Sutureless manual extracapsular cataract extraction with posterior chamber IOL implantation

For several years, I have employed linear scleral tunnel incision for manual extracapsular cataract extraction. In selected cases, this technique proved very efficient in the sutureless closure of the cataract wound. The scleral incision is placed in the superficial half the thickness of the sclera about 2 mm behind the 12 o'clock limbus, and extended in the sclera parallel to the horizontal diameter of the cornea. The length of the incision is such that the nucleus of the cataract can be expressed through it. A scleral tunnel reaching the limits of this incision is dissected up to the clear limbal cornea. The anterior chamber is entered with a stab incision in the clear cornea under the scleral flap for anterior capsulotomy, following which the nucleus is expressed. After standard manual aspiration-irrigation for cortox removal and posterior chamber intraocular lens implanatation the anterior chamber is reformed with balanced salt solution. A small peripheral iridectomy or iridotomy is performed in all patients. If an updrawn pupil, a rare occurrence, is noticed on the first or second postoperative day, the patient is placed on pilocarpine 2% solution drops to constrict the pupil and pull the iris away from the wound. This manual sutureless technique was used in 23 patients, and in all of them it proved satisfactory and successful after months to two years of follow-up. In one patient updrawn pupil was noticed on the first postoperative day. The technique is not recommended for physically disabled, the habitual lid squeezers, diabetics, those with bleeding tendencies, the poor healers, the mentally labile, and those with chronic respiratory problems.[Pakistan Journal of Ophthalmology 10:7-10, January, 1994.]

Orbital emphysema in paternal abuse

A 71-year-old was seen with conjunctive and orbital emphysema due to orbital floor and medial wall fractures of the left eye as a results of a beating from the patient's drunken son. The patient left hospital against medical advice for fear of getting this situation exposed, and died a few days later, either from complication of the initial beating or from another beating. Ophthalmologists need to remain alert to the possibility of parental abuse in multiple or repeated injuries of the elderly. [Pakistan Journal of Ophthalmology 10:5, 17, January, 1994.]

Bulbar conjunctival granuloma following scleral buckling

A 36-year-old man developed the now rare bulbar conjuctiva granuloma nearly two years after scleral bukling procedure in his right eye. [Pakistan Journal of Ophthalmology 10:6, 17, January, 1994.]

Subhyaloid hemorrhage due to macroaneurysm of the inferior temporal retinal artery

A 68-year-old woman with bilateral cataract came in for preoperative evaluation. On ophthalmoscopic examination the interesting finding of subhyaloid hemorrhage in the left center retinal area from a macroaneurysm of the inferior temporal retinal artery was found. Paradoxically, the sight was better in this eye, perhaps because of the more advanced macular degeneration in the right eye. The patient was referred to a retinal surgeon for Nd: YAG laser hyaloidotomy and argon laser therapy of the macroaneurysm. [Pakistan Journal of Ophthalmology, Volume 10:34 and 59, April and July, 1994]

Intralenticular metallic foreign body retained for 31 years

A 40-year-old man lost his right eye when a dynamite cap blew up in his face at age of 9 sought ophthalmic care because of irritation of his left eye. On slit lamp examination through the dilated left pupil, a rusty intraolenticlar foreign body with an opacified track was noted in the upper nasal periphery of the lens. An overlying through and through corneal scar was also present. The patient had no history of any other ocular trauma. It was interesting that the patient was neither himself aware of the foreign body, nor was he ever told of it by any previous doctor. The foreign body was not creating any problem with the sight or the health of the eye. [Pakistan Journal of Ophthalmology, 10:33 and 59, April and July, 1994]

Persistent corneal abrasion from the retained beestinger in the eyelid

An 80-year-old man, a beekeeper who had over the years developed immunity to the bee venom got multiple beestings on the face. He wasn't bothered by them, but after a few days, he developed persistent corneal abrasion of the right cornea that did not respond to treatment by an emergency room physician and his family doctor. Examination of the everted right upper eyelid under a slit lamp revealed a minute black object protruding through the conjuctiva. On removal, it was found to be consistent with a beestinger lancet, which had slowly migrated inward after a beesting on the eyelid. The removal of the stinger and topical antibiotics completely cleared the condition in a few days. [Pakistan Journal of Ophthalmology, 10:32 and 58, April and July, 1994]

