Ocular Bottles
Injuries
From
Beverage
To the Editor.\p=m-\Therecent article in the Archives entitled "Ocular Injuries From Exploding Beverage Bottles" by Mondino et al (96:2040-2041, 1978) is of interest to me, because I happened to see two cases of similar injuries with considerable damage to the eyes, in the summer of 1977. The first case was in a young girl who had been trying to remove the cap from one of the new unbreakable plastic bottles, when the cap hit her left eye, causing corneoscleral laceration, vitreous prolapse, and cataract formation. The second case also occurred when the cap of a bottle hit the
patient's eye while she was working in the kitchen; it caused a corneal opacity without affecting her vision.
If I small
injuries in a community of 25,000 people, in one summer, I must conclude that beverage-bottle injuries of the eyes must not be very infrequent, but probably most of them go unreported. Even if the bottle is unbreakable, the cap remains a hazard. Perhaps the larger the bottle, the more hazardous it is, because of the pressure inside the bottle. The authors of the article in the Archives are to be commended for bringing this hazard to the attention of the ophthalmic community. Jila S. Waikhom, MD Xenia, Ohio see
two serious eye
To the Editor.\p=m-\Inregard to a recent article in the Archives by Mondino et al (96:2040-2041, 1978), I have personally seen nearly half a dozen injuries related to "exploding" carbonated beverage bottles in 1978. I would concur that the incidence is surely higher than that suggested by infrequent reports in the literature; however, I would suggest that this may be so because serious injury may be rare, relative to incidence of all such injuries. For example, on Feb 3, 1978, I was asked to see a 26-year-old woman who had sustained an explosion injury to her right eye that day, from a carbonated beverage bottle. The injury was
said to be spontaneous, having occurred with a chilled bottle that had not been shaken, and had undergone only normal cap removal. Although her vision was initially only hand motion in the injured eye, within four weeks her visual acuity had improved to 6/6 (20/20). She sustained a 100% cellular hyphemia and traumatic iritis. Both cleared within one month with
mydriatic therapy, topically applied. patient also sustained a corneal abrasion, which healed within two days with patching and antibiotic ointment. She had no angle alteration, retinal damage, orbital changes, or other ocular sequelae of the injury, except a slightly peaked and irregular pupil, which has persisted to date. There was no sign of cataractous change, no posterior segment hemor¬ rhage, no iridodialysis, and no disrup¬ tion of globe integrity. The
None of my other
this year the one described here; I conclude that rela¬ tively inconsequential injuries from exploding bottle tops may commonly be minor. I certainly agree with the safety precautions recommended in the article by Mondino et al. Kenneth R. Fox, MD Falls Church, Va were even
equally
cases
severe as
Corneal Edema After Use of Carbachol
To the Editor.\p=m-\In a recent issue of the Archives (96:1897-1901,1978) Vaughn et al described their experimental data on the perfusion of the anterior chamber of rabbits with carbachol. They noted transitory but reversible swelling of the cornea, which implied some transitory endothelium dysfunction. However, they advised caution in using this solution in humans in whom the cornea has already compromised endothelial cells. In the past two years, the National Registry of Drug-Induced Ocular Side Effects has had numerous reports of patients having transitory and even persistent corneal edema after the use of this drug intraocularly to induce miosis. In the majority of cases of persistent corneal edema that have
Downloaded From: http://archopht.jamanetwork.com/ by a UQ Library User on 06/17/2015
been reported to the registry, the surgeon reformed the anterior chamber at the end of the procedure with this solution. This procedure is not intended by the manufacturer and should not be performed. That this is, indeed, a drug-related event is most difficult to prove, since in any operative procedure, inadvertent endothelium trauma can occur with resultant corneal edema, and the drug might incorrectly be implicated. However, there are a number of cases in the registry that suggest a possible rela¬ tionship. This drug is commonly used and only a rare adverse reaction has been reported; however, with in¬ creased procedures that have a poten¬ tial of endothelial trauma during the
operation (intraocular lenses, phacoemulsification) or in surgical proce¬
dures with more endothelial trauma than usual, bathing these cells with a solution with a pH of 5.2 theoretically may not be in the patient's best inter¬ est. Therefore, we agree with the above authors that carbachol should be used with caution in patients with increased endothelial trauma, Fuchs' dystrophy, or in corneal transplant surgery. Frederick T. Fraunfelder Portland, Ore Name and Trademarks of Drug
Nonproprietary
Carbachol-Caròacei Bufopto, Carbamiotin, Miostat, Mistura C, P.V. Carbachol.
