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Monocanalicular nasolacrimal duct intubation: Authors’ reply
Ophthalmology Volume 105, Number 10, October 1998 month, the rate of complications was divided by 4 for the Monoka and by 2 for the BCI.5 The Monoka is an alternative device for the treatment of lacrimonasal obstruction2,3,5,6 or laceration,1 which may simplify both the surgical procedure and the removal of material in children. More importantly, the Monoka may help avoid some of the severe complications associated with the bicanalicular intubation, such as stricturotomies. Recent reports suggest that its efficacy may be equivalent to that of BCI. Given its dependence on meatal stability, this method may, however, be more appropriate for short- to mediumterm intubation purposes. BRUNO FAYET, MD MICHAEL ASSOULINE, MD, PHD JEAN-ANTOINE BERNARD, MD Paris, France Bruno Fayet, MD, is the original patent owner of the Monoka and currently holds financial interests in this device. Jean-Antoine Bernard, MD, is a paid consultant for FCI, manufacturer of the Monoka. Michael Assouline, MD, PhD, has no financial interest in any of the devices cited in this letter. References 1. Fayet B, Bernard JA, Pouliquen Y. Re´paration des plaies canaliculaires re´centes avec une sonde mono-canaliculaire a` fixation me´atique [Eng. Abstr.]. Bull Soc Ophtalmol Fr 1989; 89:819 –25. 2. Fayet B, Bernard JA. Une sonde mono-canaliculaire a` fixation me´atique auto-stable dans la chirurgie des voies lacrymales d’excre´tion. Premiers re´sultats. [Eng. Abstr.]. Ophtalmologie 1990;4:351–7. 3. Ruban JM, Guigon B, Boyrivent V. Analyse de l’efficacite´ de la sonde d’intubation mono-canaliculo-nasale grande collerette dans le traitement du larmoiement par obstruction conge´nitale des voies lacrymales d’excre´tion du nourrisson [Eng. Abstr.]. J Fr Ophtalmol 1995;18:377– 83. 4. Pe MRL, Langford JD, Linberg JV, et al. Ritleng intubation system for treatment of congenital nasolacrimal duct obstruction. Arch Ophthalmol 1998;116:387–91. 5. Fayet B, Bernard J-A, Assouline M, et al. Bicanalicular versus monocanalicular silicone intubation for nasolacrimal duct impatency in children: a comparative study. Orbit 1993;12:149 – 56. 6. Boyrivent V, Ruban JM, Ravault MP. Place de l’intubation lacrymonasale dans le traitement du larmoiement par obstruction conge´nitale des voies lacrymales du nourrisson [Eng Abstr]. J Fr Ophtalmol 1993;16:532–7.
Authors’ reply Dear Editor: I would like to thank Drs. Fayet, Assouline, and Bernard for calling attention to our oversight in not referencing their and others’ previous publications on the subject. Unfortunately, a search of Medline and an inquiry to the manufacturer of the Monoka tube, FCI (Issy-les-Moulineaux Cedex, France), failed to identify these previously published reports as cited by Drs. Fayet et al. As stated in their letter, the results of the aforementioned references were very similar to our own experience, both in terms of success rates and
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complications. We continue to use the device on a regular basis for the treatment of congenital nasolacrimal duct obstruction. LAWRENCE M. KAUFMAN, MD, PHD LISE GUAY–BHATIA, MD Chicago, Illinois
Potato Gun Ocular Injury Dear Editor: The important article by Barker–Griffith et al (Ophthalmology 1998;105:535–538) calls our attention to a new source of ocular trauma, the potato gun. Shooting fairly large and blunt objects (such as a potato) from these high-powered weapons obviously threatens the eye with open globe injuries and potentially disastrous consequences. The authors presented two cases of potato gun–related “penetrating” eye injuries but unfortunately failed to recognize the true nature of the injury in one of their patients. As described in the Birmingham Eye Trauma Terminology system,1 injuries caused by blunt objects are usually ruptures with frequent and extensive loss of the intraocular contents. In Case 1, the description makes it obvious that it was the potato itself that impacted the eye and resulted in loss of the iris, ciliary body, lens, and the retina; this injury is therefore a rupture, not a “penetrating injury.” Conversely, those injuries caused by sharp objects are usually less severe with limited or no tissue prolapse. In their Case 2, with the impacting object probably being the shattered plastic lens and not the potato, the authors correctly identified the injury as penetrating. Barker-Griffith et al deserve credit for introducing the danger posed by potato guns into the medical literature. Proper classification of the injury types, however, has important clinical implications and should not be regarded as a purely academic issue. FERENC KUHN, MD Birmingham, Alabama Reference 1. Kuhn F, Morris R, Witherspoon CD, et al. A standardized classification of ocular trauma. Ophthalmology 1996; 103:240 –3.
