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Intracameral Preserved Lidocaine
LEITERS
could tear the capsule or snag the iris. The glide can be layered with viscoelastic substance and the 10L inserted into the eye over the glide. The glide should be withdrawn as the lens is being inserted. The lens glide can also be placed in the ciliary sulcus to facilitate sulcus fIxation of a posterior chamber lens in cases of posterior capsule rupture. In cases of posterior capsule rupture with remaining nuclear fragments, the lens glide can be placed behind the fragments to prevent their posterior dislocation during the attempts at removal. The glide may also facilitate insertion of the phacoemulsifIcation or irrigationlaspiration instruments into the anterior chamber in cases in which iris hooks cause upward tenting of the iris or when there is iris prolapsing through the incision, as may occur with posterior keratome entry or in eyes with short axial lengths. In this instance, the glide must be trimmed to fIt the incision SIze. The Sheets lens glide is an old device that has flexibility and applicability to modern cataract surgery and should be incorporated into the anterior segment surgeon's armamentarium. MICHELE R PICCONE, MD MICHAEL E. SULEWSKI, MD DAVID M. KOZART, MD
Philadelphia, Pennsylvania References 1. Sheets JH, Maida JW. Lens glide in implant surgery. Arch Ophthalmol1978; 96:145-146 2. McGowan BL. A modified lens glide for intraocular lens implantation. Am Intra-Ocular Implant Soc J 1980; 6:172-173 3. Siepser SB. Modification to rhe Sheets glide for anterior chamber diameter measurement. Ophthalmic Surg 1982; 13:412 4. Perry HD, Nelson DB. A new merhod for inferior caps ulotomy in the face of ruptured zonules. Ophthalmic Surg 1984; 15:765766 5. Michelson MA. Use of a Sheets glide as a pseudoposterior capsule in phacoemulsification complicated by posterior capsule rupture. Eur J Implant Refract Surg 1993; 5:70-72
Intracameral Preserved Lidocaine
I
have recently been doing most of my cases, including planned extracap and scleral tunnel procedures, under topical anesthesia using Gills' technique of intracameral nonpreserved 1% lidocaine. This intracameral lidocaine seems to make essentially all anterior segment procedures pain free, including planned extracap, scleral 10
tunnel, and pupil stretching. Just this week, however, after case 14, I noted that preserved lidocaine had been inadvertently substituted for nonpreserved. Anecdotally, I have heard it stated that preserved lidocaine is tolerated by the corneal endothelium. Hoping this was true, I was relieved on the next morning to fInd that all these cases had clear corneas and looked as good as the cases in which nonpreserved lidocaine was used. I do not wish to recommend preserved intracameral lidocaine. However, in this small series, which was done inadvertently, small amounts appear to be well tolerated. LUTHER L. FRY, MD
Garden City, Kansas
Radial Keratotomy Before and After Retinal Detachment Surgery
T
his case report presents a patient who required an enhancement because of an unusual situation postradial keratotomy-retinal detachment with encircling band surgery. The patient, a 32-year-old man, had bilateral radial keratotomies (RKs) in 1991. The left eye, preoperatively - 2.62 spherical equivalent by cycloplegic refraction, had four radial incisions with a 3.75 mm optical zone. The right eye, also - 2.62 spherical equivalent, had eight radial incisions with a 4.25 mm optical zone. An enhancement in the left eye of four additional radial cuts at a 4.25 mm optical zone was performed several months later, and the patient achieved 20/20 uncorrected visual acuity in each eye with a spherical equivalent of - 0.25 in the right eye and plano in the left eye by cycloplegic examination. The patient maintained 20/20 visual acuity until 1994, when he developed bilateral bullous retinal detachments requiring encircling bands. Postoperatively, the patient's cycloplegic refraction stabilized at a spherical equivalent of -2.37 in the right eye and -2.75 in the left eye, which was essentially his prescription prior to his initial RKs. His keratometry pre-retinal detachment and post-retinal detachment remained unchanged at approximately 39.50 sphere. Two years following the retinal detachment repair, a reoperation was performed in the right eye, which consisted of recutting the eight radial incisions from the 3.25 mm optical zone to the 8.00 mm optical zone. Postoperatively, the patient again achieved a spherical
