Scleral buckles and rotation of the ciliary body.

Angle closure glaucoma is a well-known complication of scleral buckling and it is of particular interest when it occurs in eyes with previously normal angles. Forward rotation of the ciliary body about the scleral spur has been postulated as one possible mechanism for such angle closure. Large buckles were used in macaque rhesus monkeys and histopathologic examination indicated rotation of the ciliary body about the scleral spur as the cause of angle closure. Pupillary block was not present and large choroidal detachments were not needed to produce the observed closure. The exaggerated buckles used do not allow these monkeys to serve as a clinical model and great caution is stressed in making clinical extrapolations.

Intraoperative complications during cataract surgery in the very old.

PURPOSE: To determine if there is a difference in intraoperative complications during cataract surgery in very old patients (> or = 88 years) compared with younger patients (< 88 years). METHODS: The records of 802 consecutive cataract operations were reviewed. Identical techniques of small-incision phacoemulsification were used in all cases. A total of 102 eyes were in patients aged 88 to 98, designated as the "very old." The remaining 700 eyes were in patients under 88, designated as "younger." The incidence of intraoperative complications in the 2 groups was compared. RESULTS: Posterior capsule tears, vitreous loss, and loss of the nucleus were found as complications. Overall, these events occurred in 10% of the very old and in only 3% of those under age 88. Vitreous loss occurred in 7% of the very old and in only 1.6% of those under 88. There was 1 dropped nucleus in the very old. In the younger patients, 90.5% of eyes with complicated surgery achieved 20/40 visual acuity or better, but only 40% of complicated cases in the very old achieved this. Furthermore, 50% of complicated cases in the very old had visual acuity of 20/200 or worse, all directly attributed to surgical difficulties. Fifteen percent of patients in both groups had trabeculectomies with no influence on complications. We noted that 8% of the very old required pupil stretching compared with 2% of those under 88. CONCLUSIONS: This study strongly suggests that very old patients (i.e., those 88 years and older) have a higher incidence of intraoperative complications during cataract surgery than younger patients. Furthermore, such complications may result in severe visual loss. These findings may have significance as the population ages.

Light intensity and visual acuity following cataract surgery.

The authors analyzed 310 cataract operations that were randomly distributed between two operating rooms, each containing a microscope with different light intensities. The light intensity of one microscope was almost threefold greater than the other. One hundred seventy-seven patients were excluded from this study because of medical or ocular problems that might affect visual acuity. The remaining 133 patients are the subjects of this paper. Seventy-one were operated upon under high intensity light, and 62 were subjected to lower illumination in the operating room. Visual acuity after operation was correlated with type of microscope, age, sex, method of cataract extraction, and use of intraocular lenses. Reduced visual acuity (20/40 or worse) was consistently more common with high intensity light and with increasing age. Further investigation is recommended to establish the cause of this reduced acuity.

Scleral fixation of posterior chamber intraocular lens implants combined with vitrectomy.

Selected patients undergoing pars plana vitrectomy and lensectomy may be ideal candidates for scleral-fixated lenses. We present our current technique for implanting such lenses, a technique designed to avoid the problems of suture exposure, lens rotation, and infection.

Scleral abscesses and ectasia caused by Pseudomonas aeruginosa.

A 76-year-old woman had signs of endophthalmitis the third day after she underwent uneventful cataract surgery. Intravitreous antibiotics were given, but the eye was unresponsive to the therapy, and, two days later, a small scleral abscess was noted that was not connected to the cornea. Pars plana vitrectomy and appropriate antibiotic therapy were successfully used, and, eventually, the retina regained useful visual acuity. A ring of multiple scleral abscesses developed that persisted for three months, producing scleral thinning and concentric ectasia of the globe. The cornea was free of ulceration at all times. We are unaware of any published cases of Pseudomonas abscess of the sclera without corneal ulceration or scleral damage.

Corneal crystalline deposits and drusenosis associated with IgA-kappa chain monoclonal gammopathy.

An unusual case is presented in which corneal deposits in mid-to-deep stroma with Doyne's posterior pole drusenosis are the initial signs of an IgA-kappa monoclonal gammopathy. The case has several unique features. Corneal deposits have been described previously with IgG and IgM-kappa light chain gammopathies, but to our knowledge have not been described before with IgA-kappa monoclonal gammopathy. Corneal stromal deposits and associated macular drusen have been described with IgM monoclonal gammopathy, but not previously with IgA monoclonal gammopathy. Bietti described superficial perilimbal corneal deposits with fundus albipunctatus, whereas the present case shows diffuse central deep corneal deposits with macular drusen.