Preventing conjunctival autograft inversion in pterygium surgery.

BACKGROUND: Surgeon-dependent variables influencing pterygium surgical outcome using the conjunctival autograft technique include conjunctival retraction as a consequence of subepithelial contracting fibrous tissue, and autograft inversion causing necrosis and sloughing of the graft. METHOD: A simple and useful technique of pterygium excision is described, which helps to ensure the correct surface and linear orientations of the conjunctival autograft, and also defines the end point of adequate excision of the subepithelial connective tissue. CONCLUSION: This simple technique of defining the anterior surface and the centrifugal orientation with the letter "G" marked on the graft prevents reverse orientation of the graft.

Case-controlled clinical and histopathological study of conjunctivochalasis.

BACKGROUND/AIMS: Conjunctivochalasis, a secondary cause of the watery eye, is frequently seen in the older age group as an elevation of the bulbar conjunctiva lying along the lateral or central lower lid margin. A prospective, interventional, case-controlled clinical and histopathological study was conducted. The relevant features of 18 patients (29 eyes) who had their conjunctivochalasis resected as part of the surgical management of their watery eye syndrome were examined. In the control group, tissue was obtained from an age matched series of 24 normal subjects undergoing routine cataract surgery. METHODS: 24 controls (24 specimens) and 18 patients (29 specimens) had conjunctival strip biopsies, taken from the usual lid margin level bulbar conjunctiva in line with the inferior limbus (controls), and the clinically apparent conjunctivochalasis (patients). These were submitted for histological study. RESULTS: 23 of 24 control sections demonstrated normal conjunctival variation. Four of 29 patient specimens demonstrated a chronic non-granulomatous conjunctivitis, while three eyes of the patient group (two patients) demonstrated features of elastosis. Of the four patients who had the inflammatory infiltrates, three had functional nasolacrimal duct obstructions (FNLDOs) and one had a primary acquired nasolacrimal duct obstruction (PANDO). Of the two patients who had elastosis, one had an FNLDO and the other had normal lacrimal drainage and was Jones 1 positive. CONCLUSION: Six of 18 patients--that is, seven of 29 specimens of conjunctivochalasis demonstrated signs of elastosis or of chronic non-granulomatous inflammation. Clinically, patients had a spectrum of aetiologies of their watery eye syndrome.

The punctal apposition syndrome: a new surgical approach.

AIMS: To assess the punctal apposition syndrome (PAS) and its response to lateral canthal tendon (LCT) repair. METHODS: In this retrospective, interventional case series, five patients (seven symptomatic eyes) with PAS were managed. Lateral canthal tendon repair was performed in all seven eyes. The main outcome measure was correction of watery eye symptomatology. RESULTS: All five patients achieved symptomatic resolution. Conjunctivochalasis and functional nasolacrimal duct obstruction were associated with the PAS. CONCLUSION: This new surgical approach to the PAS, using a LCT repair, was successful in all patients. Two patients (three eyes) required conjunctivochalasis excision.

Light microscopic and electron microscopic histopathology of an iris microhaemangioma.

A patient who had been observed to have an iris microhaemangioma (capillary haemangioma), confirmed on fluorescein iris angiography, came to cataract surgery. The lesion was excised at the time of surgery and submitted to light and electron microscopic study. It had the features of a hamartoma of the capillary haemangioma type, with its characteristics being specific for vessels seen in iris tissue.

Prospective study of 1 surgeon's experience with 115 cases using the Unfolder lens injection system.

PURPOSE: To describe the experience of 1 surgeon's first 115 cases using the Allergan Unfolder intraocular lens (IOL) injection system. SETTING: Free-standing day-surgery center, Chatswood, Australia. METHODS: After standard phacoemulsification, an SI-40NB IOL (Allergan) was implanted using the Unfolder. Data on complications and the success of implantation were collected prospectively. RESULTS: Ninety-four percent of patients achieved a 1 month visual acuity of 6/6 or better. Of the 13 cases with a potential complication related to the Unfolder, all achieved a visual acuity of 6/6 or better. No complication affected the eye adversely or reduced visual acuity significantly. CONCLUSION: Implantation of SI-40NB IOLs with the Unfolder led to no serious complications and gave satisfactory visual results.

Primary phacoemulsification for uncontrolled angle-closure glaucoma.

PURPOSE: To report the results of primary phacoemulsification to treat uncontrolled angle-closure glaucoma. SETTING: Private practice and teaching hospital department. METHODS: This retrospective interventional case series assessed 3 patients having phacoemulsification and posterior chamber intraocular lens implantation for uncontrolled intraocular pressure (IOP) after acute primary angle-closure glaucoma. RESULTS: Intraocular pressure control was achieved in all patients postoperatively. CONCLUSIONS: Primary phacoemulsification with the option of future trabeculectomy should be considered in selected patients with persistent appositional angle closure and uncontrolled IOP after angle-closure glaucoma.

Artist's impression of endocapsular phacoemulsification surgery.

A 77-year-old artist having endocapsular phacoemulsification surgery and intraocular lens implantation illustrated her visual impressions of the procedure in 6 stages, from draping to lens implantation. Her illustrations and commentary indicate that she experienced clear visualization of instruments and colorful abstract imagery. These paintings were shown to 30 consecutive patients to assess their usefulness in preoperatively informing and preparing patients for surgery. With the widespread use of local and topical anesthesia, it is pertinent to the ophthalmic surgeon to understand what patients may seen when vision is retained during the procedure.

Prospective study of the SI-40NB foldable silicone intraocular lens.

