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Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation Combined With Trabeculectomy in Patients With Glaucoma: Reply
Correspondence
Vol. 105, No. 6
of m e i b o m i a n gland d y s f u n c t i o n . Proliferation of d e s q u a m a t e d e p i t h e l i u m p r o b a b l y occurs as a s e q u e l a e to h y p e r k e r a t i n i z a t i o n of d u c t a l epi t h e l i u m a n d results in a loss of p a t e n c y of the gland orifice. An occlusion of t h e external ori fice of the m e i b o m i a n g l a n d w i t h d e s q u a m a t e d e p i t h e l i u m may f u r t h e r inhibit the e x p r e s s i o n of m e i b o m i a n g l a n d m a t e r i a l . If similar c h a n g e s occur in p a t i e n t s w i t h b l e p h a r i t i s , it w o u l d be a p p r o p r i a t e to treat this d i s o r d e r , in p a r t , by p r o p o s i n g r e g u l a r s c r u b b i n g of the eyelid mar gin to r e m o v e excess d e b r i s , w h i c h w o u l d in clude k e r a t i n i z e d cells.
References 1. Jester, J. V., Nicolaides, N., and Smith, R. E.: Meibomian gland studies. Histologic and ultrastructural investigations. Invest. Ophthalmol. Vis. Sci. 20:537, 1981. 2. Jester, J. V., Rife, L., Nii, D., Luttrull, J. K., Wilson, L., and Smith, R. E.: In vivo biomicroscopy and photography of meibomian glands in a rabbit model of meibomian gland dysfunction. Invest. Ophthalmol. Vis. Sci. 22:660, 1982.
Correspondence Correspondence concerning recent articles or other mate rial published in THE JOURNAL should be submitted within six weeks of publication. Correspondence must be typed double-spaced, on 8'/2 x 11-inch bond paper with lVi-inch margins on all four sides and should be no more than two typewritten pages in length. Every effort will be made to resolve controversies between the correspondents and the authors of the article before publication.
Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation Combined With Trabeculectomy in Patients With Glaucoma EDITOR: In t h e article, " E x t r a c a p s u l a r cataract ex traction a n d p o s t e r i o r c h a m b e r i n t r a o c u l a r lens i m p l a n t a t i o n c o m b i n e d w i t h trabeculec t o m y in p a t i e n t s w i t h g l a u c o m a , " by S. T. S i m m o n s , D. Liftoff, D. A. N i c h o l s , M. B. S h e r w o o d , a n d G. L. S p a e t h (Am. J. O p h t h a l
705
mol. 104:465, N o v e m b e r 1987), I w a s sur p r i s e d by two p o i n t s : T h e a u t h o r s d i d not cite a n article o n this subject, w h i c h I p u b l i s h e d in the F r e n c h liter a t u r e t o g e t h e r w i t h my c o l l e a g u e s . 1 Also, t h e a u t h o r s did not refer to a n y o t h e r t y p e of i n t e r v e n t i o n , s u c h as s e p a r a t e inci s i o n s for the e x t r a c t i o n of the lens a n d the t r a b e c u l e c t o m y . S e p a r a t e incisions m a y de crease the risk of i n f l a m m a t i o n a n d h y p h e m a , a n d m a y a s s u r e m o r e p e r m e a b i l i t y of the tra beculectomy. I w a s also s u r p r i s e d by the a b s e n c e of sec o n d a r y s u b l u x a t i o n of the i n t r a o c u l a r lens a n d modification of t h e size a n d a s p e c t of the p u p i l , except in o n e case. DAN A. LEBUISSON, M.D. Neuilly-sur-Seine, France
Reference 1. Lebuisson, D., Delbecque, P., Leroy, L., Montin, J.-F., and Bamba, M.: L'operation combinee. Cataracte et glaucome avec implantation. Resultats d'une serie de 28 cas. J. Fr. Ophtalmol. 7:781, 1984.
Reply EDITOR: We t h a n k Dr. L e b u i s s o n for his i n t e r e s t a n d c o m m e n t s a b o u t o u r article. This s t u d y w a s u n d e r t a k e n to r e v i e w o u r r e s u l t s in p a t i e n t s u n d e r g o i n g c o m b i n e d cataract extraction a n d t r a b e c u l e c t o m y p e r f o r m e d in the m a n n e r out lined in t h e p a p e r . The i n v e s t i g a t i o n c o n c e n t r a t e d o n i n t r a o c u l a r p r e s s u r e control a n d vis ual r e s u l t s , a n d t h e s e w e r e r e p o r t e d . T h e p u r p o s e of this p a p e r w a s not to review this topic or to c o m p a r e this surgical a p p r o a c h to o t h e r s b e c a u s e only a p r o s p e c t i v e , r a n d o m ized trial can clearly a d d r e s s t h e s e i s s u e s . We r e g r e t o u r o v e r s i g h t in not citing Dr. L e b u i s s o n ' s p u b l i c a t i o n in o u r references a n d a g a i n a p p r e c i a t e his i n t e r e s t a n d c o m m e n t s . STEVEN T. SIMMONS, M.D. Philadelphia, Pennsylvania and Albany, New York DAVID LITOFF, B.A. Albany, New York DAN A. NICHOLS, M.D. MARK B. SHERWOOD, M.D. GEORGE L. SPAETH, M.D. Philadelphia, Pennsylvania
Vol. 105, No. 6
of m e i b o m i a n gland d y s f u n c t i o n . Proliferation of d e s q u a m a t e d e p i t h e l i u m p r o b a b l y occurs as a s e q u e l a e to h y p e r k e r a t i n i z a t i o n of d u c t a l epi t h e l i u m a n d results in a loss of p a t e n c y of the gland orifice. An occlusion of t h e external ori fice of the m e i b o m i a n g l a n d w i t h d e s q u a m a t e d e p i t h e l i u m may f u r t h e r inhibit the e x p r e s s i o n of m e i b o m i a n g l a n d m a t e r i a l . If similar c h a n g e s occur in p a t i e n t s w i t h b l e p h a r i t i s , it w o u l d be a p p r o p r i a t e to treat this d i s o r d e r , in p a r t , by p r o p o s i n g r e g u l a r s c r u b b i n g of the eyelid mar gin to r e m o v e excess d e b r i s , w h i c h w o u l d in clude k e r a t i n i z e d cells.
