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Cataract Aspiration Cannula with Knife-Needle
V O L . 66, N O . 5
N O T E S , CASES, I N S T R U M E N T S
961
enced no difficulty in wearing them five to six cyl ax° 140. A few cells were noted on the corneal hours. In addition to the contact lenses, he wore biendothelium. Some vitreous strands were present, focal spectacle lenses with a piano lens for distance and no foveal reflex could be seen. The patient no and a +2.50 sphere for near and a 6-diopter prism longer wears contact lenses. base down in the right lens for a right hyperphoria that had been present prior to surgery. SUMMARY The patient was seen in the eye clinic on SeptemA case is presented of endophthalmitis ocber 22, 1967, with a history of irritation and redness in the right eye for three to four days. He had curring in a man who wore contact lenses in worn his contact lenses until the previous day. Corthe presence of a filtering bleb. After intenrected vision was 20/40 in the right eye and 20/20 sive treatment the patient recovered useful in the left eye with spectacle lenses. There was mild injection of the right eye with no exudate. The vitvision in this eye. reous was clear although there was an occasional 4200 East Ninth Avenue (80220) cell in the anterior chamber. The previously noted filtering bleb was present. Atropine was instilled in REFERENCES this eye and dexamethasone-neomycin-polymyxin solution was prescribed. The patient was told to re1. Wild, J. J. : Endophthalmitis in a contact lens turn the next day if his condition had not improved. wearer. Am. J. Ophth. 54:847, 1962. He did not return until three days later, at which 2. Dixon, J. M., Young, C. A., Jr., Baldone, J. time vision in the right eye was reduced to light A., Halberg, G. P., Sampson, W . and Stone, W . , perception. The eye was severely injected and the Jr.: Complications associated with the wearing of pupil was 5 mm and round. The anterior chamber contact lenses. J A M A 195:901, 1966. contained 4 + cells as well as a hypopyon in the lower one-third of the anterior chamber. No fundus reflex could be seen. The filtering bleb had disappeared. The patient was hospitalized and given methicillin one gram every six hours intravenously, chloramphenicol one gram every six hours intravenously, CATARACT ASPIRATION prednisone 30 mg a day orally, and topical 1 % atroCANNULA W I T H KNIFE-NEEDLE pine, 10% phenylepherine, and neomycin-bacitracinpolymixin solution. He was given cephalosporin 50 M. HARVEY RUBIN, M.D. mg subconjunctivally on the day of admission; this Greensboro, North Carolina was repeated the following day and again one week later. Lens aspiration as a surgical treatment Conjunctival cultures of the right eye taken prior to therapy, were negative for bacterial for both congenital and soft cataracts has growth. Culture of the right contact lens case rebecome increasingly popular over the past vealed several species of nonlactose fermenting several years. This operation has been gram-negative bacteria which included species of Alcaligenes and Flavobacterium ; these were considbrought to its present prominence by Scheie,1 ered to be nonhuman pathogens. A culture of the who stated that it probably has been used left lens case also showed a species of Pseudosince 1884 and possibly was used prior to monas. The patient was discharged on September 30, that time. 1967, on a regimen of chloramphenicol 250 mg four The procedure, according to Scheie, intimes a day, prednisone 25 mg every day, and topicludes local or general anesthesia, the use of cal medications. Chloramphenicol was discontinued on October 4, 1967, and tetracycline 250 mg four a conjunctival flap, and entry into the antetimes a day was prescribed. rior chamber with a Ziegler knife. The lens The vitreous began to clear in two weeks, and a capsule is incised and an 0.72-inch 19-gauge red fundus reflex could be seen. One month following admission, the vision in the right eye had imthin-walled needle with an oval tip proved to 20/200. The eye was mildly injected and (Atkinson) is used to aspirate the lens matethere were a few cells in the anterior chamber. The rial and irrigate the anterior chamber. The tetracycline was discontinued, and the prednisone was gradually tapered and completely discontinued needle enters the anterior chamber through on November 10, 1967. Topical medications were the incision made by the discission knife. 3 continued for several months. On January 12, 1968, Among the surgical complications of this vision in the right eye was 20/50; slight vitreous haze was present. From the Division of Ophthalmology, University When the patient was last examined on April 24, of North Carolina. 1968, vision was 20/50 with + 9 . 0 0 sphC + 175
962
AMERICAN JOURNAL OF OPHTHALMOLOGY
N O V E M B E R , 1968
An instrument which should simplify the lens aspiration technique for congenital, and soft cataract surgery has been devised. The instrument consists of a combination Teflon cannula and discission knife-needle of the Ziegler type. The cannula is a thin-walled 0.75-inch 19-gauge Teflon needle which can be sterilized by any of the methods now in use. The knife-needle fits into the cannula snugly in the fashion of a stylet, with the blade exposed* (fig. 1). The technique employed with this instrument is essentially the same as that described above, except that the knife-needle and its Teflon sheath enter the eye as a unit. After the lens capsule incision is made, the knife-needle is removed, a syringe is attached to the cannula, and the irrigation-aspiration proceeds in the usual fashion. The advantages are apparent. It is necessary to enter the anterior chamber only once. Since the cannula employed is blunt-tipped, semi-transparent, flexible, and relatively soft, the possibility of injuring either the posterior capsule, vitreous face, iris, or cornea is greatly diminished. The advantages of this type needle for intraocular use have been previously described. 3
SUMMARY Fig. 1 (Rubin). Left, Thin-walled cannula with knife-needle fitting as a stylet with blade exposed. Center, Cannula and discission knife-needle. Note blunt tip and semitransparency of cannula. Right, Magnification of cannula with discission knifeneedle.
