Perfluorocarbon heavy liquids in the management of posterior dislocation of the lens nucleus during phakoemulsification.

We report a case in which the lens nucleus dislocated into the vitreous cavity through a posterior capsular rupture during phakoemulsification. We performed a vitrectomy and removed the lens nucleus using the perfluorocarbon heavy liquid perfluoro-1,3-dimethylcyclohexane. The management of posterior dislocation of the lens nucleus during cataract surgery is discussed.

Trabeculectomy in uveitis Are antimetabolites necessary at the first procedure?

A retrospective study was undertaken analysing the results of trabeculectomy without antimetabolites in 33 eyes with uveitis compared to 33 eyes with primary open angle glaucoma (POAG). Both groups were matched for surgeon with a median follow-up of 19 months (range 2-44 months) for the uveitis group and 24 months (range 6-92 months) for the POAG group. The overall one and two year success (IOP ± 21 mmHg with or without medication) was 92% and 83% respectively for the uveitis group and 96% for both years for the POAG group (p = 0.241, Mantel-Haenszel test). These results indicate that the success of trabeculectomy in patients with inflammatory glaucoma compares well with that of the POAG group. In the absence of other risk factors, primary trabeculectomy without the use of antimetabolites should be considered as the first choice of surgical treatment for raised intraocular pressure in patients with intraocular inflammatory disease.

Corneal neovascularisation in acute hydrops.

Four cases of corneal neovascularisation complicating acute hydrops in keratoconus are presented. Three cases were atopic. In two cases high doses of topical steroids failed to inhibit the neovascular process. The pathogenesis of neovascularisation in this situation is uncertain. Risk factors may be the size of the hydrops and the proximity of oedematous cornea to the limbal vascular arcades, with an associated inflammatory reaction. The coexistence of atopic keratoconjunctivitis may be an additional factor. Patients with large peripheral hydrops should be observed closely for the development of new vessels, and systemic steroids prescribed if topical medication fails to inhibit a neovascular reaction. Consideration should be given to the possibility of removing the stimulus to neovascularisation by corneal grafting, although the technical difficulties and the patients atopic state may militate against this.