References 1. Jester, J. V., Nicolaides, N., and Smith, R. E.: Meibomian gland studies. Histologic and ultrastructural investigations. Invest. Ophthalmol. Vis. Sci. 20:537, 1981. 2. Jester, J. V., Rife, L., Nii, D., Luttrull, J. K., Wilson, L., and Smith, R. E.: In vivo biomicroscopy and photography of meibomian glands in a rabbit model of meibomian gland dysfunction. Invest. Ophthalmol. Vis. Sci. 22:660, 1982.
Correspondence Correspondence concerning recent articles or other mate rial published in THE JOURNAL should be submitted within six weeks of publication. Correspondence must be typed double-spaced, on 8'/2 x 11-inch bond paper with lVi-inch margins on all four sides and should be no more than two typewritten pages in length. Every effort will be made to resolve controversies between the correspondents and the authors of the article before publication.
Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation Combined With Trabeculectomy in Patients With Glaucoma EDITOR: In t h e article, " E x t r a c a p s u l a r cataract ex traction a n d p o s t e r i o r c h a m b e r i n t r a o c u l a r lens i m p l a n t a t i o n c o m b i n e d w i t h trabeculec t o m y in p a t i e n t s w i t h g l a u c o m a , " by S. T. S i m m o n s , D. Liftoff, D. A. N i c h o l s , M. B. S h e r w o o d , a n d G. L. S p a e t h (Am. J. O p h t h a l
705
mol. 104:465, N o v e m b e r 1987), I w a s sur p r i s e d by two p o i n t s : T h e a u t h o r s d i d not cite a n article o n this subject, w h i c h I p u b l i s h e d in the F r e n c h liter a t u r e t o g e t h e r w i t h my c o l l e a g u e s . 1 Also, t h e a u t h o r s did not refer to a n y o t h e r t y p e of i n t e r v e n t i o n , s u c h as s e p a r a t e inci s i o n s for the e x t r a c t i o n of the lens a n d the t r a b e c u l e c t o m y . S e p a r a t e incisions m a y de crease the risk of i n f l a m m a t i o n a n d h y p h e m a , a n d m a y a s s u r e m o r e p e r m e a b i l i t y of the tra beculectomy. I w a s also s u r p r i s e d by the a b s e n c e of sec o n d a r y s u b l u x a t i o n of the i n t r a o c u l a r lens a n d modification of t h e size a n d a s p e c t of the p u p i l , except in o n e case. DAN A. LEBUISSON, M.D. Neuilly-sur-Seine, France
Reference 1. Lebuisson, D., Delbecque, P., Leroy, L., Montin, J.-F., and Bamba, M.: L'operation combinee. Cataracte et glaucome avec implantation. Resultats d'une serie de 28 cas. J. Fr. Ophtalmol. 7:781, 1984.
Reply EDITOR: We t h a n k Dr. L e b u i s s o n for his i n t e r e s t a n d c o m m e n t s a b o u t o u r article. This s t u d y w a s u n d e r t a k e n to r e v i e w o u r r e s u l t s in p a t i e n t s u n d e r g o i n g c o m b i n e d cataract extraction a n d t r a b e c u l e c t o m y p e r f o r m e d in the m a n n e r out lined in t h e p a p e r . The i n v e s t i g a t i o n c o n c e n t r a t e d o n i n t r a o c u l a r p r e s s u r e control a n d vis ual r e s u l t s , a n d t h e s e w e r e r e p o r t e d . T h e p u r p o s e of this p a p e r w a s not to review this topic or to c o m p a r e this surgical a p p r o a c h to o t h e r s b e c a u s e only a p r o s p e c t i v e , r a n d o m ized trial can clearly a d d r e s s t h e s e i s s u e s . We r e g r e t o u r o v e r s i g h t in not citing Dr. L e b u i s s o n ' s p u b l i c a t i o n in o u r references a n d a g a i n a p p r e c i a t e his i n t e r e s t a n d c o m m e n t s . STEVEN T. SIMMONS, M.D. Philadelphia, Pennsylvania and Albany, New York DAVID LITOFF, B.A. Albany, New York DAN A. NICHOLS, M.D. MARK B. SHERWOOD, M.D. GEORGE L. SPAETH, M.D. Philadelphia, Pennsylvania