Wedge Resection to Treat Ectatic Dystrophies

to the surgeon for subsequent cataract surgery should be limited to the 9 mm optical zone. Avoid using the arcuate incision for subsequent cataract surgery if the incision is closer to the optical center of the eye than the 9 mm optical zone." I trust that before surgeons use this very powerful technique, they become familiar with the instrumentation and procedure as outlined in my textbook and closely follow the published nomograms. If they do, an error in interpretation of the technique and its application can be avoided. Robert M. Kershner, M.D. Tucson, Arizona

REFERENCE 1. Kershner RM. Refractive Keratotomy for Cataract Surgery and the Correction of Astigmatism. Thorofare, NJ, Slack, 1994

Wedge Resection to Treat Ectatic Dystrophies To the Editor: Dr. Martin describes a useful alternative to other managements of ectatic corneal dystrophies in his case report on wedge resection. 1 Dr. Mark Terry, Dr. Jim Rowsey, and I presented similar excellent results at the 1994 meeting of the Association for Research in Vision and Ophthalmology (ARVO). We reported similar findings using a wedge resection in pellucid marginal degeneration. In our series of eight patients, we looked at wedge resections as well as relaxing incisions and compression sutures as an option to treat ectatic dystrophies such as pellucid marginal degeneration. Although we have had success with wedge resections in similar conditions, we have observed regression with this type of procedure. Several of our patients retain contact lens vision even though they were unsuccessful in contact lens wear preoperatively. Regression of effect occurs with suture removal. We therefore attempt an initial overcorrection with the procedure. In addition, a tongue-in-groove advancement of corneal stroma into an adjacent pocket of stromal tissue adds tectoric support to the thin cornea without sacrificing any tissue. We agree with Dr. Martin that this is a viable alternative for treating corneal dystrophies in lieu of a full-thickness penetrating keratoplasty (PKP). Although PKP in keratoconus patients has a high success rate, pellucid marginal degeneration is more difficult in terms of corneal transplantation. We concur with Dr. Martin's assessment that a wedge resection is an alternative to treatment of isolated cases, as he presented and as we 598

reported in our series presented at the 1994 ARVO meeting. Karl G. Stonecipher, M.D. Greensboro, North Carolina

Mark A. Terry, M.D. Portland, Oregon

J. James Rowsey, M.D. Tampa, Florida

REFERENCES 1. Martin RG. Wedge resection in the cone after failed refractive surgery in a patient with keratoconus. J Cataract Refract Surg 1995; 21:348-350 2. Stonecipher KG, Terry MA, Rowsey JJ. Pellucid marginal degeneration: new ways to treat an old problem. ARVO abstract 1621. Invest Ophthalmol Vis Sci 1994; 35:1603

Descemet's Detachment Repair To the Editor: I read with interest Walland and coauthors' article on repair of Descemet's membrane detachment 1 and wish to comment on my own experience with a case. A 69-year-old woman with 20/60 visual acuity in her right eye resulting from a + 1.5/+4 nuclear cataract had elective cataract extraction with intraocular lens (IOL) implantation anticipated. A superior temporal scleral tunnel incision was performed, the cataract phacoemulsified, and the cortex removed in an uncomplicated fashion, and I began to refill the anterior chamber with viscoelastic in preparation for posterior chamber IOL implantation. It became increasingly difficult to make the viscoelastic syringe squirt, and I assumed the cannula was plugged and pressed harder. It was a wrong assumption. I did not realize that the viscoelastic cannula tip had migrated anterior to Descemet's when it was inserted into the incision. The viscoelastic came out of the syringe and detached 60% of Descemet's membrane, extending across the visual axis. A second empty syringe was inserted between Descemet's and stroma, and viscoelastic was withdrawn. The original viscoelastic syringe was used to place viscoelastic posterior to Descemet's, and a posterior chamber lens was placed uneventfully. Viscoelastic was removed and air placed in the anterior chamber. The wound was sutured. The patient was followed for five days, with 20/400 visual acuity, + 3 stromal edema over the area of Descemet's detachment, and nonplanar detachment of Descemet's that sagged posteriorly off the stroma 1.5 mm to 2.0 mm into the anterior chamber. Without signs of improvement, on day 5 the patient was taken to the operating room where a combination of vis-

J CATARACT REFRACT SURG-VOL 21, NOVEMBER 1995