Aharon Grinbaum

Comparison of Intraocular Pressure Profiles During Cataract Surgery by Phacoemulsification and Extracapsular Cataract Extraction

BACKGROUND AND OBJECTIVE In view of reports of fluctuations in intraocular pressure (IOP) during phacoemulsification, real-time IOP during small-incision, manual extracapsular cataract extraction (ECCE) and phacoemulsification was measured to determine the effect of anterior chamber maintainer infusion on intraoperative IOP dynamics. PATIENTS AND METHODS A comparative study of IOP during cataract surgery was conducted by these two methods in 29 patients. An anterior chamber maintainer infused balanced salt solution continuously into the eye throughout ECCE. The anterior chamber maintainer was open in 7 cases throughout phacoemulsification and switched off during phacoemulsification in 7 cases. RESULTS IOP measurements during small-incision ECCE were physiologic (range, 5 to 20 mm Hg) during most of the operation and coincided with the value of hydrostatic pressure established by the height of the anterior chamber maintainer infusion bottle. During phacoemulsification without concomitant anterior chamber maintainer, IOP was positive (> 2 to 3 mm Hg) as long as the phacoemulsification infusion line was activated (position 1). Moving to position 0 caused hypotony. Occlusion breaks occasionally caused wide fluctuations in IOP. Concomitant anterior chamber maintainer and phacoemulsification infusion did not prevent surges, but may account for the lower range of fluctuation. The anterior chamber maintainer also maintained a positive IOP at position 0 during phacoemulsification. CONCLUSIONS An anterior chamber maintainer in conjunction with a self-sealing incision can maintain stable physiologic IOP during small-incision ECCE. The IOP fluctuations during phacoemulsification, especially during occlusion breaks, can be attenuated by an anterior chamber maintainer.

Preventing expulsive hemorrhage using an anterior chamber maintainer to eliminate hypotony

Abstract We describe a method in which constant infusion inflow through an anterior chamber maintainer (ACM) is used to maintain positive intraocular pressure (IOP) during cataract extraction through a self‐sealing tunnel incision. A retrospective review of patient records showed that the difference in the incidence of intraoperative suprachoroidal hemorrhage was significantly greater in eyes in which IOP was not constant throughout surgery than in eyes in which IOP was maintained using the ACM system.

Predicted and actual refraction after intraocular lens implantation in eyes with silicone oil

Objective: To determine the difference between the predicted and postoperative refraction in eyes with silicone oil that had extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation. Setting: Ophthalmology department providing primary, secondary, and tertiary care in central Israel. Methods: Eight patients with silicone‐oil‐filled eyes following vitreoretinal procedures had ECCE and IOL implantation. The IOL power calculation was performed with the modified SRK II, the SRK/T, and the Holladay emmetropia/ametropia formulas, using the axial length of the eye, measured prior to the silicone oil injection, and the keratometric readings. The predicted and postoperative refractions were compared. Results: The postoperative refraction was more hyperopic than predicted by an average of 4.08 diopters (D) for the SRK II formula, 3.91 D for the SRK/T formula, and 4.01 D for the Holladay emmetropia/ametropia formula. Removing the silicone oil from two eyes several months after cataract extraction reduced the deviation from the predicted refraction to 0.25 and 0.80 D. Conclusion: The presence of silicone oil in the vitreous space induces a hyperopic shift in eyes having ECCE and IOL implantation. This hyperopic shift should be considered when calculating the IOL power if a long‐term tamponade with the oil is planned. If the silicone oil is to be removed shortly after the cataract extraction, the IOL power should be calculated solely from the formula.

Analysis of Cell-Free Human α1 Integrin with a Monoclonal Antibody to the I-Domain: Detection in Ocular Fluid and Function as an Adhesion Substrate

The α1β1 integrin, an inserted (I) domain containing collagen receptor, is expressed in the cell surface membrane of normal and malignant cells, and may play a role in their migration through tissues or in metastatic spread. Here we report that a functional anti-human α1β1 integrin monoclonal antibody (mAb) (1B3.1) directly and specifically binds plastic bound recombinant human α1 I-domain protein containing the collagen binding site. Detection was diminished by acidification of the I-domain protein but was enhanced by increasing concentrations of Mg2+ cation. Furthermore, we detected binding of the mAb to proteins from the ocular fluids of 6 patients, with the highest concentration, corresponding to 22.1 ng/ml of I-domain, found in a sample from the eye of a patient with metastatic lung adenocarcinoma. Interestingly, we found that both SKNSH neuroblastoma cells and virally transformed human T cells adhered specifically to plastic wells coated with either immobilized collagen IV oral I-domain. MAb 1B3.1 inhibited adhesion to collagen IV but not to immobilized I-domain. These results suggest a novel function for cell free α1 I-domain as a substrate for cellular adhesion, which may have relevance in tumor spread in vivo.

Drug induced myopia associated with treatment for gynecological problems.

We present three cases of women who developed acute transient myopia caused by drugs for gynecological problems. One patient was treated with disothiazide for premenstrual edema. The second had acute cystitis and was treated by sulphonamide and the third developed myopia coincident with metronidazole treatment for trichomonas vaginalis. We followed these patients by A scan ultrasonographic ocular measurements, documenting reduction of the anterior chamber depth combined with lens thickening. The ocular and myopic changes cleared up completely on discontinuation of the causative agent. The possible mechanism is thought to be an allergic reaction to the drug.