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Healon (Sodium Hyaluronate) in Posterior Chamber Lens Implantation
VOL. 97, NO. 3
LETTERS TO THE JOURNAL
microbial keratitis. Alternate antibacterial agents have been suggested for penicillin-resistant pneumococci including cephalosporins, vancomycin, chloramphenicol, and clindamycin," although higher minimal inhibitory concentrations for cefazolin and mezlocillin have occurred.! Our patient's isolate demonstrated intermediate resistance to cephalothin that may have accounted for the delayed improvement until vancomycin was added. Of 72 previous isolates of S. pneumoniae received at the Ocular Microbiology Laboratory, Cullen Eye Institute, from ocular specimens over the past ten years, none were resistant to penicillin, one was resistant to vancomycin, and three were resistant to chloramphenicol (68 isolates determined by Kirby-Bauer method on Mueller-Hinton agar with sheep red blood cells added, unpublished data). Based upon this in vitro data and our recent clinical experience, we suggest that appropriate alternate therapy for pneumococcal keratitis, initially unresponsive or caused by a strain resistant to penicillin G, should include a cephalosporin or vancomycin.
389
BEALON (SODIUM BYAWRONATE) IN POSTERIOR CHAMBER LENS IMPLANTATION
M. PANDOLFI, M.D., AND C. LENNARTZ, M. D. Department of Ophthalmology. University Hospital. Malmo, Sweden. Inquiries to M. Pandolfi, M. D., Department of Ophthalmology, University of Lund, MalfJlO General Hospital, S-214 01 Malmo, Sweden.
While it is generally easy to place the inferior loop of a posterior chamber lens behind the iris, the positioning of the
REFERENCES 1. Jones, D. B.: Polymicrobial keratitis. Trans.
Am. Ophthalmol. Soc. 79:153, 1981. 2. Istre, G. R., Humphreys, J. T.,
Albrecht, M." and Hopkins, R. S.: Chloramphenicol and penicillin resistance in pneumococci isolated from blood and cerebrospinal fluid. A prevalence study in metropolitan Denver. J. Coo. Microbiol. 17:472, 1983. 3. Michel, J., Dickman, D., Greenberg, Z., and Bergrer-Rabinowitz, S.: Serotype distribution of penicillin-resistant pneumococci and their susceptibilities to seven antimicrobial agents. Antimicrob. Agents Chemother. 23:397, 1983. 4. Ward, J. L., and Moellring, R. C., [r.: Susceptibility of pneumococci to 14 beta-lactam agents. Comparison of strains resistant, intermediate resistant, and susceptible to penicillin. Antimicrob. Agents Chemother. 20:204, 1981.
K. D., Thornsberry, C., Swenson,
J.
Figure (Pandolfi and Lennartz). A, The tip of a U-shaped cannula is placed behind the iris at the 12 o'clock meridian, and Healon is injected to create space behind the iris, leading to a sectorial ballooning of the superior iris. B-D, The intraocular lens is inserted and the loops are compressed. When pressure is released the superior loop slips easily into the deepened posterior chamber.
390
AMERICAN JOURNAL OF OPHTHALMOLOGY
superior loop is far more difficult. When released, the superior loop tends to spring back in a plane anterior to that of the iris, ending up in the anterior chamber angle. To make this step easier, some manufacturers have devised intraocular lenses with a notched superior loop that is placed behind the iris with the help of a "pusher." However, this improvement is far from being perfect. As a rule, placing the superior loop is made difficult by the falling back of the iris after lens extraction. We found it useful to inject Healon (sodium hyaluronate) behind the iris in amounts sufficient to maneuver the tissue to produce a ballooning of the iris diaphragm between the 11 and the 1 o'clock meridians (Figure). A V-shaped delivery cannula facilitates the procedure. Healon must be injected immediately before the lens implantation to create and maintain the necessary space. This measure makes possible a correct placement of the superior lens loop at the first possible attempt. Furthermore, rotation of the intraocular lens is much smoother because of the lubricating action of Healon in the ciliary sulcus. This maneuver uses Healon as a liquid disposable instrument.
