To the Editor: In answer to Dr. Shapiro's question concerning anticoagulants and implantation of intraocular lenses, we have had some experience in that area. We routinely do not stop warfarin sodium (Coumadin) before our cataract surgery, and since February of 1977 have done ten intracapsular cataract extractions coupled with medallion-style intraocular lens implantation in patients on warfarin. We have experienced no greater than the usual amount of operative bleeding, and one patient had a small hyphema which readily cleared. Donald L. Hall, M.D. Shreveport, LA
To the Editor: To respond to the question on inserting intraocular lenses in patients that are on anticoagulation therapy, we have inserted lenses in 68 patients. The same procedure was performed in each case. Anticoagulation therapy was stopped at least five days prior to surgery. The prothrombin time was checked prior to surgery. All patients received either iris plane or iris clip lenses; none had anterior chamber lenses. Anticoagulation therapy was usually resumed one week after surgery. The maximum follow-up period has been nine years. We have seen no post-op complications related to anticoagulation therapy in these cases. Stephen M. Kulvin, M.D. Miami Beach, FL
IRIS EROSION AND EDGE FINISHING To the Editor: After reading articles on iris erosion resulting from contact with uneven lens edges, I wonder whether there is an objective way to gauge the quality of edge finish for artificial lenses. Although I have never seen this with my own iris suture Medallion (Medical Workshop) lenses, these lenses are lightly supported by the iris and are not forced against the mobile surface of the iris. However, I am concerned about those lens designs which require more iris surface contact than the standard Medallion lens. I would like to see the edges of lenses which have been removed following development of Ellingson's uveitis-glaucoma-hyphema syndrome. I am writing to ask if anyone could show me a Choyce-style lens which has been removed for this
reason so that I could compare its obviously unphysiological edge finish with the edge finish of other lenses and thereby determine whether some standard of edge finish could be set. I recently saw a patient who had a Ridley anterior chamber lens (Rayner) implanted 20 years ago. Although one edge of this lens is constantly rubbing against the iris, there is not the slightest sign of atrophy. The implication is that prolonged chafing of the iris surface with a lens edge will not lead to iris atrophy if the edge of the lens has been properly polished. Edge finishing of intraocular lenses demands a degree of skill and care which is not compatible with assembly line manufacturing procedures. It is imperative to the best interests of our patients that we find an objective means of gauging the quality of edge finishing. Jan G.F. Worst, M.D. Haren, Holland
AIOIS FELLOWSHIP To the Editor: The Binkhorst Medal Lecture delivered at the joint meeting of the AIOIS and Academy was a milestone in American intraocular implant history. It marked the first time the theme of this prestigious lecture emphasized basic research. This departure from previous lectures reflects our increasing curiosity about the basic mechanisms in implantation. The work presented on the endothelium represents the culmination of 16 months of laboratory-oriented animal experimentation. A prodigious effort was required to accumulate the data and it is significant that the work was, in large measure, produced by the AIOIS fellow, Dr. Edward Fetherolf. It was distressing to learn, therefore, that the Scientific Advisory Board of the AIOIS recently decided to withhold future funding of this fellowship. The pioneers in this field established a rationale for implantation. Almost three decades of clinical experience and observation nurtured lens implantation from a mere notion to an accepted surgical procedure. At this moment in our development we are seeking answers to some of those questions posed by clinicians. This is a logical step in the sequence for attaining new information. Since 1974 AIOIS has served as the voice of implant surgeons in this country. Its publication, AIOIS], is designed to present new developments with the needs of the surgeon in mind. But this is not sufficient. This Society must expand its influence and
AM INTRA-OCULAR IMPLANT SOC J-VOL. V, JANUARY 1979
37
To the Editor: To respond to the question on inserting intraocular lenses in patients that are on anticoagulation therapy, we have inserted lenses in 68 patients. The same procedure was performed in each case. Anticoagulation therapy was stopped at least five days prior to surgery. The prothrombin time was checked prior to surgery. All patients received either iris plane or iris clip lenses; none had anterior chamber lenses. Anticoagulation therapy was usually resumed one week after surgery. The maximum follow-up period has been nine years. We have seen no post-op complications related to anticoagulation therapy in these cases. Stephen M. Kulvin, M.D. Miami Beach, FL
IRIS EROSION AND EDGE FINISHING To the Editor: After reading articles on iris erosion resulting from contact with uneven lens edges, I wonder whether there is an objective way to gauge the quality of edge finish for artificial lenses. Although I have never seen this with my own iris suture Medallion (Medical Workshop) lenses, these lenses are lightly supported by the iris and are not forced against the mobile surface of the iris. However, I am concerned about those lens designs which require more iris surface contact than the standard Medallion lens. I would like to see the edges of lenses which have been removed following development of Ellingson's uveitis-glaucoma-hyphema syndrome. I am writing to ask if anyone could show me a Choyce-style lens which has been removed for this
reason so that I could compare its obviously unphysiological edge finish with the edge finish of other lenses and thereby determine whether some standard of edge finish could be set. I recently saw a patient who had a Ridley anterior chamber lens (Rayner) implanted 20 years ago. Although one edge of this lens is constantly rubbing against the iris, there is not the slightest sign of atrophy. The implication is that prolonged chafing of the iris surface with a lens edge will not lead to iris atrophy if the edge of the lens has been properly polished. Edge finishing of intraocular lenses demands a degree of skill and care which is not compatible with assembly line manufacturing procedures. It is imperative to the best interests of our patients that we find an objective means of gauging the quality of edge finishing. Jan G.F. Worst, M.D. Haren, Holland
AIOIS FELLOWSHIP To the Editor: The Binkhorst Medal Lecture delivered at the joint meeting of the AIOIS and Academy was a milestone in American intraocular implant history. It marked the first time the theme of this prestigious lecture emphasized basic research. This departure from previous lectures reflects our increasing curiosity about the basic mechanisms in implantation. The work presented on the endothelium represents the culmination of 16 months of laboratory-oriented animal experimentation. A prodigious effort was required to accumulate the data and it is significant that the work was, in large measure, produced by the AIOIS fellow, Dr. Edward Fetherolf. It was distressing to learn, therefore, that the Scientific Advisory Board of the AIOIS recently decided to withhold future funding of this fellowship. The pioneers in this field established a rationale for implantation. Almost three decades of clinical experience and observation nurtured lens implantation from a mere notion to an accepted surgical procedure. At this moment in our development we are seeking answers to some of those questions posed by clinicians. This is a logical step in the sequence for attaining new information. Since 1974 AIOIS has served as the voice of implant surgeons in this country. Its publication, AIOIS], is designed to present new developments with the needs of the surgeon in mind. But this is not sufficient. This Society must expand its influence and
AM INTRA-OCULAR IMPLANT SOC J-VOL. V, JANUARY 1979
37