Authors’ reply Dear Editor: We appreciate Dr. Kuhn’s perspective on “A Standardized Classification of Ocular Trauma” (Ophthalmology 1996; 103:240 –3) and acknowledge his pioneering work in this area. Kuhn et al’s new system of always using the entire globe as the tissue of reference should reduce the ambiguity in clinical usage. The term rupture is not used as a pathologic diagnosis at this time, nor did this globe appear ruptured, defined as a “bursting” or a “breaking apart,”1 to us or the surgical team. The globe was neatly lacerated and virtually bisected almost back to the optic nerve, either from bone fragments that were extensive in the orbit, potato fragments, or other projectile. These were no stellate features characteristic of a
Authors’ reply Dear Editor: I would like to thank Drs. Fayet, Assouline, and Bernard for calling attention to our oversight in not referencing their and others’ previous publications on the subject. Unfortunately, a search of Medline and an inquiry to the manufacturer of the Monoka tube, FCI (Issy-les-Moulineaux Cedex, France), failed to identify these previously published reports as cited by Drs. Fayet et al. As stated in their letter, the results of the aforementioned references were very similar to our own experience, both in terms of success rates and
1796
complications. We continue to use the device on a regular basis for the treatment of congenital nasolacrimal duct obstruction. LAWRENCE M. KAUFMAN, MD, PHD LISE GUAY–BHATIA, MD Chicago, Illinois
Potato Gun Ocular Injury Dear Editor: The important article by Barker–Griffith et al (Ophthalmology 1998;105:535–538) calls our attention to a new source of ocular trauma, the potato gun. Shooting fairly large and blunt objects (such as a potato) from these high-powered weapons obviously threatens the eye with open globe injuries and potentially disastrous consequences. The authors presented two cases of potato gun–related “penetrating” eye injuries but unfortunately failed to recognize the true nature of the injury in one of their patients. As described in the Birmingham Eye Trauma Terminology system,1 injuries caused by blunt objects are usually ruptures with frequent and extensive loss of the intraocular contents. In Case 1, the description makes it obvious that it was the potato itself that impacted the eye and resulted in loss of the iris, ciliary body, lens, and the retina; this injury is therefore a rupture, not a “penetrating injury.” Conversely, those injuries caused by sharp objects are usually less severe with limited or no tissue prolapse. In their Case 2, with the impacting object probably being the shattered plastic lens and not the potato, the authors correctly identified the injury as penetrating. Barker-Griffith et al deserve credit for introducing the danger posed by potato guns into the medical literature. Proper classification of the injury types, however, has important clinical implications and should not be regarded as a purely academic issue. FERENC KUHN, MD Birmingham, Alabama Reference 1. Kuhn F, Morris R, Witherspoon CD, et al. A standardized classification of ocular trauma. Ophthalmology 1996; 103:240 –3.
Authors’ reply Dear Editor: We appreciate Dr. Kuhn’s perspective on “A Standardized Classification of Ocular Trauma” (Ophthalmology 1996; 103:240 –3) and acknowledge his pioneering work in this area. Kuhn et al’s new system of always using the entire globe as the tissue of reference should reduce the ambiguity in clinical usage. The term rupture is not used as a pathologic diagnosis at this time, nor did this globe appear ruptured, defined as a “bursting” or a “breaking apart,”1 to us or the surgical team. The globe was neatly lacerated and virtually bisected almost back to the optic nerve, either from bone fragments that were extensive in the orbit, potato fragments, or other projectile. These were no stellate features characteristic of a