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Excision of Pupillary Membrane after Cataract Extraction with the Vitreous Infusion Suction Cutter
NOTES, CASES, INSTRUMENTS EXCISION O F PUPILLARY MEM BRANE A F T E R CATARACT EX TRACTION W I T H T H E VITREOUS INFUSION SUCTION CUTTER HAROLD N. JACKLIN,
M.D.
Greensboro, North Carolina
Pupillary membranes may persist or de velop after planned or unplanned extracapsular cataract extraction.1 Treatment is in dicated when visual acuity is impaired, or pupillary block glaucoma occurs. A single or double knife discission through a corneal stab limbal incision may provide an adequate opening in the thin membrane. When a thick irregular membrane is present "simple" discission becomes complicated with an in effective opening being achieved or post operative closure. A larger corneoscleral in cision with microscopic cutting of the thickened membrane may be complicated by vitreous fluid entering the anterior cham ber with incarceration in the operative in cision. Posterior lensectomy has been achieved with the vitreous infusion suction cutter when lens opacity prevented visualization of deeper vitreous pathology during vitrectomy.2 I used the vitreous infusion suction cutter to excise a thick pupillary membrane after cataract extraction.
While the patient was anesthetized locally, I per formed a posterior capsulectomy, using the Machemer vitreous infusion suction cutter instrument. A small conjunctival incision was made in the upper temporal quadrant and a 2-mm scierai incision ex posed the underlying uveal tissue. Light diathermy applications were applied and a 4-0 Dacron suture was placed across the lips of the incision. Under microscopic visualization I incised the uveal tissue and inserted the vitreous infusion suction cutter into the anterior vitreous cavity. The orifice of the
Fig. 1 (Jacklin). Thick pupillary membrane after cataract extraction.
CASE REPORT
In 1958, a 51-year-old woman had acute angleclosure glaucoma of the right eye. A filtering pro cedure was performed in the right eye and a pe ripheral iridectomy in the left eye. Intraocular pressures remained stable without medication. Pro gressive nuclear cataract changes developed in the right lens with deterioration of visual acuity to 20/200. A planned extracapsular cataract extrac tion was performed in the right eye through a corneal incision to preserve the filtering bleb. After surgery the remaining posterior capsule became opaque without improvement in visual acuity (Fig. 1)· Fig. 2 (Jacklin). Clear pupillary aperture after Reprint requests to Harold N. Jacklin, M.D., pars plana vitrectomy excision. 1014 N. Elm St., Greensboro, NC 27401. 1050
VOL. 79, NO. 6
NOTES, CASES, INSTRUMENTS
tip was placed anteriorly. Slow suction and cutting of the opaque posterior capsular membrane were achieved with a clear pupillary opening. The in strument was withdrawn and the preplaced suture closed. The overlying conjunctiva was closed with a running 7-0 chromic catgut suture. The anterior chamber remained clear without vitreous herniation throughout the procedure. Indirect ophthalmoscopy at surgery revealed clear vitreous fluid and good visualization of the posterior fundus. Visual acuity improved to 20/30 within one week with aphakic refraction (Fig. 2). SUMMARY
The vitreous infusion suction cutter in strument was used to excise a thick pupillary membrane after extracapsular cataract ex traction through a pars plana incision in a 51-year-old woman with acute angle-closure glaucoma. Successful removal was achieved without vitreous herniation or incarceration in the anterior or posterior chamber.
10S1
Figure (Loebel and Gassner). Abbreviated lens prescription seen on a spectacle temple.
the numbers in parentheses indicating any bifocal addition or prism. One hundred persons used the system in cluding students and army personnel. The procedure is simple and does not interfere with placing the name of the patient on the inner side of the temple. SUMMARY
An abbreviated inscription of a lens pre scription on a spectacle temple, such as + 1.25 + 1.50 X 90 ( + 2 2 e 2BD), facili tates prompt replacement of broken lenses.
REFERENCES 1. Jaffe, N. : Cataract Surgery And Its Compli cations. St. Louis, C. V. Mosby, 1972, pp. 322-324. 2. Machemer, R. : A new concept for vitreous surgery. 2. Surgical technique and complications. Am. J. Ophthalmol. 74:1022, 1972.
L E N S PRESCRIPTION IDENTIFICATION DAVID LOEBEL, M.D., AND SIDNEY GASSNER, M.D.
Petah Tiqva, Israel
The lens prescription engraved on the inner surface of spectacle temples, either directly or on a small recessed metal plaque, facilitates prompt replacement of broken lenses. School physicians found the innova tion to be useful in their work, and it has proved helpful in visual screening. The data are registered in an abbreviated form, such as +1.2S + 1.50X90 (+2 2B 2BD), with From the Beilinson Medical Center, Tel Aviv University Medical School, Petah Tiqva, Israel. Reprint requests to David Loebel, M.D., Beilin son Medical Center, Tel Aviv University Medical School, Petah Tiqva, Israel.
ARGON LASER IRIDOTOMY IN INCOMPLETE PERIPHERAL IRIDECTOMY HOWARD H. TESSLER, M.D., GHOLAM A. PEYMAN, M.D., FELIPE HUAMONTE, M.D., AND IRWIN MENACHOF, M.D.
Chicago, Illinois In performing a peripheral iridectomy the surgeon must be sure to include the pigment epithelium.1 Methods of insuring inclusion of the pigment layer include wiping the speci men on a cloth to be certain pigment comes off, using an operating microscope for better visualization, and, if coaxial illumination is present, using transillumination through the pupil shining back via the iridectomy site.2 Despite these precautions, incomplete periph eral iridectomies occur. From the Department of Ophthalmology, Univer sity of Illinois Eye and Ear Infirmary, 18SS W. Taylor St., Chicago, IL 60612. Reprint requests to Howard H. Tessler, M.D., University of Illinois Eye and Ear Infirmary, 18SS W. Taylor St., Chicago, IL 60612.
