Louis J. Girard

Pars Plana Phacoprosthesis (Aphakic Intraocular Implant): A Preliminary Report

A preliminary report is presented on a new intraocular implant which is inserted through the pars plana and is anchored to the sclera in that area. The optic is positioned in the posterior chamber allowing free movement of the iris and best optical correction. Twenty implants are reported without serious complications after a minimum follow-up of one year; however, two retinal detachments have occurred in more recent operations.

Cataract and uveitis management by pars plana lensectomy and vitrectomy by ultrasonic fragmentation

Cataract and uveitis occurs usually in young individuals and produces loss of vision from opacification of both the lens and vitreous. The condition does not lend itself to conventional surgery. In the experience of the authors and several other investigators, pars plana lensectomy and vitrectomy by ultrasonic fragmentation not only improves vision but apparently causes a remission of uveitis. A retrospective study of 23 eyes with cataract and uveitis undergoing pars plana lensectomy and vitrectomy by ultrasonic fragmentation (21 eyes) or vitrectomy alone (2 eyes) showed improved vision in 91.3%, no operative complications, and remission of the uveitis in 100% with observation periods of 1-11 years (average, 5 years). Pars plana lensectomy and vitrectomy appears to be the treatment of choice in cataract and chronic uveitis.

Seleral fixation of a subluxated posterior chamber intraocular lens

ABSTRACT A Surgical technique for the treatment of a subluxated intraocular lens is described. It consists of a scleral incision 2 mm from the limbus, hooking the loop haptic of the implant into the scleral wound, and imbricating the loop into the sclera for permanent fixation. Four eyes in which this technique was applied successfully are reported.

Use of grafts smaller than the opening for keratoconic myopia and astigmatism A prospective study

ABSTRACT A prospective study was conducted on 15 consecutive keratoconic eyes to evaluate the use of grafts smaller than the opening in keratoconic myopia and astigmatism. All surgeries were performed by the senior author. Average age of the patients was 41.1 years. Average follow‐up was 1.6 years. After all sutures were removed, results showed an average decrease in myopia of 13.24 diopters (D) (range 1.75 to 23.25) principally from corneal flattening and a small reduction in axial length. Average postoperative spherical equivalent was −2.17 D (range +1.50 to −7.25). The average postoperative astigmatism was 3.78 D (range 1.75 to 6.00). This study and a previous retrospective study suggest that the use of grafts 0.25 mm smaller than the opening, i.e., 7.50/7.75 mm, for penetrating keratoplasty in keratoconus is justified.

Effect of penetrating keratoplasty using grafts of various sizes on keratoconic myopia and astigmatism

ABSTRACT The records of 72 consecutive keratoconic eyes undergoing penetrating keratoplasty were reviewed for changes in myopia and astigmatism. Ages of the patients averaged 32.7 years. All sutures were removed after three months. Follow‐up average was 40.2 months. Results showed an average decrease in myopia of 6.63 diopters (D) in 60 eyes (82.86%a) and an average increase in myopia of 1.88 D in 12 of 70 eyes (17.14%). The decrease/increase in myopia and postoperative astigmatism was compared for grafts equal to the opening, grafts smaller than the opening, and grafts larger than the opening. The largest average decrease in myopia was 13.86 D (range 6.63 to 20.00), which occurred when a graft smaller than the opening was used (P < .01). This group also showed the least postoperative astigmatism (2.82 D) (P < .01). From this study, it appears that the use of a graft 0.25 mm smaller than the trephine opening in the host (i.e., 7.50 mm graft/7.75 mm opening) for penetrating keratoplasty in keratoconus is justified. A prospective study is now in progress.

Pars Plana Lensectomy for Subluxated and Dislocated Lenses

Pars plana lensectomy by ultrasonic fragmentation appears to be the treatment of choice for extraction of subluxated and dislocated lenses. The closed system technique allowed extraction of 11/11 subluxated lenses without operative or postoperative complications with an average observation period of 4.5 years. The technique was employed in four traumatically dislocated lenses in eyes with accompanying traumatic pathology requiring additional surgical procedures, i.e., cryoretinopexy and scleral buckling. There were no complications in 4/4 eyes with an average observation period of 1.5 years. Pars plana lensectomy avoids many of the complications of the open-sky limbal approach i.e. anterior synechiae, vitreous incarceration, wound dehiscence, aphakic or pupillary block glaucoma, bullous keratopathy, epithelial ingrowth, stromal ingrowth or outgrowth and surgically induced astigmatism.

Subluxated (ectopic) lenses in adults : long-term results of pars plana lensectomy-vitrectomy by ultrasonic fragmentation with and without a phacoprosthesis

The long-term results of pars plana lensectomy-vitrectomy by ultrasonic fragmentation for 18 consecutive subluxated (ectopic) lenses were retrospectively reviewed. There were no serious operative or postoperative complications at the 16-year follow-up. Visual acuity of 20/15 to 20/50 was obtained in 16 (89%) of 18 eyes. Lensectomy-vitrectomy for subluxated lenses appears to be a relatively safe and effective procedure. The technique can be combined with a phacoprosthesis (intraocular lens implant) in adults.

Ligneous Conjunctivitis After Pingueculae Removal in an Adult

A 45-year-old man who had uneventful excision of bilateral pingueculae developed bilateral membranous lesions involving the bulbar conjunctivae and corneas. Histologically, the membranes were composed mainly of large fibrinous deposits intermixed with acute and chronic inflammatory cells with areas of fibroblastic and capillary proliferation resembling granulation tissue. By electron-microscopy the amorphous acidophilic masses were composed of electron-dense, fibrillar material with a periodicity of 10–12 mm, which was consistent with fibrin. Despite mechanical removal of the membranes, they continued to recur rapidly over a period of several months. The lesions apparently responded slowly to topical enzymatic therapy that consisted of hyaluronidase (175 U/ml) and α-chymotrypsin (1:5000) drops. Follow-up examination, ∼1 year after surgery, revealed that the patient was asymptomatic. Ocular examination disclosed slight persistence of gelatinous membranes on the bulbar conjunctivae, most prominent in the left eye.

Complications of the Simcoe Flexible Loop Phacoprosthesis in the Anterior Chamber

A preliminary study of the use of a Simcoe 101-J implant in the anterior chamber after pars plana lensectomy by ultrasonic fragmentation showed initially good results. Further observations of these and additional eyes showed 20/20-20/40 vision in 86.9%, retinal detachment in 3.5%, retinal hole in 1.5%, clinical cystoid maculopathy in 13%, and so-called UGH syndrome in 5%. Pars plana lensectomy alone in the last 136 eyes resulted in vision of 20/20-20/40 in 98.5%, a retinal detachment rate of 0.73%, retinal hole rate of 0.73%, no UGH syndrome, and no clinical cystoid maculopathy. Pars plana lensectomy alone appears to be a far safer procedure than pars plana lensectomy plus a Simcoe implant in the anterior chamber. Implantation of the Simcoe 101-J manufactured by IOLAB Corp. in the anterior chamber is not recommended.

Buried Quasi-integrated Enucleation Implant of Proplast II A Preliminary Report

A preliminary report of a new design for a buried quasi-integrated implant made of Proplast II (Vitek, Inc., Houston, Texas, U.S.A.) is presented. The design is intended to combine the benefits of an integrated and buried implant.