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Side Effect of Microscope Drape
acept Jacobi's figure of 2,650 as normal cell density at this age, 2 cell loss in this case was 8.1%. This means that with modern techniques a dislocated lens can be removed safely. Tsutomu Hara, M. D. Takako Hara, M.D. Utsunomiya, Japan
REFERENCES 1. Katz NNK, Byers NT, Bergquist RJ : Inadvertent intracameral
air instillation during noncontact tonometry. Am] Ophthalmol 95:708-709, 1983 2. Jacobi KW, Strobel J: Diffe re nt parame te rs of the corneal endothelium of the human eye. Am Intra-Ocular Implant Soc ] 7:140-142, 1981
PREPARING THE SCLERAL FLAP To the Editor: I have found the use of a guarded knife made by M yocure, Inc., with a preset depth of 435 microns very useful in making the initial scleral incision prior to dissecting the sclera anteriorly with a Grishaber knife. The Myocure knife assures the surgeon that the initial scleral incision is at the correct depth, making the remainder of the scleral dissection much easier. Although two knives are used to complete the scleral flap , both can be gas sterilized and reused a few times if cost is a serious consideration. Robert P. Gervais, M. D . Mesa, Arizona
types of lens loops or other instruments to remove the nucleus. I much prefer a central posterior capsular break than the zonular rupture with vitreous loss that can occur during manual expression or using other techniques. I though this might be of interest to other surgeons, especially when they encounter a soft eye with a lens that is very far posterior. A hard nucleus can also be removed through a small pupil using the same technique without a sector iridectomy. Clark R. Cobble, M.D . Danville, Virginia
SIDE EFFECT OF MICROSCOPE DRAPE To the Editor: We wish to bring to your attention another complication of surgical microscope drapes. During an otherwise uneventful intracapsular cataract extraction, a foreign object was noted on the intraocular lens (IOL). The lens was replaced and the case concluded uneventfully. Postoperative inspection of the IOL revealed asmall pink-red object on the lens optic. The lens was forwarded to the manufacturer who unfortunatel y could not locate or identify the material. It was noted at the time of our inspection that one of the red rubbe r bands used to hold the sterile microscope drapes in place was chafed (Figure 1) and upon closer inspection appeared to be of identical color and texture as the foreign obj ect located on the implant optic.
USING A SINSKEY HOOK FOR NUCLEUS REMOVAL To the Editor: For the past three years, I have used a Sinskey hook for nucleus removal during cataract surgery. This was originally intended for the manipulation of a posterior chamber intraocular lens inside the eye at the time of implantation. I perform extracapsular cataract surgery with a can-opener anterior caps ulotomy. I take the hook to lift the posterior pole of the nucleus upward and slide it under the nucleus with the hook pointed laterally. When the hook is under the nucleus anywhere from a third to half its diameter, I then turn the hook upward and withdraw the nucleus from the eye. I have used this in several hundred cases and have had five or six cases of central posterior capsular rupture. Half these cases did not require any vitrectomy because (1) there was only a vitreous strand which could be pushed back with sodium hyaluronate or (2) the vitreous face was not broken. One can actually feel the posterior capsule pop when this happens. In every case of posterior capsular rupture using the technique, I have been too vigorous and have not kept the hook as horizontal as I should have . If the nucleus is not hard enough, one can widen the wound or revert to various
Fig. l.
(Berger) Frayed ruber band securing microscope drape .
Regrettably, more specific identification of the foreign object could not be made and this must remain a clinical observation. However, we wish to bring this hazard to the attention of our colleagues who use microscope drapes and in particular to those who secure the microscope drapes with rubber bands . Ronald O. Berger, M.D. Marcia White, L.P.N. Winsted, Connecticut
J CATARACT REFRACT SURG-VOL 12, JANUARY 1986
63
REFERENCES 1. Katz NNK, Byers NT, Bergquist RJ : Inadvertent intracameral
air instillation during noncontact tonometry. Am] Ophthalmol 95:708-709, 1983 2. Jacobi KW, Strobel J: Diffe re nt parame te rs of the corneal endothelium of the human eye. Am Intra-Ocular Implant Soc ] 7:140-142, 1981
PREPARING THE SCLERAL FLAP To the Editor: I have found the use of a guarded knife made by M yocure, Inc., with a preset depth of 435 microns very useful in making the initial scleral incision prior to dissecting the sclera anteriorly with a Grishaber knife. The Myocure knife assures the surgeon that the initial scleral incision is at the correct depth, making the remainder of the scleral dissection much easier. Although two knives are used to complete the scleral flap , both can be gas sterilized and reused a few times if cost is a serious consideration. Robert P. Gervais, M. D . Mesa, Arizona
types of lens loops or other instruments to remove the nucleus. I much prefer a central posterior capsular break than the zonular rupture with vitreous loss that can occur during manual expression or using other techniques. I though this might be of interest to other surgeons, especially when they encounter a soft eye with a lens that is very far posterior. A hard nucleus can also be removed through a small pupil using the same technique without a sector iridectomy. Clark R. Cobble, M.D . Danville, Virginia
SIDE EFFECT OF MICROSCOPE DRAPE To the Editor: We wish to bring to your attention another complication of surgical microscope drapes. During an otherwise uneventful intracapsular cataract extraction, a foreign object was noted on the intraocular lens (IOL). The lens was replaced and the case concluded uneventfully. Postoperative inspection of the IOL revealed asmall pink-red object on the lens optic. The lens was forwarded to the manufacturer who unfortunatel y could not locate or identify the material. It was noted at the time of our inspection that one of the red rubbe r bands used to hold the sterile microscope drapes in place was chafed (Figure 1) and upon closer inspection appeared to be of identical color and texture as the foreign obj ect located on the implant optic.
USING A SINSKEY HOOK FOR NUCLEUS REMOVAL To the Editor: For the past three years, I have used a Sinskey hook for nucleus removal during cataract surgery. This was originally intended for the manipulation of a posterior chamber intraocular lens inside the eye at the time of implantation. I perform extracapsular cataract surgery with a can-opener anterior caps ulotomy. I take the hook to lift the posterior pole of the nucleus upward and slide it under the nucleus with the hook pointed laterally. When the hook is under the nucleus anywhere from a third to half its diameter, I then turn the hook upward and withdraw the nucleus from the eye. I have used this in several hundred cases and have had five or six cases of central posterior capsular rupture. Half these cases did not require any vitrectomy because (1) there was only a vitreous strand which could be pushed back with sodium hyaluronate or (2) the vitreous face was not broken. One can actually feel the posterior capsule pop when this happens. In every case of posterior capsular rupture using the technique, I have been too vigorous and have not kept the hook as horizontal as I should have . If the nucleus is not hard enough, one can widen the wound or revert to various
Fig. l.
(Berger) Frayed ruber band securing microscope drape .
Regrettably, more specific identification of the foreign object could not be made and this must remain a clinical observation. However, we wish to bring this hazard to the attention of our colleagues who use microscope drapes and in particular to those who secure the microscope drapes with rubber bands . Ronald O. Berger, M.D. Marcia White, L.P.N. Winsted, Connecticut
J CATARACT REFRACT SURG-VOL 12, JANUARY 1986
63