1993 Archives of Ophthalmology
doi: 10.1001/archopht.1993.01090020005001
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
Stewart, Michael W.;Lambrou, Fred H.
1993 Archives of Ophthalmology
doi: 10.1001/archopht.1993.01090020015004pmid: 8431142
Abstract To the Editor. —We enjoyed reading the article by Friedberg et al1 describing their experience with local anesthesia in sub-Tenon's space for vitreoretinal surgery. They reported successful anesthesia in 98 of 100 patients with no associated morbidity. We expect that as more surgeons use this technique, there will be a decrease in the incidence of retrobulbar hemorrhage, optic nerve injection, and perforation of the globe.We have also used anesthesia in sub-Tenon's space both primarily and as a supplement to incomplete retrobulbar and peribulbar blocks. A single injection in sub-Tenon's space of 3 mL of anesthetic (2% lidocaine hydrochloride and 0.75% bupivacaine hydrochloride) is adequate supplementation for most patients with failed primary blocks. However, it is particularly distressing for both the surgeon and the patient when incomplete anesthesia is achieved despite repeated supplementations in sub-Tenon's space. Friedberg et al reported two cases with failed block. In our experience these References 1. Friedberg MA, Spellman FA, Pilkerton AR, Perraut LE Jr, Stephens RF. An alternative technique of local anesthesia for vitreoretinal surgery . Arch Ophthalmol . 1991;109:1615-1616.Crossref 2. Zahl K, Jordan A, McGroarty J, Gotta AW. pH-adjusted bupivacaine and hyaluronidase for peribulbar block . Anesthesiology . 1990;72:230-232.Crossref
Hamed, Latif M.;Tse, David T.;Glaser, Joel S.;Byrne, Sandra Frazier;Schatz, Norman J.
1993 Archives of Ophthalmology
doi: 10.1001/archopht.1993.01090020015003
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract In Reply. —An extensive MEDLINE search under optic nerve sheath fenestration and/or optic nerve sheath decompression did not produce the reference cited by Dr Skalka. His article shows a case of optic nerve sheath decompression with a bleb close to the fenestration site on B-scan echography. We are impressed that this degree of anatomic detail was demonstrable in 1976, given the crude quality of ultrasound equipment available then. Our article shows B- and A-scan echograms of the blebs and the optic nerves, as well as the magnetic resonance appearance of the bleb in one case. We apologize for overlooking this reference. Had we found the reference by Dr Skalka, we would have credited it in our article.We congratulate Dr Skalka for his original observations that further strengthen our own. We expect more work on this subject in the future.
Smiddy, William E.;Flynn, Harry W.
1993 Archives of Ophthalmology
doi: 10.1001/archopht.1993.01090020015005pmid: 8431144
Abstract To the Editor. —Several recent reports on repositioning posteriorly dislocated intraocular lenses (IOLs) have described a variety of techniques for transscleral suture fixation of the IOL haptics. Refinements have been directed toward the most challenging aspect of such techniques: fixing the suture to the haptic. Suturing techniques requiring intraocular needle retrieval are awkward. Introducing a suture loop through a sclerotomy potentially impedes further surgical maneuvers through that sclerotomy, or requires extra sclerotomies.1 Exteriorizing the IOL haptic to allow suture placement involves blindly dragging the haptic through the vitreous base, risking peripheral retinal damage.2 We describe and illustrate below a minor modification in technique, using a needle developed for iris fixation.3 This modification facilitates easy and precise scleral suture placement. Technique. —Partial-thickness scleral flaps are dissected at the meridian desired. Standard pars plana vitrectomy sclerotomies are prepared. A 9-0 or 10-0 polypropylene suture with a needle attached to References 1. Maguire AM, Blumenkranz MS, Ward TG, Winkelman JZ. Scleral loop fixation for posteriorly dislocated intraocular lenses . Arch Ophthalmol . 1991;109:1754-1758.Crossref 2. Chan CK. An improved technique for management of dislocated posterior chamber implants . Ophthalmology . 1992;99:51-57.Crossref 3. Murray TG, Abrams GW, Stanley J. Pars plana vitrectomy in the management of dislocated posterior chamber lenses . Am J Ophthalmol . 1990;109:362.
1993 Archives of Ophthalmology
doi: 10.1001/archopht.1993.01090020015002pmid: 8431143
Abstract To the Editor. —Hamed et al,1 in their fine May 1992 article, describe the magnetic resonance (in one patient) and echographic (in two patients) appearances of a "heretofore unreported" fluid compartment extending into the orbit from the fenestration site after orbital optic nerve decompression for pseudotumor cerebri. The echographic appearance of a patent surgical subarachnoid-orbital shunt was actually shown as far back as 1976,2 albeit using a cruder and now obsolescent echographic instrument. References 1. Hamed LM, Tse DT, Glaser JS, Byrne SF, Schatz NJ. Neuroimaging of the optic nerve after fenestration for management of pseudotumor cerebri . Arch Ophthalmol . 1992;110:636-639.Crossref 2. Skalka HW. Ultrasonographic demonstration of patency of subarachnoidorbital shunt . J Clin Ultrasound . 1976;4:219-220.Crossref
Wuebbolt, Gordon E.;Patel, Bhupendra C.;Silver, Janet H.;Collin, J. Richard O.