PURPOSE: To evaluate the surgical performance and postoperative outcomes of 100 consecutive implantations of the new AMO PhacoFlex SI-40NB foldable intraocular lens (IOL). SETTING: Concord Hospital and Dalcross Private Hospital, Sydney, Australia. METHODS: This prospective study comprised 100 consecutive patients who had endocapsular phacoemulsification cataract surgery with implantation of the AMO SI-40NB IOL, which has a silicone optic and poly(methyl methacrylate) (PMMA) haptics. Patients were excluded if trabeculectomy was performed concomitantly. The main outcome measures were control of folding, ease of implantation, centration, intraoperative and postoperative complications, and visual acuity. A minimum of 4 months follow-up was planned. RESULTS: Mean follow-up was 4.3 months +/- 2.1 (SD) (range 1 to 12 months). The lens permitted excellent control of folding and insertion, as well as excellent centration at surgery and 4 months. There was one lens-related intraoperative complication because of crimping of the trailing lens haptic. Postoperative complications were minimal, and 92% of patients achieved a visual acuity of 20/20 or better at 1 and 4 months. Excluding the eyes with retinal pathology, 100% achieved 20/20 or better at 4 months. CONCLUSION: The AMO SI-40NB three-piece silicone IOL with PMMA haptics provided excellent operative control, centration, and visual outcome and is suitable for small incision cataract surgery.

Intraoperative complications of 1000 phacoemulsification procedures: a prospective study.

PURPOSE: To determine the frequency and nature of intraoperative complications of endocapsular phacoemulsification cataract surgery. SETTING: Dalcross Private Hospital and the Departments of Ophthalmology, Concord Hospital and Prince of Wales Hospital, Sydney, Australia. METHODS: This prospective study included the first 1000 cases of planned endocapsular phacoemulsification cataract surgery performed by an experienced surgeon. A standardized proforma was completed at the time of surgery. Data recorded included pre-existing ocular abnormalities, duration of surgery, nuclear sclerosis grade, and intraoperative complications. RESULTS: Major complications comprised posterior capsule tears with vitreous loss (1.4%), isolated posterior capsule tears (0.7%), and zonulysis (0.1%). Minor complications included anterior capsule tears (3.8%), iris prolapse (0.6%), and ciliary body incision (0.2%). There was a significant trend toward complications as the nuclear sclerosis grade increased. The incidence of major complications was 9.3% in the first 150 cases and 0.9% in the last 850. This represents a relative risk of 9.9 (95% confidence interval 4.2 to 23.0) of a major complication occurring in the first 150 compared with the later 850 cases. CONCLUSION: The frequency of major and minor complications fell sharply after the first 150 operations and was maintained. This study may provide a guide for beginning phacoemulsification surgeons and a basis for experienced surgeons to compare their performance outcomes.

Management of acute surgical orbital haemorrhage: an otorhinolaryngological and ophthalmological perspective.

This retrospective report describes the management and outcome of seven patients who suffered an acute surgical orbital haemorrhage (ASOH), secondary to a surgical procedure performed on either the sinuses, orbits or eyelids. All patients but one recovered their pre-operative vision. A management plan is outlined on how to assess and tackle this complication, so that the ENT surgeon may be better prepared to meet such an acute surgical emergency, should it arise.

Kinetic observational exophthalmometry: a simple clinical method of assessing the relative axial positions of the eyes.

A simple clinical method for detecting the presence of unilateral proptosis or enophthalmos is described. It is important that in a patient with orbital disease, a detailed ophthalmic and orbital history be taken and a careful clinical evaluation be performed. In the clinical assessment of such a patient, it is also essential to determine the presence of any asymmetry of eye position after excluding any asymmetry in eye size or in the skeletal structure of the face. Observation of the patient's head from above and noting the relative positions of the two eyes has been the traditional method in the clinical assessment of proptosis. We believe that this method of assessment of proptosis has not been adequately described or fully exploited in the past. This paper describes an extension of the same technique. It involves the examiner making the observation from above while slowly moving the patient's head passively from a position of neck flexion to one of neck extension, and then noting which eye in a patient comes into view first. We believe that this kinetic technique provides an accurate method of noting any asymmetry in eye position in relation to the supraciliary ridge. It should therefore prove to be a clinically useful method in the initial assessment of a patient with suspected ocular displacement.

Fibres found in the eye during and after phacoemulsification cataract surgery.

PURPOSE: Fibres are regularly found within the delivery cartridge (DC) and in the anterior chamber (AC) during phacoemulsification cataract surgery (PCS) and postoperatively. The purpose of this study was to identify their frequency and possible significance. SETTING: Dedicated ophthalmic day surgery. DESIGN: Prospective, consecutive, single-surgeon, cohort study. METHODS: In 639 eyes undergoing PCS, the presence of fibres was documented in or on both the DC and in the AC intraoperatively, and in the AC postoperatively. The intraoperative method of fibre removal was documented. Corrected distance visual acuity (CDVA) was recorded preoperatively, and at day 1, week 1, and week 4 postoperatively. The incidence of clinical cystoid macular oedema (CMO) and endophthalmitis in the retained fibre subcohort was compared with that of the non-fibre subcohort. RESULTS: A total of 5.2% of the operated eyes had a fibre or fibres in or on the DC, which in all cases was removed with forceps intraoperatively. A total of 14.6% of operated eyes had a fibre or fibres in the AC intraoperatively; these were removed by irrigation/aspiration. Postoperatively, five eyes (0.78%) had a fibre in the AC. There was no significant difference in postoperative CDVA between the fibre and non-fibre subcohorts (P=0.26), and no clinically significant CMO or endophthalmitis in either subcohort. CONCLUSIONS: Most fibres seen on the DC or in the eye are sterile and non-inflammatory. However, there have been reports of endophthalmitis attributed to retained fibres. In this study, there were no complications attributable to the fibres, but their removal may minimise any adverse potential.