Anterior sub-Tenon's anesthesia for the treatment of retinopathy of prematurity.

The authors describe a technique of combined oral chloral hydrate and sub-Tenon's anesthesia that is simple, avoids the risks of general anesthesia, and provides superior anesthesia to topical agents alone.

Vitrectomy without postoperative posturing for idiopathic macular holes.

PURPOSE: To determine the success of vitrectomy with ILM peeling and C(3)F(8) tamponade for macular holes without the need for postoperative face-down posturing. METHODS: Twenty-four eyes of 24 consecutive patients undergoing pars plana vitrectomy with indocyanine green-assisted ILM peeling and C(3)F(8) tamponade without prone posturing were included in the study. All patients had follow up on 1 day, 2 weeks and 3 months postoperatively. Biomicroscopy and optical coherence tomography were used to assess macular hole closure at 3 months postoperatively. Snellen visual acuity was compared pre- and postoperatively. RESULTS: Of the 24 eyes recruited, two (8%) had stage II, 17 (71%) had stage III and five (21%) had stage IV macular holes. Nineteen (79%) eyes were phakic and five (21%) eyes were pseudophakic at the time of surgery. The macular holes had been present for an average of 7.5 months (range 3-18 months). At 3-month follow up, 22/24 (91.6%) holes were closed. Both of the two holes that failed to close were stage IV macular holes. Preoperative visual acuity ranged from 6/18 to 6/60 (mean 6/36). Postoperative visual acuity ranged from 6/9 to 6/60 (mean 6/18). Eighteen eyes had improvement of visual acuity of at least one line on the Snellen chart, six eyes had no improvement. No eyes had worse vision postoperatively. CONCLUSION: Macular hole surgery without face-down posturing provides anatomical and functional results comparable to those with prone posturing. Combined phacovitrectomy is not essential to avoid prone posturing.

Effect of lens epithelial cell aspiration on postoperative capsulorhexis contraction with the use of the AcrySof intraocular lens: randomized clinical trial.

PURPOSE: To determine whether aspiration of lens epithelial cells (LECs) from under the anterior capsule reduces postoperative contraction of the capsulorhexis aperture. SETTING: Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, United Kingdom. METHODS: This prospective randomized observer-masked study comprised 100 patients who had routine phacoemulsification by the same surgeon at a district general hospital in the United Kingdom. The postoperative changes in capsulorhexis apertures and anterior capsule opacification (ACO) between Group A (aspiration of LECs) and Group B (control) were compared. Digital retroillumination images of the capsulorhexis aperture were taken 1 week and 3 months postoperatively. The area of capsulorhexis aperture was determined with computer software, and capsule opacification was graded subjectively. RESULTS: Three months postoperatively, the mean decrease in capsulorhexis aperture was 1.9% in Group A and 5.6% in Group B (P = .02). The ACO at 3 months was grade 2 in 44% of eyes in Group A and in 61% in Group B (P = .13). CONCLUSION: Aspiration of LECs from the anterior capsule was a safe procedure that reduced capsulorhexis aperture contraction 3 months after cataract surgery.

Corneal perforation due to severe peripheral ulcerative keratitis in Crohn disease.

PURPOSE: To describe corneal perforation secondary to severe peripheral ulcerative keratitis (PUK) in a patient with Crohn disease. METHODS: Interventional case report. RESULTS: A 72-year-old male with biopsy-proven Crohn disease presented with reduced vision, PUK, and corneal perforation in the right eye. Despite initial treatment with intravenous methylprednisolone and a conjunctival flap, a tectonic sectorial penetrating keratoplasty was required to preserve the globe and achieve a good visual result. CONCLUSIONS: Crohn disease may be associated with severe PUK leading to corneal perforation. Tectonic corneal grafting combined with treatment of the underlying systemic disease was associated with a favorable outcome.

Self-inserted intraorbital foreign bodies.

We report an unusual case of self-mutilation by insertion of multiple foreign bodies in the orbit. A 26-year-old female psychiatric patient with a severe emotionally unstable personality disorder was reviewed in the ophthalmology clinic. She had allegedly inserted a metal staple into her right eye 2 days previously and was complaining of pain around the right eye. Radiography showed multiple foreign bodies in the right orbit and one in the left orbit. Self-mutilation in psychiatric patients has been well documented. The management of nonorganic, nontoxic intraorbital foreign bodies is discussed. A low threshold for imaging in these cases is of vital importance.