RETINAL TEAR LOCALIZATION FOLLOWING FLUID-GAS EXCHANGE DURING PARS PLANA VITREORETINAL SURGERY YALE L. FISHER, M.D., AND JOHN A. SORENSON, M.D.
Manhattan Eye, Ear, and Throat Hospital. Inquiries to Yale L Fisher, M.D., Manhattan Eye, Ear, and Throat Hospital, 210 E. 64th St., New York, NY 10021.
Retinal tear localization after retinal reattachment using fluid-gas exchange is
MARCH,1984
often difficult because of the minified view and multiple light reflexes seen with the gas-filled globe. To insure proper localization and treatment of all tears, lightly applied trans pars plana bipolar diathermy marks are placed on the retina adjacent to each tear before the fluid-gas exchange. We use a low setting (15-20) on the Mentor Wet-Field Coagulator and either a bimanual probe or a 20-gauge one-hand bipolar diathermy probe. 1 Gray-white burns are produced that do not cause retinal holes. The gray-white marks are readily seen following fluid-gas exchange and make localization and treatment of the tears easier. We have used this technique in over 200 cases without serious complication. REFERENCE 1. Charles,S., White, J., Dennison, C., and Eichenbaum, D.: Bimanual, bipolar intraocular diathermy. Am. J. OphthalmoI. 81:101, 1976.
SUCTION CUP FOR FORCED DUCTION TESTING FREDERICK S. MILLER III, M.D., AND ROBERT E. KALINA, M.D.
Section of Ophthalmology, Dartmouth- Hitchcock Medical Center (F.S.M); and Department of Ophthalmology, University of Washington (R.E. K.). Inquiries to Frederick S. Miller III, M. D., Section of Ophthalmology, Dartmouth-Hitchcock Medical Center, Hanover, NH 03576.
The detection of mechanical factors limiting ocular movement is important in the treatment of patients with strabismus. Forced duction testing typically has been performed using toothed forceps which may cause discomfort to the patient and superficial ocular trauma. For these reasons, physicians have hesitated to perform this test when evaluating disorders of ocular motility.
LETTERS TO THE JOURNAL
microbial keratitis. Alternate antibacterial agents have been suggested for penicillin-resistant pneumococci including cephalosporins, vancomycin, chloramphenicol, and clindamycin," although higher minimal inhibitory concentrations for cefazolin and mezlocillin have occurred.! Our patient's isolate demonstrated intermediate resistance to cephalothin that may have accounted for the delayed improvement until vancomycin was added. Of 72 previous isolates of S. pneumoniae received at the Ocular Microbiology Laboratory, Cullen Eye Institute, from ocular specimens over the past ten years, none were resistant to penicillin, one was resistant to vancomycin, and three were resistant to chloramphenicol (68 isolates determined by Kirby-Bauer method on Mueller-Hinton agar with sheep red blood cells added, unpublished data). Based upon this in vitro data and our recent clinical experience, we suggest that appropriate alternate therapy for pneumococcal keratitis, initially unresponsive or caused by a strain resistant to penicillin G, should include a cephalosporin or vancomycin.
389
BEALON (SODIUM BYAWRONATE) IN POSTERIOR CHAMBER LENS IMPLANTATION
M. PANDOLFI, M.D., AND C. LENNARTZ, M. D. Department of Ophthalmology. University Hospital. Malmo, Sweden. Inquiries to M. Pandolfi, M. D., Department of Ophthalmology, University of Lund, MalfJlO General Hospital, S-214 01 Malmo, Sweden.
While it is generally easy to place the inferior loop of a posterior chamber lens behind the iris, the positioning of the
REFERENCES 1. Jones, D. B.: Polymicrobial keratitis. Trans.
