Albert Galand

Use of human fibrin glue and amniotic membrane transplant in corneal perforation.

Purpose. To repair corneal perforation using human fibrin glue (HFG) and amniotic membrane transplant (AMT). Methods. Three patients in whom central corneal perforations, approximately 2 mm in diameter, occurred after ocular or systemic disease were successfully cured using HFG and AMT. The technique consists first of using a high-viscosity sodium hyaluronate viscoelastic material to restore anterior chamber depth followed by a debridement of the ulcer. The perforation site is filled with the HFG to corneal surface level. The so-formed plug is then secured with an AMT to avoid its extrusion. An extended-wear bandage contact lens and topical antibiotics were used in these patients for 3 weeks. Results. Total reepithelialization was observed after an average of 15 postoperative days. The AMT dissolved within 8 weeks to uncover a whitish scar formed within the perforation sites. No complications were observed in any patients. After a follow-up period of 195–325 days, all corneas remained stable; there was no infection or ulcer recurrence, but some corneal scar thinning was observed in all three cases. Conclusion. The described surgical approach using HFG and AMT allowed a successful repair of corneal perforations with a diameter of 2 mm associated with significant loss of stroma. This method may be a good alternative to delay penetrating keratoplasty for treating corneal perforations, especially in acute cases in which graft rejection risk is high.

Posterior capsulorhexis in adult eyes with intact and clear capsules

Purpose: To evaluate the feasibility and risks of primary posterior capsulorhexis. Setting: Department of Ophthalmology, University Hospital of Liège, Belgium. Methods: Retrospective analysis of 319 patients with cataracts who had phacoemulsification or manual extracapsular cataract extraction with a simultaneous circular posterior capsulorhexis between August 1993 and April 1994. The number of intraoperative complications and the number of postoperative complications that could be related to the posterior capsule opening were looked at. Fluorescein angiography was performed in a random sample of patients. Results: Twelve intraoperative complications consisted of 5 irregular tears, 4 vitreous prolapses into the posterior capsulorhexis, and 3 vitreous prolapses into the anterior chamber; 11 occurred in eyes with positive posterior pressure. Postoperative complications consisted of 3 vitreous prolapses into the pupil and 1 retinal detachment. Two of the 3 late vitreous prolapses occurred in eyes in which the posterior capsulorhexis was larger than the intraocular lens (IOL) optic. The retinal detachment occurred in an eye with a 25.79 mm axial length. Fluorescein angiography of 49 cases revealed 3 with cystoid macular edema. Conclusions: Based on our results, we believe that primary posterior capsulorhexis can be a routine procedure during cataract surgery and IOL implantation in adults, except in cases of positive pressure. The diameter of the posterior capsulorhexis should be smaller than the diameter of the IOL optic.

Complicated posterior capsulorhexis: aetiology, management, and outcome

BACKGROUND A 1 year retrospective analysis of 650 patients, who underwent a posterior capsulorhexis on their intact capsules, was performed to examine the incidence of complications, their aetiologies, and the outcome. METHODS Data were analysed on 32 patients with complicated capsulorhexis for type of surgery, preoperative and postoperative factors, and relative risk factors for vitreous issue. RESULTS There were six patients with vitreous loss. The posterior capsulorhexis was uncontrolled in 14 cases and difficult to perform in 12 cases. Implantation into the capsular bag was possible in all cases. Systemic vascular hazard and old age (over 80 years) were found to be statistically significant risk factors for vitreous loss (p=0.002 and p=0.03 respectively). The mean follow up was 13.5 months (range 4–25 months). One patient developed a retinal detachment and two had a transient clinical cystoid macular oedema. Visual acuity of ≥ 20/40 was obtained in 93% of the patients. CONCLUSION Loss of control of the posterior capsulorhexis has a low incidence but can lead to serious problems during surgery. A good knowledge of the technique is necessary to complete the procedure with a posterior capsulorhexis of the optimum size without vitreous loss.

Preliminary report on the rigid disc lens

ABSTRACT Theoretically, a circular and lenticular implant is the most appropriate for implantation in the capsular bag. Various prototypes have led to a single‐piece model in polymethylmethacrylate with a biconvex 7‐mm optic and a 9‐mm total diameter. This so‐called disc lens has been implanted in 61 eyes. The longest follow‐up is IS months. Thus far, the clinical results are excellent. It appears that this 9‐mm disc lens permits centration without acting as a spring in the capsular bag. A large mydriasis and the use of viscoelastic material are mandatory for inserting the rigid disc lens. A circular implant appears to be an advance in IOL design adapted to the capsular bag configuration. A greater number of cases and longer follow‐up are necessary to evaluate the rigid disc lens.

Two-year postoperative results of Galand lens implantation

ABSTRACT The Galand lens is a closed J‐loop implant for capsular‐bag fixation. We present a retrospective study of 214 eyes implanted with this lens. Eyes were examined at three months, six months, one year, and two years after surgery. Results indicate that 82.2% of eyes obtained a visual acuity of 20/40 or better at two years after implantation. If patients with other ocular pathology were excluded, the percentage of those whose visual acuity was 20/40 or better at two years was 93.7%. Although this implant avoids “spring action” within the capsular bag, the rate of dislocation into the posterior chamber was low (0.93% in this series). Early stability, before sealing of the capsular leaflets, was obtained by limiting the anterior capsulectomy to the pupillary area. No late zonular rupture was observed. Secondary posterior capsulotomy has been performed in 9.8% of the eyes.