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Excision of Anterior Capsular Tags
Vol. 101, No.3
Letters to The Journal
383
Excision of Anterior Capsular Tags Seymour Perlstein, M.D., and Gary S. Chubak, M.D. Departments of Ophthalmology, Kingsbrook Jewish Medical Center (S.P.) and Long Island Jewish Medical Center (C.S.c.). Inquiries to Seymour H. Perlstein, M.D., 1842 50th sr.. Brooklyn, NY 11204. Fig. 2 (Jordan, Nerad, and Tse). Dislodged stent remains intact with knot secured (arrow).
showed a patent lacrimal system with a properly positioned silicone stent. In August 1985, ten years after the initial lacrimal surgery, the patient noticed that the "tubing" had come out of the nostril after she had wiped her nose. There had been no additional surgery or trauma to the area throughout this time. Examination of the left eye showed that both upper and lower canaliculi were completely marsupialized (Fig. 1). One could clearly see where the tube had eroded through the common canaliculus and into the nasolacrimal sac (Fig. 1, arrow). Dye disappearance testing was normal in each eye. The tube itself was found to be intact (Fig. 2). When canalicular erosion is present, it is generally mild. This case illustrated how extensive the erosion can be. It could have been prevented easily if the stents had been removed at an earlier stage. To our knowledge, this is the first report of complete canalicular erosion caused by silicone stents. Surprisingly, the patient remained asymptomatic for ten years, despite extensive erosion. We recommend watching for punctaI erosion postoperatively and removing the stent before extensive canalicular erosion occurs.
Extracapsular cataract extraction has become the predominant method of cataract surgery in the United States. Residual anterior capsular tags after the anterior capsulotomy may pose problems during the aspiration of cortical material. The tags may become engaged in the aspiration port and clog the irrigationaspiration unit. Additionally, tearing of the tag is to be avoided because it can lead to breaking of the zonules. We have found the following technique to be useful for the excision of residual anterior capsular tags. The aspiration port of the unit engages the tag, putting it on mild stretch. An intraocular scissors or a long Vannas scissors is then put into the anterior chamber to excise the tag. The unit is then removed from the eye while in the aspiration mode, thus the tag is still engaged. This technique avoids the need for special hooks-! that risk zonular disruption. Also, this method allows easier engagement of the tag than use of a forceps because the mobile tag may float away from the grasp of the forceps.! References 1. Schulze, R. R.: The anterior capsular nibbler. Ophthalmic Surg. 16:510, 1985. 2. Emery, J. M., and McIntyre, D. J.: Extracapsular Cataract Surgery. St. Louis, C. V. Mosby, 1985, pp. 164-166.
References 1. Katowitz, J. A.: Silicone tubing in canalicular obstructions. Arch. Ophthalmol. 91:459, 1974. 2. Anderson, R. L., and Edwards, J. J.: Indications, complications, and results with silicone stents. Ophthalmology 86:1474, 1979. 3. Kraft, S. P., and Crawford, J. S.: Silicone tube intubation in disorders of the lacrimal system in children. Am. J. Ophthalmol. 94:290, 1982.
Compensatory Head Positions in Muscle Palsies Michael Vrabec, M.D. Department of Ophthalmology, University of Wisconsin Medical School. Inquiries to Michael Vrabec, M.D., Department of Ophthalmology, F4/338 Clinical Science Center, 600 Highland Ave., Madison, WI 53792.
Letters to The Journal
383
Excision of Anterior Capsular Tags Seymour Perlstein, M.D., and Gary S. Chubak, M.D. Departments of Ophthalmology, Kingsbrook Jewish Medical Center (S.P.) and Long Island Jewish Medical Center (C.S.c.). Inquiries to Seymour H. Perlstein, M.D., 1842 50th sr.. Brooklyn, NY 11204. Fig. 2 (Jordan, Nerad, and Tse). Dislodged stent remains intact with knot secured (arrow).
showed a patent lacrimal system with a properly positioned silicone stent. In August 1985, ten years after the initial lacrimal surgery, the patient noticed that the "tubing" had come out of the nostril after she had wiped her nose. There had been no additional surgery or trauma to the area throughout this time. Examination of the left eye showed that both upper and lower canaliculi were completely marsupialized (Fig. 1). One could clearly see where the tube had eroded through the common canaliculus and into the nasolacrimal sac (Fig. 1, arrow). Dye disappearance testing was normal in each eye. The tube itself was found to be intact (Fig. 2). When canalicular erosion is present, it is generally mild. This case illustrated how extensive the erosion can be. It could have been prevented easily if the stents had been removed at an earlier stage. To our knowledge, this is the first report of complete canalicular erosion caused by silicone stents. Surprisingly, the patient remained asymptomatic for ten years, despite extensive erosion. We recommend watching for punctaI erosion postoperatively and removing the stent before extensive canalicular erosion occurs.
Extracapsular cataract extraction has become the predominant method of cataract surgery in the United States. Residual anterior capsular tags after the anterior capsulotomy may pose problems during the aspiration of cortical material. The tags may become engaged in the aspiration port and clog the irrigationaspiration unit. Additionally, tearing of the tag is to be avoided because it can lead to breaking of the zonules. We have found the following technique to be useful for the excision of residual anterior capsular tags. The aspiration port of the unit engages the tag, putting it on mild stretch. An intraocular scissors or a long Vannas scissors is then put into the anterior chamber to excise the tag. The unit is then removed from the eye while in the aspiration mode, thus the tag is still engaged. This technique avoids the need for special hooks-! that risk zonular disruption. Also, this method allows easier engagement of the tag than use of a forceps because the mobile tag may float away from the grasp of the forceps.! References 1. Schulze, R. R.: The anterior capsular nibbler. Ophthalmic Surg. 16:510, 1985. 2. Emery, J. M., and McIntyre, D. J.: Extracapsular Cataract Surgery. St. Louis, C. V. Mosby, 1985, pp. 164-166.
References 1. Katowitz, J. A.: Silicone tubing in canalicular obstructions. Arch. Ophthalmol. 91:459, 1974. 2. Anderson, R. L., and Edwards, J. J.: Indications, complications, and results with silicone stents. Ophthalmology 86:1474, 1979. 3. Kraft, S. P., and Crawford, J. S.: Silicone tube intubation in disorders of the lacrimal system in children. Am. J. Ophthalmol. 94:290, 1982.
Compensatory Head Positions in Muscle Palsies Michael Vrabec, M.D. Department of Ophthalmology, University of Wisconsin Medical School. Inquiries to Michael Vrabec, M.D., Department of Ophthalmology, F4/338 Clinical Science Center, 600 Highland Ave., Madison, WI 53792.