Am. Ophthalmol. Soc. 79:153, 1981. 2. Istre, G. R., Humphreys, J. T.,
Albrecht, M." and Hopkins, R. S.: Chloramphenicol and penicillin resistance in pneumococci isolated from blood and cerebrospinal fluid. A prevalence study in metropolitan Denver. J. Coo. Microbiol. 17:472, 1983. 3. Michel, J., Dickman, D., Greenberg, Z., and Bergrer-Rabinowitz, S.: Serotype distribution of penicillin-resistant pneumococci and their susceptibilities to seven antimicrobial agents. Antimicrob. Agents Chemother. 23:397, 1983. 4. Ward, J. L., and Moellring, R. C., [r.: Susceptibility of pneumococci to 14 beta-lactam agents. Comparison of strains resistant, intermediate resistant, and susceptible to penicillin. Antimicrob. Agents Chemother. 20:204, 1981.
K. D., Thornsberry, C., Swenson,
J.
Figure (Pandolfi and Lennartz). A, The tip of a U-shaped cannula is placed behind the iris at the 12 o'clock meridian, and Healon is injected to create space behind the iris, leading to a sectorial ballooning of the superior iris. B-D, The intraocular lens is inserted and the loops are compressed. When pressure is released the superior loop slips easily into the deepened posterior chamber.
390
AMERICAN JOURNAL OF OPHTHALMOLOGY
superior loop is far more difficult. When released, the superior loop tends to spring back in a plane anterior to that of the iris, ending up in the anterior chamber angle. To make this step easier, some manufacturers have devised intraocular lenses with a notched superior loop that is placed behind the iris with the help of a "pusher." However, this improvement is far from being perfect. As a rule, placing the superior loop is made difficult by the falling back of the iris after lens extraction. We found it useful to inject Healon (sodium hyaluronate) behind the iris in amounts sufficient to maneuver the tissue to produce a ballooning of the iris diaphragm between the 11 and the 1 o'clock meridians (Figure). A V-shaped delivery cannula facilitates the procedure. Healon must be injected immediately before the lens implantation to create and maintain the necessary space. This measure makes possible a correct placement of the superior lens loop at the first possible attempt. Furthermore, rotation of the intraocular lens is much smoother because of the lubricating action of Healon in the ciliary sulcus. This maneuver uses Healon as a liquid disposable instrument.
RETINAL TEAR LOCALIZATION FOLLOWING FLUID-GAS EXCHANGE DURING PARS PLANA VITREORETINAL SURGERY YALE L. FISHER, M.D., AND JOHN A. SORENSON, M.D.
Manhattan Eye, Ear, and Throat Hospital. Inquiries to Yale L Fisher, M.D., Manhattan Eye, Ear, and Throat Hospital, 210 E. 64th St., New York, NY 10021.
Retinal tear localization after retinal reattachment using fluid-gas exchange is
MARCH,1984
often difficult because of the minified view and multiple light reflexes seen with the gas-filled globe. To insure proper localization and treatment of all tears, lightly applied trans pars plana bipolar diathermy marks are placed on the retina adjacent to each tear before the fluid-gas exchange. We use a low setting (15-20) on the Mentor Wet-Field Coagulator and either a bimanual probe or a 20-gauge one-hand bipolar diathermy probe. 1 Gray-white burns are produced that do not cause retinal holes. The gray-white marks are readily seen following fluid-gas exchange and make localization and treatment of the tears easier. We have used this technique in over 200 cases without serious complication. REFERENCE 1. Charles,S., White, J., Dennison, C., and Eichenbaum, D.: Bimanual, bipolar intraocular diathermy. Am. J. OphthalmoI. 81:101, 1976.
SUCTION CUP FOR FORCED DUCTION TESTING FREDERICK S. MILLER III, M.D., AND ROBERT E. KALINA, M.D.
Section of Ophthalmology, Dartmouth- Hitchcock Medical Center (F.S.M); and Department of Ophthalmology, University of Washington (R.E. K.). Inquiries to Frederick S. Miller III, M. D., Section of Ophthalmology, Dartmouth-Hitchcock Medical Center, Hanover, NH 03576.
The detection of mechanical factors limiting ocular movement is important in the treatment of patients with strabismus. Forced duction testing typically has been performed using toothed forceps which may cause discomfort to the patient and superficial ocular trauma. For these reasons, physicians have hesitated to perform this test when evaluating disorders of ocular motility.