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Catheter Erisophake
866
NOTES, CASES, I N S T R U M E N T S
3. Godtfredsen, E. : Electric cataract and electrocardiographic changes after electric shock. Acta. Ophth., 2 0 : 6 9 , 1942. 4. A d a m , A . L., and K l e m , M.: Electric cataract: N o t e s o n case and review of literature. Brit. J. Ophth., 2 9 : 1 6 9 ( A p r . ) 1945. 5. Gonzalez del Rio, P . : Cataract due to action of high tension current: R e v i e w o f literature and report of case. A r c h . Soc. O f t a l - H i s p a n o - A m . , 6:245 ( M a r . ) 1956. 6. Knusel, O . : L a t e f o r m of electric cataract: Case. Ophthalmologica, 1 1 7 : 2 9 9 ( A p r . - M a y ) 1949. 7. M o r u l a s , D . : Spastic paraplegia and bilateral cataracts following electric shock. Case in workman. A c t a espan. neurol. & psiquiet., 1 0 : 6 9 ( F e b . ) 1951. 8. François, J., Beal, F., and Doise, P . : L e s cataractes électrique, apropos de 2 observations. A r c h . Mal. P r o f e s s . , 17:499, 1956. 9. Beiz and V e r g e z : Cataracte électrique d'apparition tardive. Bull. Soc. ophtal. France, M a y , 1956, p. 561. 10. Lock, J. A . N . : Electrical cataract produced by a 240-volt current. Brit. J. Ophth., 4 1 : 5 0 0 ( A u g . ) 1957. 11. Chavanne, M. H . : Pseudo-trou maculaire par electrocution. Bull Soc. ophtal. France, Mar. 1958, p. 27. 12. D u k e - E l d e r , S. : T e x t b o o k of Ophthalmology. Kimpton, London, 1954, v. 6, p. 6435. 13. W a l s h , F . J.: Clinical N e u r o - O p h t h a l m o l o g y . Baltimore, W i l l i a m s & W i l k i n s , 1947, p. 1282.
CATHETER NOEL T .
ERISOPHAKE
SIMMONDS,
Alexandria,
M.D.
Louisiana
In using the nipple type erisophake, it is necessary to hold the rubber nipple in the operating hand, squeeze the nipple and, while maintaining pressure on the nipple, gently apply the cup to the anterior lens capsule and, while still maintaining gentle steady pressure on the lens capsule, release the pressure on the bulb and allow the vacuum to suck the capsule into the cup. To me this is an awkward maneuver. T o simplify this, a piece of No. 22 catheter about 18-cm. long has been substituted for the nipple. The free end of the catheter can be closed by doubling it over and tying it, or the metal plug that closes the piece of catheter in a Harrington erisophake can be used. In using this catheter erisophake, the catheter is held in the operating hand near the erisophake. The other hand holds the catheter near its free end and squeezes the catheter to evacuate enough solution to obtain vacuum when it is released. In this way, the hand applying the erisophake does nothing but apply gentle pressure to the capsule while the other hand squeezes and releases the catheter (fig. 1 ) . The free end
F i g . 1 ( S i m m o n d s ) . Gentle pressure is applied to the capsule by one hand while the other hand squeezes and releases the catheter.
of the catheter is then turned loose and by its own elasticity straightens itself and fits in the operating hand more or less like a flexible pencil (fig. 2 ) .
F i g . 2 ( S i m m o n d s ) . T h e catheter straightens itself to fit in the operating hand like a flexible pencil.
NOTES, CASES,
The only disagreeable feature about the catheter erisophake is that it takes a little bit longer to evacuate the air from the catheter and fill it with saline than it does with the nipple-type erisophake. 1300 Jackson Street.
INSTRUMENTS
867
F i g . 1 ( S a y o c ) . ( L e f t ) B e f o r e operation. ( R i g h t ) O n e month after operation.
MONOCULAR PTOSIS WITHOUT LEVATOR ACTION BURGOS
T.
SAYOC,*
Quezon
COL.
City,
( M C ) A.F.P.