operation are those inherent in any procedure in which entry into the anterior chamber is essential. Particular dangers are those of trauma to the corneal endothelium, the iris and in this situation especially, to the posterior capsule of the lens and the vitreous face. In addition, the necessity for reentry into the anterior chamber with a needle after withdrawal of the discission knife is a further source for concern.
A new type of instrument, a knife-needle with cannula, has been devised which eliminates some of the dangers in the surgery of congenital and soft cataracts by the aspirationirrigation technique and simplifies the procedure employed. REFERENCES 1. Scheie, H . G. : Aspiration of congenital or soft cataracts: A new technique. Am. J. Ophth. 50:1048, 1960. 2. Scheie, H . G., Rubenstein, R. A . and Kent, R. B. : Aspiration of congenital or soft cataracts : Further experience. Am. J. Ophth. 63:3, 1967. 3. Rubin, M. H . : Teflon needle for intraocular use. Am. J. Ophth. 65:250, 1968.
N O T E S , CASES, I N S T R U M E N T S
961
enced no difficulty in wearing them five to six cyl ax° 140. A few cells were noted on the corneal hours. In addition to the contact lenses, he wore biendothelium. Some vitreous strands were present, focal spectacle lenses with a piano lens for distance and no foveal reflex could be seen. The patient no and a +2.50 sphere for near and a 6-diopter prism longer wears contact lenses. base down in the right lens for a right hyperphoria that had been present prior to surgery. SUMMARY The patient was seen in the eye clinic on SeptemA case is presented of endophthalmitis ocber 22, 1967, with a history of irritation and redness in the right eye for three to four days. He had curring in a man who wore contact lenses in worn his contact lenses until the previous day. Corthe presence of a filtering bleb. After intenrected vision was 20/40 in the right eye and 20/20 sive treatment the patient recovered useful in the left eye with spectacle lenses. There was mild injection of the right eye with no exudate. The vitvision in this eye. reous was clear although there was an occasional 4200 East Ninth Avenue (80220) cell in the anterior chamber. The previously noted filtering bleb was present. Atropine was instilled in REFERENCES this eye and dexamethasone-neomycin-polymyxin solution was prescribed. The patient was told to re1. Wild, J. J. : Endophthalmitis in a contact lens turn the next day if his condition had not improved. wearer. Am. J. Ophth. 54:847, 1962. He did not return until three days later, at which 2. Dixon, J. M., Young, C. A., Jr., Baldone, J. time vision in the right eye was reduced to light A., Halberg, G. P., Sampson, W . and Stone, W . , perception. The eye was severely injected and the Jr.: Complications associated with the wearing of pupil was 5 mm and round. The anterior chamber contact lenses. J A M A 195:901, 1966. contained 4 + cells as well as a hypopyon in the lower one-third of the anterior chamber. No fundus reflex could be seen. The filtering bleb had disappeared. The patient was hospitalized and given methicillin one gram every six hours intravenously, chloramphenicol one gram every six hours intravenously, CATARACT ASPIRATION prednisone 30 mg a day orally, and topical 1 % atroCANNULA W I T H KNIFE-NEEDLE pine, 10% phenylepherine, and neomycin-bacitracinpolymixin solution. He was given cephalosporin 50 M. HARVEY RUBIN, M.D. mg subconjunctivally on the day of admission; this Greensboro, North Carolina was repeated the following day and again one week later. Lens aspiration as a surgical treatment Conjunctival cultures of the right eye taken prior to therapy, were negative for bacterial for both congenital and soft cataracts has growth. Culture of the right contact lens case rebecome increasingly popular over the past vealed several species of nonlactose fermenting several years. This operation has been gram-negative bacteria which included species of Alcaligenes and Flavobacterium ; these were considbrought to its present prominence by Scheie,1 ered to be nonhuman pathogens. A