the marked postoperative pressure elevation which I have observed after use of sodium hyaluronate, the rapid clearing of methylcellulose appears to be advantageous. Paul U. Fechner, M. D.
Hannover, West Germany
SHEARING-STYLE VS. PLATINA-STYLE IOLs To the Editor: Among the reported advantages of posterior chamber intraocular lenses (IOLs) is a reduced incidence of glare, light sensitivity and reflections,1-3 as well as decreased aniseikonia and sharper visual acuity.1 ,3 We compared the subjective reactions of20 bilaterally pseudophakic patients who had a Shearing-style posterior chamber implant in one eye and an iridectomy clip 2-100p implant (Plantina-style) in the other. The only selection criteria were a corrected visual acuity of 20/30 or better in both eyes and a follow-up period of at least three months. Patients were unaware that they had dissimilar implants. Each patient was ;lsked the following questions: 1) Do you notice any difference (with glasses on if worn) in the vision of your two eyes? 2) Do you notice any difference in the size of objects as seen by either eye? 3) Is either eye sensitive to light? 4) Do you notice any flaring of lights at night in e ither eye? These questions were asked verbally and explained if necessary. One patient noted an increased amount of light sensitivity in the eye with the Shearing-style lens. No patient reported reRections, dazzle or Rare in either eye, and there were no complaints of differences in the size of objects or differences in corrected vision between the two eyes. These responses do not indicate that the Shearing-style posterior chamber lens has subjective visual advantages, at least when compared to an iridocapsular-style implant. David D. Dulaney, M.D. L. Wayne Freeman , M. D.
Sun City, AZ
REFERE NCES 1. Shearing S: A practical posterior chamber lens. Contact and
Intraocular Lens Med J 4(3):114, 1978
2. Kratz RP, Mazzocco TR, Davidson B: The consecutive implantation of 250 Shearing intraocular lenses. Contact and Intraocular Lens MedJ 5(1):123, 1979 3. Jaffe NS: The changing scene of intraocular lens surgery. Am J Ophthalmol 88:819, 1979
BILATERAL PUPILLARY BLOCK To the Editor: I have a female patient in her late sixties in whom I implanted Binkhorst-style 4-100p lenses bilaterally after intracapsular surgery, with a two-year hiatus between procedures in each eye. Both times the surgery was completely uneventful and both times the peripheral iridectomy was blocked on the first postoperative day, causing anterior chamber shallowing and a marked elevation in tension. In both cases, slitlamp exam showed that fibrin had covered the iridectomy and it was necessary to perform an additional peripheral iridectomy to relieve the condition. The patient recovered quickly in each instance with no sequelae and good vision. Preoperative intraocular tensions were normal and remain so postoperatively. I would like to know if anyone else has experienced this complication twice in the same patient; I have not had this occur in any other patient unilaterally or bilaterally. Leonard Flom, M.D. Fairfield, eN
Dr. Clayman replies: Pupillary block glaucoma can occur after cataract extraction with lens implantation, or after secondary lens implantation. However, fibrin blocking of both peripheral iridectomies in a bilateral case is unique in my experience. With the advantage of hindsight, an additional iridectomy in the second eye might have been helpful, given the experience with the first eye. Henry M. Clayman , M.D.
Scientific Editor
OCULAR PNEUMOPLETHYSMOGRAPHY AFTER LENS IMPLANTATION To the Editor: I was interested to read the letter from Oscar Wand, M.D., asking about the use of ocular pneumoplethysmography (OPC) after implantation of an intraocular lens (Am Intra-Ocular Implant Soc] 6:278, 1980). Two years ago a patient of mine who had had a successful iris suture Medallion (Medical Workshop) lens implant one year preViously underwent OPC. Immediately afterwards she noted blurring of
AM INTRA-OCULAR IMPLANT SOC J-VOL. 6, OCTOBER 1980
369
Hannover, West Germany
SHEARING-STYLE VS. PLATINA-STYLE IOLs To the Editor: Among the reported advantages of posterior chamber intraocular lenses (IOLs) is a reduced incidence of glare, light sensitivity and reflections,1-3 as well as decreased aniseikonia and sharper visual acuity.1 ,3 We compared the subjective reactions of20 bilaterally pseudophakic patients who had a Shearing-style posterior chamber implant in one eye and an iridectomy clip 2-100p implant (Plantina-style) in the other. The only selection criteria were a corrected visual acuity of 20/30 or better in both eyes and a follow-up period of at least three months. Patients were unaware that they had dissimilar implants. Each patient was ;lsked the following questions: 1) Do you notice any difference (with glasses on if worn) in the vision of your two eyes? 2) Do you notice any difference in the size of objects as seen by either eye? 3) Is either eye sensitive to light? 4) Do you notice any flaring of lights at night in e ither eye? These questions were asked verbally and explained if necessary. One patient noted an increased amount of light sensitivity in the eye with the Shearing-style lens. No patient reported reRections, dazzle or Rare in either eye, and there were no complaints of differences in the size of objects or differences in corrected vision between the two eyes. These responses do not indicate that the Shearing-style posterior chamber lens has subjective visual advantages, at least when compared to an iridocapsular-style implant. David D. Dulaney, M.D. L. Wayne Freeman , M. D.
Sun City, AZ
REFERE NCES 1. Shearing S: A practical posterior chamber lens. Contact and
Intraocular Lens Med J 4(3):114, 1978
2. Kratz RP, Mazzocco TR, Davidson B: The consecutive implantation of 250 Shearing intraocular lenses. Contact and Intraocular Lens MedJ 5(1):123, 1979 3. Jaffe NS: The changing scene of intraocular lens surgery. Am J Ophthalmol 88:819, 1979
BILATERAL PUPILLARY BLOCK To the Editor: I have a female patient in her late sixties in whom I implanted Binkhorst-style 4-100p lenses bilaterally after intracapsular surgery, with a two-year hiatus between procedures in each eye. Both times the surgery was completely uneventful and both times the peripheral iridectomy was blocked on the first postoperative day, causing anterior chamber shallowing and a marked elevation in tension. In both cases, slitlamp exam showed that fibrin had covered the iridectomy and it was necessary to perform an additional peripheral iridectomy to relieve the condition. The patient recovered quickly in each instance with no sequelae and good vision. Preoperative intraocular tensions were normal and remain so postoperatively. I would like to know if anyone else has experienced this complication twice in the same patient; I have not had this occur in any other patient unilaterally or bilaterally. Leonard Flom, M.D. Fairfield, eN
Dr. Clayman replies: Pupillary block glaucoma can occur after cataract extraction with lens implantation, or after secondary lens implantation. However, fibrin blocking of both peripheral iridectomies in a bilateral case is unique in my experience. With the advantage of hindsight, an additional iridectomy in the second eye might have been helpful, given the experience with the first eye. Henry M. Clayman , M.D.
Scientific Editor
OCULAR PNEUMOPLETHYSMOGRAPHY AFTER LENS IMPLANTATION To the Editor: I was interested to read the letter from Oscar Wand, M.D., asking about the use of ocular pneumoplethysmography (OPC) after implantation of an intraocular lens (Am Intra-Ocular Implant Soc] 6:278, 1980). Two years ago a patient of mine who had had a successful iris suture Medallion (Medical Workshop) lens implant one year preViously underwent OPC. Immediately afterwards she noted blurring of
AM INTRA-OCULAR IMPLANT SOC J-VOL. 6, OCTOBER 1980
369