Bruner We

Management of Epithelial Cysts of the Anterior Chamber

Epithelial cysts in the anterior chamber are treated only if they obstruct the pupil or cause other serious complications. A closed-eye method is used in aphakic eyes to collapse the cyst and devitalize the epithelial cells using cryotherapy without incising the cyst wall. In phakic eyes, the cyst is dissected away from the cornea and the partially excised through an open-sky approach followed by transscleral cryotherapy to devitalize epithelial remnants. Four of seven eyes operated on with these methods were successfully treated without complications. Persistent cystoid macular edema occurred in two of the other three eyes, and one eye developed a postoperative sheet-like epithelial ingrowth requiring further surgery and resulting in corneal edema. The cyst did not recur in any of these seven eyes.

Combined keratoplasty, cataract extraction, and intraocular lens implantation: experience at the Wilmer Institute.

A review of 12 cases of combined keratoplasty, cataract extraction and IOL implantation performed during the past five years at the Wilmer Institute is presented. The results show 80% of cases with 6/12 (20/40) vision or better with a follow-up of at least six months. All but one of the grafts remained clear. Our current technique for keratoplasty, extracapsular cataract extraction and posterior-chamber IOL implantation is described. This technique has several advantages, including the following: an intact posterior capsule, no anterior vitrectomy, protection of the cornea from the IOL by the iris, and potential for full pupil dilation after surgery. Conservative and highly selective use of the procedure is recommended.

Use of the Honan intraocular pressure reducer at The Wilmer Institute.

Our technique for the preparation of the patient for cataract surgery is discussed, with description of our use of the Honan intraocular pressure reducer (HIPR). Results of preoperative use of the HIPR in a prospective study of 21 patients and our retrospective experience with over 1,000 patients undergoing cataract surgery (with or without lens implantation) are discussed. The HIPR appears to be a safe and effective means of reducing intraocular pressure preoperatively when used with due care.

Glycosidases of normal human donor cornea.

Although there have been reports of glycosidases in various ocular tissues, there are very few quantitative data concerning human corneal glycosidases. In this study, the pH optima, apparent Km, and Vmax values were determined for seven glycosidases of human donor corneas obtained from an eye bank. In terms of micromoles of substrate cleaved per milligram of protein per hour, the enzymatic activity of the glycosidases was in the following order of decreasing magnitude: β-galactosaminidase, β-glucosaminidase, β-galactosidase, β-glucuronidase, α-mannosidase, α-fucosidase, α-glucosidase. The pH optima of the enzymes ranged from 3.4 to 5.7.

Management of retropseudophakos membranes

Retropseudophakos membranes are becoming a more frequent problem. When simple discission is not successful in creating an adequate pupillary space, instruments and techniques designed for pars plana vitreous surgery provide advantages over conventional methods for dealing with selected reto-IOL membranes.

A simple method of repairing inadvertent filtering blebs after cataract surgery.

We have developed a simple, safe, and effective procedure for repairing inadvertent filtering blebs after cataract surgery with several interrupted 7-0 or 8-0 silk sutures placed externally over the bleb and through the wound cleft, and without opening the conjunctiva or the anterior chamber. We have treated more than 20 eyes successfully with this method.