culture of the who stated that it probably has been used left lens case also showed a species of Pseudosince 1884 and possibly was used prior to monas. The patient was discharged on September 30, that time. 1967, on a regimen of chloramphenicol 250 mg four The procedure, according to Scheie, intimes a day, prednisone 25 mg every day, and topicludes local or general anesthesia, the use of cal medications. Chloramphenicol was discontinued on October 4, 1967, and tetracycline 250 mg four a conjunctival flap, and entry into the antetimes a day was prescribed. rior chamber with a Ziegler knife. The lens The vitreous began to clear in two weeks, and a capsule is incised and an 0.72-inch 19-gauge red fundus reflex could be seen. One month following admission, the vision in the right eye had imthin-walled needle with an oval tip proved to 20/200. The eye was mildly injected and (Atkinson) is used to aspirate the lens matethere were a few cells in the anterior chamber. The rial and irrigate the anterior chamber. The tetracycline was discontinued, and the prednisone was gradually tapered and completely discontinued needle enters the anterior chamber through on November 10, 1967. Topical medications were the incision made by the discission knife. 3 continued for several months. On January 12, 1968, Among the surgical complications of this vision in the right eye was 20/50; slight vitreous haze was present. From the Division of Ophthalmology, University When the patient was last examined on April 24, of North Carolina. 1968, vision was 20/50 with + 9 . 0 0 sphC + 175
962
AMERICAN JOURNAL OF OPHTHALMOLOGY
N O V E M B E R , 1968
An instrument which should simplify the lens aspiration technique for congenital, and soft cataract surgery has been devised. The instrument consists of a combination Teflon cannula and discission knife-needle of the Ziegler type. The cannula is a thin-walled 0.75-inch 19-gauge Teflon needle which can be sterilized by any of the methods now in use. The knife-needle fits into the cannula snugly in the fashion of a stylet, with the blade exposed* (fig. 1). The technique employed with this instrument is essentially the same as that described above, except that the knife-needle and its Teflon sheath enter the eye as a unit. After the lens capsule incision is made, the knife-needle is removed, a syringe is attached to the cannula, and the irrigation-aspiration proceeds in the usual fashion. The advantages are apparent. It is necessary to enter the anterior chamber only once. Since the cannula employed is blunt-tipped, semi-transparent, flexible, and relatively soft, the possibility of injuring either the posterior capsule, vitreous face, iris, or cornea is greatly diminished. The advantages of this type needle for intraocular use have been previously described. 3
SUMMARY Fig. 1 (Rubin). Left, Thin-walled cannula with knife-needle fitting as a stylet with blade exposed. Center, Cannula and discission knife-needle. Note blunt tip and semitransparency of cannula. Right, Magnification of cannula with discission knifeneedle.
operation are those inherent in any procedure in which entry into the anterior chamber is essential. Particular dangers are those of trauma to the corneal endothelium, the iris and in this situation especially, to the posterior capsule of the lens and the vitreous face. In addition, the necessity for reentry into the anterior chamber with a needle after withdrawal of the discission knife is a further source for concern.
A new type of instrument, a knife-needle with cannula, has been devised which eliminates some of the dangers in the surgery of congenital and soft cataracts by the aspirationirrigation technique and simplifies the procedure employed. REFERENCES 1. Scheie, H . G. : Aspiration of congenital or soft cataracts: A new technique. Am. J. Ophth. 50:1048, 1960. 2. Scheie, H . G., Rubenstein, R. A . and Kent, R. B. : Aspiration of congenital or soft cataracts : Further experience. Am. J. Ophth. 63:3, 1967. 3. Rubin, M. H . : Teflon needle for intraocular use. Am. J. Ophth. 65:250, 1968.