David B. Soll

The Anophthalmic Socket

Following enucleation or evisceration surgery, the anatomy and physiology of the orbit are changed. These changes affect not only the cosmetic appearance of the anophthalmic patient but also the function of the socket and the prosthesis. Surgical techniques for primary enucleation and evisceration surgery and correction of early and late complications are described. During the course of this century many operations and prosthetic devices have been advocated. A brief summary of these is given as well as detailed surgical descriptions of techniques the author believes have proven successful over the years.

Primary Choroidal and Cutaneous Melanomas Occurring in a Patient with the B-K Mole Syndrome Phenotype

A patient with malignant melanoma of the choroid and ciliary body had a primary cutaneous melanoma and the B-K mole syndrome phenotype. Because of this newly described association, all patients with the B-K mole syndrome (phenotype) should have a complete ocular examination to discover if there is any evidence of ocular melanoma. Likewise, all patients with ocular melanoma should have a thorough dermatologic examination to determine evidence of cutaneous melanoma and the B-K mole syndrome (phenotype).

Chondroitin Sulfate: A New and Effective Protective Agent for Intraocular Lens Insertion

Chondroitin sulfate (CDS) has been found to serve as an excellent protective coating for intraocular lens (IOL) implantation to avoid any damage to the corneal endothelium; the protection is total. Using a new vital dye, acid violet 49, as a stain, a series of possible coatings including albumin and hyaluronic acid was evaluated in vitro and in vivo. Some 600 animal corneas were trephined, and the sample buttons submitted to the dragging of variously coated lenses across the endothelium. The animal species were rabbit, pig, cow, dog, cat, and monkey. IOLs were traumatically inserted in rabbits and monkeys. Chondroitin sulfate surpassed by far the protective qualities of other compounds: albumin was second best; hyaluronic acid third, the latter two yielding substantial damage in our tests. Comparisons with the commercially available Healon still revealed chondroitin sulfate to be the most efficacious protective agent. The material was eliminated from the anterior chamber in periods less than 40 hours. Monitoring of postoperative intraocular pressures revealed only normal pressures in our animals.

evaluation and protection of corneal endothelium

A series of experiments was performed in vitro, on animal and human corneas, and in vivo, on monkeys and rabbits, to test the efficacy of various substances which may be used as coatings for intraocular lenses to protect the corneal endothelium from damage. The vital dye, acid violet 49, was applied to evaluate endothelial cell function and damage. Our results indicate that chondroitin sulphate is far superior to other substances tested in preventing endothelial damage due to intraocular lens contact. Acid violet 49 is very sensitive in detecting endothelial cell damage, and the intensity of cellular staining with acid violet 49 correlates well with the degree of endothelial cell damage.

Silicone Intubation: An Alternative to Dacryocystorhinostomy

Silicone intubation is an alternative to dacryocystorhinostomy in selected patients who have epiphora and obstruction of the nasolacrimal system. Silicone tubing may be passed through the nasolacrimal system and left in place for a prolonged period of time. In many instances, this obviates the need for a dacryocystorhinostomy. If the intubation is not completely successful, a dacryocystorhinostomy can always be carried out at a later date.

Evisceration With Eversion of the Scleral Shell and Muscle Cone Positioning of the Implant

Six patients underwent a new surgical procedure to repair extruding evisceration implants. The scleral shell was everted and used as an anterior wall for the placement of a donor sclera-encased implant within the muscle cone. Early results showed good cosmesis and no recurrent extrusions.