John H. Sheets

Effect of a plano-convex posterior chamber lens on capsular opacification from Elschnig pearl formation

ABSTRACT Opacification of the posterior capsule occurs most commonly from Elschnig pearl migration or fibrosis. The physical contact of a posterior chamber lens, particularly one with a reverse optic, has been postulated to decrease the rate of capsular opacification by creating a barrier to Elschnig pearl migration. This randomized prospective clinical study comparing the 3M style 34S convex‐plano optic and style 34R plano‐convex (reverse) optic posterior chamber lens demonstrated a statistically significant reduction in capsular opacification by Elschnig pearls at one year in the reverse optic lenses (18.2% versus 7.6%, P = .03). No statistically significant difference in capsular fibrosis rates was noted (2.5% versus 4.5%, P = .48). The reverse optic implant also demonstrated greater iris to implant optic clearance.

Neodymium:YAG laser posterior capsulotomy

Posterior capsule opacification, caused by pearl formation or fibrosis, occurs commonly following cataract surgery. This paper presents results of a study of 367 Nd:YAG laser posterior capsulotomies and discusses both risks and benefits. Specific attention has been given to intraocular pressure (IOP), corneal endothelial cell integrity, and visual acuities. The average maximum induced IOP rise was 1.4 mm Hg and this occurred within one hour of the capsulotomy. The average corneal endothelial cell change was a loss of 7% or 115 cells/mm2. Visual acuity improved to better than 20/30 in 87.5% of patients.

External application of an irrigating lens loop for extracapsular cataract extraction

A modified irrigating lens loop applied externally to the eye may be used to express the nucleus in an extracapsular cataract extraction. No skill is required in subluxating the nucleus into the anterior chamber, as this maneuver is not necessary. The danger of posterior capsule rupture is diminished because no counter-pressure is applied and the lens loop is not placed in the eye. It is occasionally necessary to peak the pupil with forceps if it is not well dilated. We recommend this technique to simplify extracapsular cataract extraction and to markedly reduce the surgeons risk of rupturing the posterior capsule.

A review of 1,147 cases of Sheets lens implantations

A review of 1,147 Sheets Style 30 intraocular lens implantations is presented. The incidence of complications is similar to or less than that of J-loop lenses. In-the-bag placement appears to eliminate some of the problems associated with J-loop lenses placed in the ciliary sulcus.

Retrobulbar block using pentothal as a sedative for ambulatory cataract surgery.

ABSTRACT Cataract surgery comprises 80% to 85% of the surgical procedures performed at our ambulatory surgical center. We have developed a safe and effective method of sedation and amnesia for performing a retrobulbar block. `Ve use sodium thiopental, administered intravenously, just prior to the block. VVe encourage the anesthesia departments of other facilities to consider this relatively simple blocking procedure for the comfort and safety of the patient.

An inexpensive semiautomated irrigation/aspiration system

A new device for irrigating and aspirating the cortex is presented. The design features, including the module and disposable pack, and the method of use are described.

Vitreous Disturbance Following Discission-Reply

In Reply. —In response to Drs Verne and Cleasby, I would like to say that I cannot agree with them more. We are hoping to point out that an operation as simple as a discission may not always be that simple, and that one should be prepared to face such complications when they occur. I believe that with very careful observation, once knowing the possibility of the vitreous wick syndrome, one can take steps as need be when it does occur. Certainly 99% + of the discissions can well be done without difficulty and without the necessity of this vitreous instrumentation. As an anterior segment surgeon, however, one must be prepared to undertake the necessary vitreous surgery or have it done elsewhere immediately.