Betagan, Betoptic, Timoptic, lopidine, Diamox, Pilopine Gel, and Miostat. J Cataract Refract Surg 1992; 18:14-19) but not focused upon. My experience is with Viscoat and Occucoat, used in extracapsular surgery. I am not sure this would be of value after A/I. It is now unusual for me to see a postoperative pressure rise. I urge you to emphasize this point in a future discussion as the opportunity arises. In the meantime I will take your advice and add an anti-glaucomatous drop to my regimen. Keith S. McKenzie, M.D. Santa Cruz, California
TEMPORARY WOUND CLOSURE To the Editor: I read with great interest the article by Hara and Hara describing temporary wound closure with used needles (J Cataract Refract Surg 1992; 18: 200-201). Dr. Daljeet Singh ofIndia has used this technique for several years to rapidly close the eye while facing expulsive choroidal hemorrhage during surgery. He has successfully used this technique in over 50 cases. After stapling the eye with needles, he waits about 30 minutes. The eye becomes soft and he is able to finish the operation. No sclerotomy or other procedure is done to reduce increased intraocular pressure. I believe Dr. Singh's success in treating this very difficult emergency is quick closure using needles. Figure 1 is a representation of his technique. Jaswant Singh Pannu, M.D. Lauderdale Lakes, Florida
Fig. 1.
424
(Pannu) Closure technique used by Daljeet Singh, M.D.
INFLAMMATION AFTER LENS IMPLANTATION To the Editor: I read with interest the editorial and the article by Monson et al. on inflammation after surgery in the March issue (Obstbaum SA. Inflammation associated with cataract surgery and intraocular lens implantation: a recurring theme. 1992; 18:119; Monson MC, Mamalis N, Olson RJ. Toxic anterior segment following cataract surgery. 1992; 18: 184189). I have had one case such as this and in traveling around America, I have met three other surgeons with similar cases. I think the cause of this problem is the rust removal solution not being adequately removed from the instruments after they have had this treatment. Certain of the older instruments do go rusty after numerous autoclaves and I note that some scrub nurses use rust remover to clean them. If the rust removal solution is not scrupulously removed following this treatment, a very toxic chemical is put into the eye. Eric J. Arnott, M.D. London, England
ARE LENS EXCHANGES AND "T" CUTS OBSOLETE? To the Editor: The excimer laser, currently under FDA investigation, is changing the way we have traditionally viewed corneal procedures. Modern cataract surgery has bestowed many miracles upon its recipients. Today's surgery is painless, precise, and rarely incurs morbidity. Occasionally, one can expect good near and distance vision without spectacles. However, there are a few clouds in paradise: either faulty lens selection causing excessive myopia or surgically induced astigmatism may diminish the magic of modern cataract surgery. Rather than the invasive lens exchange for pseudophakic anisometropia, the current state of excimer refractive technology offers an alternative-pseudophakic photorefractive keratectomy (PPK). Consider the nearly full thickness invasion of the cornea with "T" cuts to modulate surgically induced astigmatism. Would it not be better to attempt a procedure that ablates only 1 0 to 20 J.lm to effect a result of 1 or 2 diopters of cylinder or sphere? In this context, the technology is here to relegate "T" cuts and lens exchanges to obsolescence. Charles H. Cozean, Jr., M.D. Cape Girardeau, Missouri
J CATARACT REFRACT SURG-VOL 18, JULY 1992
TEMPORARY WOUND CLOSURE To the Editor: I read with great interest the article by Hara and Hara describing temporary wound closure with used needles (J Cataract Refract Surg 1992; 18: 200-201). Dr. Daljeet Singh ofIndia has used this technique for several years to rapidly close the eye while facing expulsive choroidal hemorrhage during surgery. He has successfully used this technique in over 50 cases. After stapling the eye with needles, he waits about 30 minutes. The eye becomes soft and he is able to finish the operation. No sclerotomy or other procedure is done to reduce increased intraocular pressure. I believe Dr. Singh's success in treating this very difficult emergency is quick closure using needles. Figure 1 is a representation of his technique. Jaswant Singh Pannu, M.D. Lauderdale Lakes, Florida
Fig. 1.
424
(Pannu) Closure technique used by Daljeet Singh, M.D.
INFLAMMATION AFTER LENS IMPLANTATION To the Editor: I read with interest the editorial and the article by Monson et al. on inflammation after surgery in the March issue (Obstbaum SA. Inflammation associated with cataract surgery and intraocular lens implantation: a recurring theme. 1992; 18:119; Monson MC, Mamalis N, Olson RJ. Toxic anterior segment following cataract surgery. 1992; 18: 184189). I have had one case such as this and in traveling around America, I have met three other surgeons with similar cases. I think the cause of this problem is the rust removal solution not being adequately removed from the instruments after they have had this treatment. Certain of the older instruments do go rusty after numerous autoclaves and I note that some scrub nurses use rust remover to clean them. If the rust removal solution is not scrupulously removed following this treatment, a very toxic chemical is put into the eye. Eric J. Arnott, M.D. London, England
ARE LENS EXCHANGES AND "T" CUTS OBSOLETE? To the Editor: The excimer laser, currently under FDA investigation, is changing the way we have traditionally viewed corneal procedures. Modern cataract surgery has bestowed many miracles upon its recipients. Today's surgery is painless, precise, and rarely incurs morbidity. Occasionally, one can expect good near and distance vision without spectacles. However, there are a few clouds in paradise: either faulty lens selection causing excessive myopia or surgically induced astigmatism may diminish the magic of modern cataract surgery. Rather than the invasive lens exchange for pseudophakic anisometropia, the current state of excimer refractive technology offers an alternative-pseudophakic photorefractive keratectomy (PPK). Consider the nearly full thickness invasion of the cornea with "T" cuts to modulate surgically induced astigmatism. Would it not be better to attempt a procedure that ablates only 1 0 to 20 J.lm to effect a result of 1 or 2 diopters of cylinder or sphere? In this context, the technology is here to relegate "T" cuts and lens exchanges to obsolescence. Charles H. Cozean, Jr., M.D. Cape Girardeau, Missouri
J CATARACT REFRACT SURG-VOL 18, JULY 1992