J CATARACT REFRACT SURG-VOL 23, JANUARY/FEBRUARY 1997
could tear the capsule or snag the iris. The glide can be layered with viscoelastic substance and the 10L inserted into the eye over the glide. The glide should be withdrawn as the lens is being inserted. The lens glide can also be placed in the ciliary sulcus to facilitate sulcus fIxation of a posterior chamber lens in cases of posterior capsule rupture. In cases of posterior capsule rupture with remaining nuclear fragments, the lens glide can be placed behind the fragments to prevent their posterior dislocation during the attempts at removal. The glide may also facilitate insertion of the phacoemulsifIcation or irrigationlaspiration instruments into the anterior chamber in cases in which iris hooks cause upward tenting of the iris or when there is iris prolapsing through the incision, as may occur with posterior keratome entry or in eyes with short axial lengths. In this instance, the glide must be trimmed to fIt the incision SIze. The Sheets lens glide is an old device that has flexibility and applicability to modern cataract surgery and should be incorporated into the anterior segment surgeon's armamentarium. MICHELE R PICCONE, MD MICHAEL E. SULEWSKI, MD DAVID M. KOZART, MD
Philadelphia, Pennsylvania References 1. Sheets JH, Maida JW. Lens glide in implant surgery. Arch Ophthalmol1978; 96:145-146 2. McGowan BL. A modified lens glide for intraocular lens implantation. Am Intra-Ocular Implant Soc J 1980; 6:172-173 3. Siepser SB. Modification to rhe Sheets glide for anterior chamber diameter measurement. Ophthalmic Surg 1982; 13:412 4. Perry HD, Nelson DB. A new merhod for inferior caps ulotomy in the face of ruptured zonules. Ophthalmic Surg 1984; 15:765766 5. Michelson MA. Use of a Sheets glide as a pseudoposterior capsule in phacoemulsification complicated by posterior capsule rupture. Eur J Implant Refract Surg 1993; 5:70-72
Intracameral Preserved Lidocaine
I
have recently been doing most of my cases, including planned extracap and scleral tunnel procedures, under topical anesthesia using Gills' technique of intracameral nonpreserved 1% lidocaine. This intracameral lidocaine seems to make essentially all anterior segment procedures pain free, including planned extracap, scleral 10
tunnel, and pupil stretching. Just this week, however, after case 14, I noted that preserved lidocaine had been inadvertently substituted for nonpreserved. Anecdotally, I have heard it stated that preserved lidocaine is tolerated by the corneal endothelium. Hoping this was true, I was relieved on the next morning to fInd that all these cases had clear corneas and looked as good as the cases in which nonpreserved lidocaine was used. I do not wish to recommend preserved intracameral lidocaine. However, in this small series, which was done inadvertently, small amounts appear to be well tolerated. LUTHER L. FRY, MD
Garden City, Kansas
Radial Keratotomy Before and After Retinal Detachment Surgery
T
his case report presents a patient who required an enhancement because of an unusual situation postradial keratotomy-retinal detachment with encircling band surgery. The patient, a 32-year-old man, had bilateral radial keratotomies (RKs) in 1991. The left eye, preoperatively - 2.62 spherical equivalent by cycloplegic refraction, had four radial incisions with a 3.75 mm optical zone. The right eye, also - 2.62 spherical equivalent, had eight radial incisions with a 4.25 mm optical zone. An enhancement in the left eye of four additional radial cuts at a 4.25 mm optical zone was performed several months later, and the patient achieved 20/20 uncorrected visual acuity in each eye with a spherical equivalent of - 0.25 in the right eye and plano in the left eye by cycloplegic examination. The patient maintained 20/20 visual acuity until 1994, when he developed bilateral bullous retinal detachments requiring encircling bands. Postoperatively, the patient's cycloplegic refraction stabilized at a spherical equivalent of -2.37 in the right eye and -2.75 in the left eye, which was essentially his prescription prior to his initial RKs. His keratometry pre-retinal detachment and post-retinal detachment remained unchanged at approximately 39.50 sphere. Two years following the retinal detachment repair, a reoperation was performed in the right eye, which consisted of recutting the eight radial incisions from the 3.25 mm optical zone to the 8.00 mm optical zone. Postoperatively, the patient again achieved a spherical
J CATARACT REFRACT SURG-VOL 23, JANUARY/FEBRUARY 1997