case report on long-term implant tolerance Herve M. Byron, M.D. Englewood, NJ
A 67-year-old white female underwent intracapsular cataract microcryoextraction with insertion of an iris clip Binkhorst intraocular lens in her left eye, under local anesthesia in March 1966. The surgery was without complications and her postoperative course for the initial several months was uneventful: vision was 20/20 with a minimal correction over this eye. Approximately nine months postoperatively, the eye began to show slight corneal epithelial edema superiorly which responded to local steroids and glycerine. Three such episodes occurred. An interval of three years followed without any other problems. The photograph in Fig. 1 was taken in February 1968, at which time no medications were being taken by the patient and she was functioning very well. The episodes of recurrent corneal epithelial edema in the nasal and temporal portions of the upper left cornea started once again in March 1970, four years after the initial surgery. These episodes responded less dramatically to local therapy, and oral cortisone
was required to eliminate the problem. The photograph in Fig. 2 was taken in July 1970 after one of these attacks had been successfully treated. Up to this point, vision in this patient's right eye was maintained at 20/20 with no evidence of ocular pathology. In March 1971 the patient suffered a central retinal artery occl usion of her right eye which decreased visual acuity to hand motion. Fig. 3 shows the right retina with a very pale optic nerve.
Fig. 2 (Byron). Four-year post-op view of left eye.
Fig. I (Byron). Two-year post-op view of left eye.
Fig. 3 (Byron). Fundus view of the right eye, following central retinal artery occlusion.
AM INTRA-OCULAR IMPLANT SOC J-VOL. V, JANUARY 1979
In 1975, the patient was hospitalized for thrombophlebitis in both legs. Following two weeks of anticoagulation therapy, she was discharged on maintenance doses of crystalline warfarin sodium (Coumadin). In early 1976, the patient'S right eye manifested a mature nuclear cataract. Two months later, in May, the patient's left eye revealed marked corneal edema extending through to Descemet's membrane and causing a marked reduction in the visual acuity of her only functioning eye. After considerable deliberation with her internist, it was decided to perform cataract surgery on her right eye, even though the history of central retinal artery occlusion made visual prognosis poor. Removal of a very ripe cataract in this right eye, followed by correction with a continuous-wear soft contact lens would provide her with slight vision pending the outcome of planned penetrating keratoplasty on her left eye. The major medical problem was adjustment and temporary cessation of the Coumadin which had been successful in controlling her vascular problems. In September 1976 a successful microcryoextraction of the right eye was performed under local anesthesia without excessive bleeding. Three days later Coumadin was resumed. In November 1976 the patient was fitted with a continuous-wear soft contact lens which provided her with a visual acuity in the right eye of 4/200. This was significantly helpful since intense corneal edema had reduced vision in the left eye to hand motion. After extensive consultation with her internist, it was decided that the patient could safely undergo the necessary corneal surgery on her left eye in early 1977. In March of that year, the patient underwent an 8-mm penetrating keratoplasty of her left eye, at which time both the nasal and temporal anterior clips of the implant were amputated. The procedure was performed under local anesthesia after Coumadin had been stopped for one week. No bleeding or other complications were encountered at the time of this surgery. The postoperative course was uneventful for the following six months, after which she developed a minor episode of thrombophlebitis in her right leg. This required hospit