Wound healing

BSS were attempted. Instead, I made an iridectomy 2 mm from the wound incision, inserted a bluntnosed IS-gauge needle and removed approximately 1 cc of fluid vitreous from the anterior periphery of the vitreous cavity. In each case, after vitreous was removed the anterior chamber deepened immediately. BSS was instilled, the chamber resufflated easily and the wound then fell together perfectly and was easily sutured. Intraocular pressure prior to aspiration of vitreous and after wound inspection was zero. Posterior vitreous pressure must have been higher when BSS was insufflated into the anterior chamber, as the vitreous bulged. The three cases did well, achieving final visual acuities of 20/20 with correction. Since the intraocular lens never touched the endothelium, there was no endothelial disruption. I would like to know if this phenomenon of pseudodiaphragmatic action in a pseudophakic eye with a flat anterior chamber has been previously reported, and what methods have been used to correct it.

LENS GLIDE IN PHACOEMULSIFICA TION To the Editor: This is to describe the use of a lens glide during phacoemulsification for the problem of iris prolapse and/or forward displacement of the iris to block advancement of the phacoemulsifier tip. This problem is often associated with a corneoscleral incision which has been made too close to the iris base. A lens glide narrowed to 2.5 mm may be introduced easily over the iris. The glide pushes the iris posteriorly so that the phacoemulsifier tip can be kept away from the corneal endothelium without touching the iris layer. Use of this glide avoids postoperative problems of pigment atrophy, iris dialysis and/or pupil irregularity. Lorin M. Swagel, M.D. Mesa, AZ

Michael J. Borer, M.D. La Mesa, CA

WOUND HEALING Dr. Blaydes' invited reply: After reading about Dr. Borer's most interesting experience, I believe he was dealing with choroidal detachments. Of course, this diagnosis could have been confirmed with B-scan ultrasonography. The fact that the anterior chamber deepened further verifies the "choroidal detachment theory," as does the zero preoperative tension. The fluid removed was probably subchoroidal, rather than fluid vitreous. If a vitreo-implant pupillary obstruction had existed, it could have been relieved by the iridectomy. Wound leakage can certainly occur with exclusive use of polyglactin 910 for wound closure after implant surgery. I recommend alternating this synthetic absorbable suture with a nonabsorbable suture to guard against the potential for wound dehiscence when heavy and prolonged use of steroids is prescribed after intraocular lens insertion.

J. Elliott Blaydes, M.D. Bluefield, WV

To the Editor: I would like to comment on Dr. Corboy's report on the traumatic loss of an anterior chamber lens (Am Intra-Ocular Implant Soc] 5:54, 1979). In 1951 I operated on an adult-onset diabetic 66-year-old female using a Von Graefe incision and round-pupil intracapsular cataract extraction without sutures. The aphakic eye seemed to heal well. The only postoperative medications used were short-term antibiotics and cycloplegics. Eighteen months later the patient ran into a wooden towel rack and her eye ruptured along the incision line. The patient was seen one hour after the accident. No iris prolapse was present. The chamber was restored with an air bubble and the eye bandaged; it rehealed within two months. Following cataract surgery this patient had had 0.50-diopter astigmatism in 105°; following the accident she had 2.50-diopter astigmatism in 90°. This case shows that wound healing under a limbus-based flap without a suture is a very slow process, even without steroid therapy. It is doubtful that the adult-onset diabetes contributed much to the difficulty. John]. Alpar, M.D. Amarillo, TX

AM INTRA-OCULAR IMPLANT SOC J-VOL. 6, JANUARY 1980

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