Philippines
I wish to emphasize in this paper the problems being met in monocular ptosis without levator action wherein the normal lid has a natural fold. Surgery of this condition may use ( 1 ) occipito-frontalis muscle for lifting the lid or ( 2 ) the superior rectus muscle if it is not paralyzed. The procedure being presented here uses both. S U R G I C A L
F i g . 2 ( S a y o c ) . ( L e f t ) B e f o r e operation. ( R i g h t ) O n e w e e k a f t e r operation.
F i g . 3 ( S a y o c ) . ( L e f t ) B e f o r e operation. ( R i g h t ) F i v e days after operation.
T E C H N I Q U E
After measuring the height and shape of the natural fold in the normal lid, they are drawn with an eyebrow pencil on the ptotic lid two mm. lower than the exact measurements. After block and infiltration anesthesia, the lid is grasped with a Sayoc lid forceps exactly on the line. With a BardParker No. 15 blade, an incision is made in one long stroke from the medial to the lateral ends, cutting the skin, subcutaneous tissue and orbicularis to the tarsus. About two to three mm. of orbicularis are excised under the lower skin flap to minimize any puffiness of the lid fold. About two mm. of orbicularis are also excised along the whole length of the incision to expose the tarsus. Then double-V sutures are inserted from the tarsus to the frontalis without lifting the lid. The lower skin flap is anchored intradermally on the tarsus two mm. higher than the height of the skin incision. Five 6-0 silk buried intradermal sutures are placed. This * D e p u t y surgeon general.
F i g . 4 ( S a y o c ) . ( L e f t ) B e f o r e operation. ( R i g h t ) T w o w e e k s after operation.
makes the skin of the lower flap a little taut so that, after closure of the incision, an initial fold line already exists. A s soon as the lid fold is constructed, the height of the lid is adjusted. Usually the inflammatory reaction is minimal. A Frost suture is kept in place after each dressing. The sutures on the fold are removed on the fourth postoperative day and those on the eyebrow on the seventh day. The patient is usually discharged after 48 hours. If after two or three weeks, the fold in the normal lid seems a little larger or smaller than that in the ptotic lid, it can be made to match by constructing a new one, disregarding the natural lid fold on the normal lid.
NOTES, CASES, I N S T R U M E N T S
3. Godtfredsen, E. : Electric cataract and electrocardiographic changes after electric shock. Acta. Ophth., 2 0 : 6 9 , 1942. 4. A d a m , A . L., and K l e m , M.: Electric cataract: N o t e s o n case and review of literature. Brit. J. Ophth., 2 9 : 1 6 9 ( A p r . ) 1945. 5. Gonzalez del Rio, P . : Cataract due to action of high tension current: R e v i e w o f literature and report of case. A r c h . Soc. O f t a l - H i s p a n o - A m . , 6:245 ( M a r . ) 1956. 6. Knusel, O . : L a t e f o r m of electric cataract: Case. Ophthalmologica, 1 1 7 : 2 9 9 ( A p r . - M a y ) 1949. 7. M o r u l a s , D . : Spastic paraplegia and bilateral cataracts following electric shock. Case in workman. A c t a espan. neurol. & psiquiet., 1 0 : 6 9 ( F e b . ) 1951. 8. François, J., Beal, F., and Doise, P . : L e s cataractes électrique, apropos de 2 observations. A r c h . Mal. P r o f e s s . , 17:499, 1956. 9. Beiz and V e r g e z : Cataracte électrique d'apparition tardive. Bull. Soc. ophtal. France, M a y , 1956, p. 561. 10. Lock, J. A . N . : Electrical cataract produced by a 240-volt current. Brit. J. Ophth., 4 1 : 5 0 0 ( A u g . ) 1957. 11. Chavanne, M. H . : Pseudo-trou maculaire par electrocution. Bull Soc. ophtal. France, Mar. 1958, p. 27. 12. D u k e - E l d e r , S. : T e x t b o o k of Ophthalmology. Kimpton, London, 1954, v. 6, p. 6435. 13. W a l s h , F . J.: Clinical N e u r o - O p h t h a l m o l o g y . Baltimore, W i l l i a m s & W i l k i n s , 1947, p. 1282.
CATHETER NOEL T .
ERISOPHAKE
SIMMONDS,
Alexandria,
M.D.