M.D.
Greensboro, North Carolina
Pupillary membranes may persist or de velop after planned or unplanned extracapsular cataract extraction.1 Treatment is in dicated when visual acuity is impaired, or pupillary block glaucoma occurs. A single or double knife discission through a corneal stab limbal incision may provide an adequate opening in the thin membrane. When a thick irregular membrane is present "simple" discission becomes complicated with an in effective opening being achieved or post operative closure. A larger corneoscleral in cision with microscopic cutting of the thickened membrane may be complicated by vitreous fluid entering the anterior cham ber with incarceration in the operative in cision. Posterior lensectomy has been achieved with the vitreous infusion suction cutter when lens opacity prevented visualization of deeper vitreous pathology during vitrectomy.2 I used the vitreous infusion suction cutter to excise a thick pupillary membrane after cataract extraction.
While the patient was anesthetized locally, I per formed a posterior capsulectomy, using the Machemer vitreous infusion suction cutter instrument. A small conjunctival incision was made in the upper temporal quadrant and a 2-mm scierai incision ex posed the underlying uveal tissue. Light diathermy applications were applied and a 4-0 Dacron suture was placed across the lips of the incision. Under microscopic visualization I incised the uveal tissue and inserted the vitreous infusion suction cutter into the anterior vitreous cavity. The orifice of the
Fig. 1 (Jacklin). Thick pupillary membrane after cataract extraction.
CASE REPORT
In 1958, a 51-year-old woman had acute angleclosure glaucoma of the right eye. A filtering pro cedure was performed in the right eye and a pe ripheral iridectomy in the left eye. Intraocular pressures remained stable without medication. Pro gressive nuclear cataract changes developed in the right lens with deterioration of visual acuity to 20/200. A planned extracapsular cataract extrac tion was performed in the right eye through a corneal incision to preserve the filtering bleb. After surgery the remaining posterior capsule became opaque without improvement in visual acuity (Fig. 1)· Fig. 2 (Jacklin). Clear pupillary aperture after Reprint requests to Harold N. Jacklin, M.D., pars plana vitrectomy excision. 1014 N. Elm St., Greensboro, NC 27401. 1050
VOL. 79, NO. 6
NOTES, CASES, INSTRUMENTS
tip was placed anteriorly. Slow suction and cutting of the opaque posterior capsular membrane were achieved with a clear pupillary opening. The in strument was withdrawn and the preplaced suture closed. The overlying conjunctiva was closed with a running 7-0 chromic catgut suture. The anterior chamber remained clear without vitreous herniation throughout the procedure. Indirect ophthalmoscopy at surgery revealed clear vitreous fluid and good visualization of the posterior fundus. Visual acuity improved to 20/30 within one week with aphakic refraction (Fig. 2). SUMMARY
The vitreous infusion suction cutter in strument was used to excise a thick pupillary membrane after extracapsular cataract ex traction through a pars plana incision in a 51-year-old woman with acute angle-closure glaucoma. Successful removal was achieved without vitreous herniation or incarceration in the anterior or posterior chamber.
10S1
Figure (Loebel and Gassner). Abbreviated lens prescription seen on a spectacle temple.
the numbers in parentheses indicating any bifocal addition or prism. One hundred persons used the system in cluding students and army personnel. The procedure is simple and does not interfere with placing the name of the patient on the inner side of the temple. SUMMARY
An abbreviated inscription of a lens pre scription on a spectacle temple, such as + 1.25 + 1.50 X 90 ( + 2 2 e 2BD), facili tates prompt replacement of broken lenses.
REFERENCES 1. Jaffe, N. : Cataract Surgery And Its Compli cations. St. Louis, C. V. Mosby, 1972, pp. 322-324. 2. Machemer, R. : A new concept for vitreous surgery. 2. Surgical technique and complications. Am. J. Ophthalmol. 74:1022, 1972.
L E N S PRESCRIPTION IDENTIFICATION DAVID LOEBEL, M.D., AND SIDNEY GASSNER, M.D.
Petah Tiqva, Israel
The lens prescription engraved on the inner surface of spectacle temples, either directly or on a small recessed metal plaque, facilitates prompt replacement of broken lenses. School physicians found the innova tion to be useful in their work, and it has proved helpful in visual screening. The data are registered in an abbreviated form, such as +1.2S + 1.50X90 (+2 2B 2BD), with From the Beilinson Medical Center, Tel Aviv University Medical School, Petah Tiqva, Israel. Reprint requests to David Loebel, M.D., Beilin son Medical Center, Tel Aviv University Medical School, Petah Tiqva, Israel.
ARGON LASER IRIDOTOMY IN INCOMPLETE PERIPHERAL IRIDECTOMY HOWARD H. TESSLER, M.D., GHOLAM A. PEYMAN, M.D., FELIPE HUAMONTE, M.D., AND IRWIN MENACHOF, M.D.
Chicago, Illinois In performing a peripheral iridectomy the surgeon must be sure to include the pigment epithelium.1 Methods of insuring inclusion of the pigment layer include wiping the speci men on a cloth to be certain pigment comes off, using an operating microscope for better visualization, and, if coaxial illumination is present, using transillumination through the pupil shining back via the iridectomy site.2 Despite these precautions, incomplete periph eral iridectomies occur. From the Department of Ophthalmology, Univer sity of Illinois Eye and Ear Infirmary, 18SS W. Taylor St., Chicago, IL 60612. Reprint requests to Howard H. Tessler, M.D., University of Illinois Eye and Ear Infirmary, 18SS W. Taylor St., Chicago, IL 60612.