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Pars Plana Vitrectomy in the Management of Dislocated Posterior Chamber Lenses: Reply
362
Pars Plana Management
March, 1990
AMERICAN JOURNAL OF OPHTHALMOLOGY
Vitrectomy of Dislocated Chamber Lenses
in the Posterior
stability in the pars plana approach warrants further investigation. TIMOTHY G. MURRAY, M.D. GARY W. ABRAMS, M.D.
Milwaukee, Wisconsin JOHN STANLEY, M.D.
EDITOR:
In the article "Pars plana vitrectomy in the management of dislocated posterior chamber lenses," by R. V. Campo, K. D. Chung, and R. T. Oyakawa (Am. J. Ophthalmol. 108:529, November 1989), the authors described a technique for transsclerally fixating a dislocated posterior chamber intraocular lens without capsular support. We developed a new needle for the placement of iris fixation sutures that we believe would greatly simplify the placement of the transscleral suture at the time of vitrectomy. The instrument is a 27-gauge needle with a 7/1,000-inch drill hole centered in the midportion of the needle bevel to allow passage of the suture material. This instrument, currently available from Trek Medical Products, would facilitate the rapid placement of the transscleral suture. We do have some concern regarding the reported technique and the associated stability of the transsclerally fixated haptic. Recently, Apple and associates' reported on the histopathologic findings in four cases of transsclerally fixated posterior chamber intraocular lenses. Only one of the eight haptics was actually located in the ciliary sulcus. Apple and associates postulated that the trans scleral suture itself may be responsible for maintaining anatomic positioning of the lens. We treated a patient with a secondary transsclerally fixated posterior chamber intraocular lens placed after postcataract traumatic primary posterior lens expulsion. This patient had traumatic iris disinsertion allowing direct visualization of the ciliary sulcus. In this patient, both lens haptics were posterior to the ciliary sulcus and the hap tics appeared to be supported by the suture itself, in agreement with the postmorten findings of Apple and associates. This observation suggests the importance of a direct physical attachment between the transscleral suture and the haptic of the posterior chamber intraocular lens. This is the technique currently advocated by Stark and associates" and Spigelman and associates" in the anterior segment approach to transscleral lens fixation. This may remain only a theoretical concern, but we believe the question of haptic
San Francisco, California
References 1. Apple, D. i. Price, F. W., Gwin, T., Imkamp, E., Daun, M., Casanova, R., Hansen, S., and Carlson, A. N.: Sutured retropupillary posterior chamber intraocular lenses for exchange or secondary implantation. Ophthalmology 96:1241,1989. 2. Stark, W. J., Goodman, G., Goodman, D., and Gottsch, J.: Posterior chamber intraocular lens implantation in the absence of posterior capsular support. Ophthalmic Surg. 19:240, 1988. 3. Spigelman, A. V., Lindstrom, R. L., Nichols, S. D., Lindquist, T. D., and Lane, S. S.: Implantation of a posterior chamber lens without capsular support during penetrating keratoplasty or as a secondary lens implant. Ophthalmic Surg. 19:396, 1988.
_ _ _ _ _ _ _ Reply
_
EDITOR:
We thank Drs. Murray, Abrams, and Stanley for their comments regarding our article and for bringing to our attention their new 27gauge sewing needle. We anxiously await the opportunity to evaluate this device, and we share their optimism regarding its applicability to our transscleral haptic suturing method. RANDY V. CAMPO, M.D. KELLY D. CHUNG, M.D. RAY T. OYAKAWA, M.D.
Phoenix, Arizona
Automated Questionnaire
Perimetry, Tonometry, and in Glaucoma Screening
EDITOR:
In the article" Automated perimetry, tonometry, and questionnaire in glaucoma screening," by T. K. Mundorf, T. J. Zimmerman, G. F. Nardin, and K. S. Kendall (Am. J. Ophthalmol. 108:505, November
Pars Plana Management
March, 1990
AMERICAN JOURNAL OF OPHTHALMOLOGY
Vitrectomy of Dislocated Chamber Lenses
in the Posterior
stability in the pars plana approach warrants further investigation. TIMOTHY G. MURRAY, M.D. GARY W. ABRAMS, M.D.
Milwaukee, Wisconsin JOHN STANLEY, M.D.
EDITOR:
In the article "Pars plana vitrectomy in the management of dislocated posterior chamber lenses," by R. V. Campo, K. D. Chung, and R. T. Oyakawa (Am. J. Ophthalmol. 108:529, November 1989), the authors described a technique for transsclerally fixating a dislocated posterior chamber intraocular lens without capsular support. We developed a new needle for the placement of iris fixation sutures that we believe would greatly simplify the placement of the transscleral suture at the time of vitrectomy. The instrument is a 27-gauge needle with a 7/1,000-inch drill hole centered in the midportion of the needle bevel to allow passage of the suture material. This instrument, currently available from Trek Medical Products, would facilitate the rapid placement of the transscleral suture. We do have some concern regarding the reported technique and the associated stability of the transsclerally fixated haptic. Recently, Apple and associates' reported on the histopathologic findings in four cases of transsclerally fixated posterior chamber intraocular lenses. Only one of the eight haptics was actually located in the ciliary sulcus. Apple and associates postulated that the trans scleral suture itself may be responsible for maintaining anatomic positioning of the lens. We treated a patient with a secondary transsclerally fixated posterior chamber intraocular lens placed after postcataract traumatic primary posterior lens expulsion. This patient had traumatic iris disinsertion allowing direct visualization of the ciliary sulcus. In this patient, both lens haptics were posterior to the ciliary sulcus and the hap tics appeared to be supported by the suture itself, in agreement with the postmorten findings of Apple and associates. This observation suggests the importance of a direct physical attachment between the transscleral suture and the haptic of the posterior chamber intraocular lens. This is the technique currently advocated by Stark and associates" and Spigelman and associates" in the anterior segment approach to transscleral lens fixation. This may remain only a theoretical concern, but we believe the question of haptic
San Francisco, California
References 1. Apple, D. i. Price, F. W., Gwin, T., Imkamp, E., Daun, M., Casanova, R., Hansen, S., and Carlson, A. N.: Sutured retropupillary posterior chamber intraocular lenses for exchange or secondary implantation. Ophthalmology 96:1241,1989. 2. Stark, W. J., Goodman, G., Goodman, D., and Gottsch, J.: Posterior chamber intraocular lens implantation in the absence of posterior capsular support. Ophthalmic Surg. 19:240, 1988. 3. Spigelman, A. V., Lindstrom, R. L., Nichols, S. D., Lindquist, T. D., and Lane, S. S.: Implantation of a posterior chamber lens without capsular support during penetrating keratoplasty or as a secondary lens implant. Ophthalmic Surg. 19:396, 1988.
_ _ _ _ _ _ _ Reply
_
EDITOR:
We thank Drs. Murray, Abrams, and Stanley for their comments regarding our article and for bringing to our attention their new 27gauge sewing needle. We anxiously await the opportunity to evaluate this device, and we share their optimism regarding its applicability to our transscleral haptic suturing method. RANDY V. CAMPO, M.D. KELLY D. CHUNG, M.D. RAY T. OYAKAWA, M.D.
Phoenix, Arizona
Automated Questionnaire
Perimetry, Tonometry, and in Glaucoma Screening
EDITOR:
In the article" Automated perimetry, tonometry, and questionnaire in glaucoma screening," by T. K. Mundorf, T. J. Zimmerman, G. F. Nardin, and K. S. Kendall (Am. J. Ophthalmol. 108:505, November