Louisiana
In using the nipple type erisophake, it is necessary to hold the rubber nipple in the operating hand, squeeze the nipple and, while maintaining pressure on the nipple, gently apply the cup to the anterior lens capsule and, while still maintaining gentle steady pressure on the lens capsule, release the pressure on the bulb and allow the vacuum to suck the capsule into the cup. To me this is an awkward maneuver. T o simplify this, a piece of No. 22 catheter about 18-cm. long has been substituted for the nipple. The free end of the catheter can be closed by doubling it over and tying it, or the metal plug that closes the piece of catheter in a Harrington erisophake can be used. In using this catheter erisophake, the catheter is held in the operating hand near the erisophake. The other hand holds the catheter near its free end and squeezes the catheter to evacuate enough solution to obtain vacuum when it is released. In this way, the hand applying the erisophake does nothing but apply gentle pressure to the capsule while the other hand squeezes and releases the catheter (fig. 1 ) . The free end
F i g . 1 ( S i m m o n d s ) . Gentle pressure is applied to the capsule by one hand while the other hand squeezes and releases the catheter.
of the catheter is then turned loose and by its own elasticity straightens itself and fits in the operating hand more or less like a flexible pencil (fig. 2 ) .
F i g . 2 ( S i m m o n d s ) . T h e catheter straightens itself to fit in the operating hand like a flexible pencil.
NOTES, CASES,
The only disagreeable feature about the catheter erisophake is that it takes a little bit longer to evacuate the air from the catheter and fill it with saline than it does with the nipple-type erisophake. 1300 Jackson Street.
INSTRUMENTS
867
F i g . 1 ( S a y o c ) . ( L e f t ) B e f o r e operation. ( R i g h t ) O n e month after operation.
MONOCULAR PTOSIS WITHOUT LEVATOR ACTION BURGOS
T.
SAYOC,*
Quezon
COL.
City,
( M C ) A.F.P.
Philippines
I wish to emphasize in this paper the problems being met in monocular ptosis without levator action wherein the normal lid has a natural fold. Surgery of this condition may use ( 1 ) occipito-frontalis muscle for lifting the lid or ( 2 ) the superior rectus muscle if it is not paralyzed. The procedure being presented here uses both. S U R G I C A L
F i g . 2 ( S a y o c ) . ( L e f t ) B e f o r e operation. ( R i g h t ) O n e w e e k a f t e r operation.
F i g . 3 ( S a y o c ) . ( L e f t ) B e f o r e operation. ( R i g h t ) F i v e days after operation.
T E C H N I Q U E
After measuring the height and shape of the natural fold in the normal lid, they are drawn with an eyebrow pencil on the ptotic lid two mm. lower than the exact measurements. After block and infiltration anesthesia, the lid is grasped with a Sayoc lid forceps exactly on the line. With a BardParker No. 15 blade, an incision is made in one long stroke from the medial to the lateral ends, cutting the skin, subcutaneous tissue and orbicularis to the tarsus. About two to three mm. of orbicularis are excised under the lower skin flap to minimize any puffiness of the lid fold. About two mm. of orbicularis are also excised along the whole length of the incision to expose the tarsus. Then double-V sutures are inserted from the tarsus to the frontalis without lifting the lid. The lower skin flap is anchored intradermally on the tarsus two mm. higher than the height of the skin incision. Five 6-0 silk buried intradermal sutures are placed. This * D e p u t y surgeon general.
F i g . 4 ( S a y o c ) . ( L e f t ) B e f o r e operation. ( R i g h t ) T w o w e e k s after operation.
makes the skin of the lower flap a little taut so that, after closure of the incision, an initial fold line already exists. A s soon as the lid fold is constructed, the height of the lid is adjusted. Usually the inflammatory reaction is minimal. A Frost suture is kept in place after each dressing. The sutures on the fold are removed on the fourth postoperative day and those on the eyebrow on the seventh day. The patient is usually discharged after 48 hours. If after two or three weeks, the fold in the normal lid seems a little larger or smaller than that in the ptotic lid, it can be made to match by constructing a new one, disregarding the natural lid fold on the normal lid.