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Ultrasharp Disposable Needles
VOL. 62, NO. 1
CORRESPONDENCE
orbit," "X-ray therapy of corneal ulcers," "Cataract extractions," "Correction of stra bismus," and "Interpretation of the hyperten sive fundus." Dr. Baird was highly respected by his col leagues for his ability in clinical diagnosis and judgment. He was recognized as a su perb ophthalmic surgeon, being especially expert in cataract extraction. His legion of friends and patients mourn his untimely passing, but give thanks that, while he lived, he made their lives happier and more useful. Alton V. Hallum
CORRESPONDENCE ULTRASHARP DISPOSABLE NEEDLES
Editor, American Journal of Ophthalmology: The vision of one eye of each of two of my cataract patients was lost by the misuse of the new ultrasharp disposable needles, as optic atrophy developed suddenly in these eyes after otherwise uncomplicated removal of the cataracts. For more than 10 years, I have used the retrobulbar technique of Atkinson, with whose blunted No. 19 needle inserted into the orbit through the lower temporal quad rant, I injected 1.0 to 1.5 cc of Xylocaine, Wydase, and epinephrine hydrochloride. My incidence of retrobulbar hemorrhage has been about one per 100 cataract extrac tions and, as far as I know, my incidence of optic atrophy with this method has been zero. (Incidently, I avoid massage of the eye to soften it from fear of damaging the retina by compressing the central artery too long. When the eye seems predisposed to vitreous loss, Mannitol IV is given preoperatively.) It is sometimes difficult to push the At kinson needle through tough skin and some times through the deeper tissue planes; in contrast, the new disposable needles, such as the 22 g 1.5 inch, wilL slide through without
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resistance. In neither of these patients did I feel the point touch the optic nerve, nor did they have retrobulbar hemorrhages. How ever, both patients, when told during the first few postoperative days how well their eyes were healing, asked why they were un able to see light. My resolve to write this warning note was strengthened because on a recent visit to a noted ophthalmic institute, one of the ranking ophthalmic surgeons volunteered the information that several eyes from which cataracts were removed at his institu tion had been lost after retrobulbar injec tions with disposable needles. It is realized that this diagnosis is assumed, not proven; it is unlikely that a section of the optic nerve of either patient will ever be made to verify my suspicion. Also, light perception and projection have followed ocular surgery when no retrobulbar injection has been made. Nevertheless, the point of this letter is that disposable needles are dangerous in the orbit. From one of these unfortunate patients I have now removed the second cataract, ob taining the retrobulbar block with an Atkin son No. 19 needle. This patient has vision correctible to 20/22 and a normal aphakic field. The other patient is scheduled for the removal of the cataract from his other eye soon. Alston Callahan Birmingham, Alabama SUBCONJUNCTIVAL CORTICOSTEROIDS
Editor, American Journal of Ophthalmology: I am delighted to note that Drs. Sturman, Laval and Sturman have rediscovered the use of subconjunctivally injected corticosteriod suspensions (Am. J. Ophth. 61:155, Jan. 1966) and quote from them: On the basis of these experiences in general medicine, we conceived the idea that Kenalog Parenteral could be used in the eye subconjunctivally as a worthwhile adjunct in the treatment of a wide
CORRESPONDENCE
orbit," "X-ray therapy of corneal ulcers," "Cataract extractions," "Correction of stra bismus," and "Interpretation of the hyperten sive fundus." Dr. Baird was highly respected by his col leagues for his ability in clinical diagnosis and judgment. He was recognized as a su perb ophthalmic surgeon, being especially expert in cataract extraction. His legion of friends and patients mourn his untimely passing, but give thanks that, while he lived, he made their lives happier and more useful. Alton V. Hallum
CORRESPONDENCE ULTRASHARP DISPOSABLE NEEDLES
Editor, American Journal of Ophthalmology: The vision of one eye of each of two of my cataract patients was lost by the misuse of the new ultrasharp disposable needles, as optic atrophy developed suddenly in these eyes after otherwise uncomplicated removal of the cataracts. For more than 10 years, I have used the retrobulbar technique of Atkinson, with whose blunted No. 19 needle inserted into the orbit through the lower temporal quad rant, I injected 1.0 to 1.5 cc of Xylocaine, Wydase, and epinephrine hydrochloride. My incidence of retrobulbar hemorrhage has been about one per 100 cataract extrac tions and, as far as I know, my incidence of optic atrophy with this method has been zero. (Incidently, I avoid massage of the eye to soften it from fear of damaging the retina by compressing the central artery too long. When the eye seems predisposed to vitreous loss, Mannitol IV is given preoperatively.) It is sometimes difficult to push the At kinson needle through tough skin and some times through the deeper tissue planes; in contrast, the new disposable needles, such as the 22 g 1.5 inch, wilL slide through without
173
resistance. In neither of these patients did I feel the point touch the optic nerve, nor did they have retrobulbar hemorrhages. How ever, both patients, when told during the first few postoperative days how well their eyes were healing, asked why they were un able to see light. My resolve to write this warning note was strengthened because on a recent visit to a noted ophthalmic institute, one of the ranking ophthalmic surgeons volunteered the information that several eyes from which cataracts were removed at his institu tion had been lost after retrobulbar injec tions with disposable needles. It is realized that this diagnosis is assumed, not proven; it is unlikely that a section of the optic nerve of either patient will ever be made to verify my suspicion. Also, light perception and projection have followed ocular surgery when no retrobulbar injection has been made. Nevertheless, the point of this letter is that disposable needles are dangerous in the orbit. From one of these unfortunate patients I have now removed the second cataract, ob taining the retrobulbar block with an Atkin son No. 19 needle. This patient has vision correctible to 20/22 and a normal aphakic field. The other patient is scheduled for the removal of the cataract from his other eye soon. Alston Callahan Birmingham, Alabama SUBCONJUNCTIVAL CORTICOSTEROIDS
Editor, American Journal of Ophthalmology: I am delighted to note that Drs. Sturman, Laval and Sturman have rediscovered the use of subconjunctivally injected corticosteriod suspensions (Am. J. Ophth. 61:155, Jan. 1966) and quote from them: On the basis of these experiences in general medicine, we conceived the idea that Kenalog Parenteral could be used in the eye subconjunctivally as a worthwhile adjunct in the treatment of a wide