Treatment of
Malignant Melanoma
To the Editor.\p=m-\Ina
recently published
article, Zimmerman
et al1 of the Armed Forces Institute of Pathology challenge the standard oncologic treatment of a malignancy, that is, en bloc excision. In a study of malignant melanoma of the choroid and ciliary body, they suggest that the enucleation of the affected eye actually may be the cause of the dissemination of tumor cells, resulting in metastatic disease. This conclusion is based on two observations. First, citing sub-
Injuries
From
Beverage
To the Editor.\p=m-\Therecent article in the Archives entitled "Ocular Injuries From Exploding Beverage Bottles" by Mondino et al (96:2040-2041, 1978) is of interest to me, because I happened to see two cases of similar injuries with considerable damage to the eyes, in the summer of 1977. The first case was in a young girl who had been trying to remove the cap from one of the new unbreakable plastic bottles, when the cap hit her left eye, causing corneoscleral laceration, vitreous prolapse, and cataract formation. The second case also occurred when the cap of a bottle hit the
patient's eye while she was working in the kitchen; it caused a corneal opacity without affecting her vision.
If I small
injuries in a community of 25,000 people, in one summer, I must conclude that beverage-bottle injuries of the eyes must not be very infrequent, but probably most of them go unreported. Even if the bottle is unbreakable, the cap remains a hazard. Perhaps the larger the bottle, the more hazardous it is, because of the pressure inside the bottle. The authors of the article in the Archives are to be commended for bringing this hazard to the attention of the ophthalmic community. Jila S. Waikhom, MD Xenia, Ohio see
two serious eye
To the Editor.\p=m-\Inregard to a recent article in the Archives by Mondino et al (96:2040-2041, 1978), I have personally seen nearly half a dozen injuries related to "exploding" carbonated beverage bottles in 1978. I would concur that the incidence is surely higher than that suggested by infrequent reports in the literature; however, I would suggest that this may be so because serious injury may be rare, relative to incidence of all such injuries. For example, on Feb 3, 1978, I was asked to see a 26-year-old woman who had sustained an explosion injury to her right eye that day, from a carbonated beverage bottle. The injury was
said to be spontaneous, having occurred with a chilled bottle that had not been shaken, and had undergone only normal cap removal. Although her vision was initially only hand motion in the injured eye, within four weeks her visual acuity had improved to 6/6 (20/20). She sustained a 100% cellular hyphemia and traumatic iritis. Both cleared within one month with
mydriatic therapy, topically applied. patient also sustained a corneal abrasion, which healed within two days with patching and antibiotic ointment. She had no angle alteration, retinal damage, orbital changes, or other ocular sequelae of the injury, except a slightly peaked and irregular pupil, which has persisted to date. There was no sign of cataractous change, no posterior segment hemor¬ rhage, no iridodialysis, and no disrup¬ tion of globe integrity. The
None of my other
this year the one described here; I conclude that rela¬ tively inconsequential injuries from exploding bottle tops may commonly be minor. I certainly agree with the safety precautions recommended in the article by Mondino et al. Kenneth R. Fox, MD Falls Church, Va were even
equally
cases
severe as
Corneal Edema After Use of Carbachol
To the Editor.\p=m-\In a recent issue of the Archives (96:1897-1901,1978) Vaughn et al described their experimental data on the perfusion of the anterior chamber of rabbits with carbachol. They noted transitory but reversible swelling of the cornea, which implied some transitory endothelium dysfunction. However, they advised caution in using this solution in humans in whom the cornea has already compromised endothelial cells. In the past two years, the National Registry of Drug-Induced Ocular Side Effects has had numerous reports of patients having transitory and even persistent corneal edema after the use of this drug intraocularly to induce miosis. In the majority of cases of persistent corneal edema that have
Downloaded From: http://archopht.jamanetwork.com/ by a UQ Library User on 06/17/2015
been reported to the registry, the surgeon reformed the anterior chamber at the end of the procedure with this solution. This procedure is not intended by the manufacturer and should not be performed. That this is, indeed, a drug-related event is most difficult to prove, since in any operative procedure, inadvertent endothelium trauma can occur with resultant corneal edema, and the drug might incorrectly be implicated. However, there are a number of cases in the registry that suggest a possible rela¬ tionship. This drug is commonly used and only a rare adverse reaction has been reported; however, with in¬ creased procedures that have a poten¬ tial of endothelial trauma during the
operation (intraocular lenses, phacoemulsification) or in surgical proce¬
dures with more endothelial trauma than usual, bathing these cells with a solution with a pH of 5.2 theoretically may not be in the patient's best inter¬ est. Therefore, we agree with the above authors that carbachol should be used with caution in patients with increased endothelial trauma, Fuchs' dystrophy, or in corneal transplant surgery. Frederick T. Fraunfelder Portland, Ore Name and Trademarks of Drug
Nonproprietary
Carbachol-Caròacei Bufopto, Carbamiotin, Miostat, Mistura C, P.V. Carbachol.
Treatment of
Malignant Melanoma
To the Editor.\p=m-\Ina
recently published
article, Zimmerman
et al1 of the Armed Forces Institute of Pathology challenge the standard oncologic treatment of a malignancy, that is, en bloc excision. In a study of malignant melanoma of the choroid and ciliary body, they suggest that the enucleation of the affected eye actually may be the cause of the dissemination of tumor cells, resulting in metastatic disease. This conclusion is based on two observations. First, citing sub-