1993 Archives of Ophthalmology
doi: 10.1001/archopht.1993.01090020016006pmid: 8431145
Abstract To the Editor. —The points used to support conventional spectacle frames function well for most, but not all, patients. We describe a spectacle frame that can support lenses by using the brow and temporoparietal regions, thus avoiding the conventional pressure points. Its use for various temporary and permanent conditions is discussed. Methods and Materials. —The Multiframe spectacle (Fig 1) is constructed of lightweight plastic. The bridge portion of the frame is contoured to the forehead and is supported by the brow, thus no nasal pads are required. It has a swivel joint that suspends the lens rims forward and allows for rotation of each lens independently. The sides have a hinged joint and are angled inward to clamp the temporoparietal area of the head. There is no contact with the postauricular area.The Multiframe is available in only one size, and the back vertex distance and the geometric centers of References 1. Springer DA. Custom modification of a frame to allow a patient with cancer of the nose to comfortably wear spectacles: a case report . Am J Optom . 1970;47:798-800.
1993 Archives of Ophthalmology
doi: 10.1001/archopht.1993.01090020017007pmid: 8431146
Abstract To the Editor. —In the article by Campochiaro et al1 in the May 1992 issue of the Archives, the authors mentioned that it was the left eye that had leukokoria, decreased visual acuity, cloudy media, and adenoma, yet in Fig 1A and Fig 4, it is the right eye that appears. Was this an error? References 1. Campochiaro PA, Gonzalez-Fernandez F, Newman SA, Conway BP, Feldman PS. Ciliary body adenoma in a 10-year-old girl who had a rhabdomyosarcoma . Arch Ophthalmol . 1992;110:681-683.Crossref
Campochiaro, Peter A.;Gonzalez-Fernandez, Federico;Newman, Steven A.;Conway, Brian P.;Feldman, Philip S.
1993 Archives of Ophthalmology
doi: 10.1001/archopht.1993.01090020017008
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract In Reply. —We are indebted to Ms Servodidio for pointing out a typographical error in our article. The legend to Fig 4 should state "a fundus photograph of the left eye." The legend for Fig 1A should also state "left eye" instead of "right eye." We would also like to provide an additional follow-up on our patient. She was examined by Dr Marianne Cowley on May 26,1992,22 months after surgery, and visual acuity was 20/30 +2 OS. Results of ophthalmoscopic examination were normal and there was no evidence of tumor recurrence.
1993 Archives of Ophthalmology
doi: 10.1001/archopht.1993.01090020017009pmid: 8431147
Abstract To the Editor. —An essay in the March 11, 1992, issue of the Journal of the American Medical Association1 deserves further discussion. It describes a man who resisted surgery for his mature cataracts, underwent a personality change for the worse after the surgery was eventually performed, and then committed suicide.I believe this patient had an extreme example of what may be termed refuge blindness.As physicians, we assume that our patients share with us certain basic attitudes about health and illness. Good health is desirable. Illness or disability is bad and should be prevented, cured, or ameliorated. This is our world picture.There are patients who do not live in this world. These patients are neither demented, mentally retarded, nor psychotic, but their failure to comply with medical advice meant to save or restore sight is so blatant, so bizarre, and so seemingly irrational that we are puzzled and References 1. Firlik AD. What we fail to see . JAMA . 1992;267:1328.Crossref
Yu, David D.;Lemp, Michael A.;Mathers, William D.;Espy, Mark;White, Thomas
1993 Archives of Ophthalmology
doi: 10.1001/archopht.1993.01090020021010pmid: 8431148
Abstract Disciform keratitis is a well-known sequela of herpes zoster ophthalmicus (HZO) and varicella.1 The clinical course can persist for many years with longterm dependence on low-dose topical steroids to suppress recurrent inflammation. The mechanism for disciform keratitis development is not known but is thought to be a delayed hypersensitivity reaction to varicella-zoster virus (VZV) antigen in the cornea. Using the polymerase chain reaction, we have demonstrated the presence of VZV DNA in the cornea of a patient who underwent penetrating keratoplasty 2 years following development of HZO. Report of a Case. —A 47-year-old woman was afflicted with HZO in V-1 and V-2 dermatomes on the left side in October 1989. Zoster keratouveitis resulted in secondary, open angle glaucoma. The patient presented in February 1991 with disciform keratitis and Streptococcus viridans corneal ulceration that was successfully treated with topical vancomycin (50 mg/mL) and topical penicillin G (100000 U/mL) (Fig 1). References 1. Wilhelmus KR, Hamill MB, Jones DB. Varicella disciform stromal keratitis . Am J Ophthalmol . 1991;111:575-580. 2. Mahalingam R, Wellish M, Wolf W, et al. Latent varicella-zoster viral DNA in human trigeminal and thoracic ganglia . N Engl J Med . 1990;323:627-631.Crossref 3. Rong B, Pavan-Langston D, Weng Q, Martinez R, Cherry J, Dunkel E. Detection of herpes simplex virus thymidine kinase and latency-associated transcript gene sequences in human herpetic corneas by polymerase chain reaction amplification . Invest Ophthalmol Vis Sci . 1991;32:1808-1815.
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