Postsurgical vertical hyphema

A 73-year-old woman had an uneventful extracapsular cataract extraction with posterior intraocular lens implantation on her right eye. She was advised not to sleep on her right side. On the first postoperative day, she had hyphema with clotted blood. The clot was attached to the nasal iris but had a sharp vertical papillary border. This peculiar shape of hyphema was due to the fact that during the exudation of blood from a nasally located papillary microhemangioma, the patient had sleep on her left side. This caused the blood to gravitate in the nasal half of the anterior chamber instead of the usual lower half, imparting the clotted blood a sharp vertical papillary margin and giving it the appearance of a saucer standing on its edge. A microhemangioma of the papillary margin became visible on slit lamp examination after the hypema absorbed in a few days, without any adverse consequences. [Pakistan Journal of Ophthalmology 10:75 88, October, 1994.]

Fundamentals of preparing a manuscript for publication

Other than the accuracy of data and language, a careful division of the text into well-defined sections and adherence to a few established rules in typing are important in the preparation of a medical manuscript that is intended for publication. In addition to a discussion of these fundamentals, this paper covers in detail the particulars of the title page, abstract, text, references, tables, and figure legends. The proofreading of a printer's galley and marking of corrections thereon also receive necessary comments. Tips for writing a cogent cover letter to the editor and points to be checked before the mailing of a finished manuscript conclude the article. Most essential to developing a good manuscript is the author's according it the same importance and scrutiny as he dose his scientific study. [Pakistan Journal of Ophthalmology 9: 7-13, January, 1993]

Flaxseeds for the ocular foreign bodies

A 72-year-old North American with woman placed a flaxseed under the upper lid of her right eye, in the hope that it would remove the foreign body that she thought was in her eye. It is interesting that this unusual folk remedy is considered an effective therapy for corneal and conjunctival foreign bodies by some inhabitants of the Appalachian region of the United States. The flaxseed caused extensive scratches of the cornea, the pain and photophobia from which incapacitated the patient. An intensive treatment with topical antibiotics and cycloplegia cured the patient in a few days. She agreed that she would not employ this therapy in her own or anyone else's eye again. [Pakistan Journal of Ophthalmology 9: 2, 14, January, 1993]

Congenital upper eyelid eversion and cleft palate

A male infant from Pakistan had rare association of complete cleft palate syndrome and total eversion of the left upper eyelid. Although other eyelid anomalies, such as lid colobomas, have been recorded in patients with cleft palate, we could not find a published report of its association with congenital ectropion or eversion of eyelids. [Pakistan Journal of Ophthalmology 9:32, 47, April, 1993.]

new technique of trabeculectomy with a removable suture

In trabeculectomy, the enhanced safety of the filtering procedure is imparted by its scleral flap. The excessive scarring of or inadequate seepage of the aqueous from under the same scleral flap may lead to failure of the operation. To overcome this situation, I have successfully employed in 10 patients the new technique of removable scleral flap suture. In this method, a scleral flap suture is tied with a half bowknot the fixed arm of which is cut short and the sliding arm long enough to be brought outside the conjunctiva and left there until the suture is removed by pulling on it within first five postoperative days. In one patient the suture could not be removed, probably due to its becoming caught in the local scarring. However, its exteriorized arm was pulled and cut so short as to allow its complete retraction under the conjunctive. Out of the 18 patients who had this operation, seven formed good filtration blebs without removal of the suture. This removable suture technique is a very helpful alternative where laser photolysis is unavailable or impracticable. [Pakistan Journal of Ophthalmology 9:57-59, July, 1993.]

Retropseudophakic endocapsular hemorrhage after extracapsular cataract extraction with intraocular lens implantation

On the second postoperative day following an uncomplicated extracapsular cataract extraction from her right eye, a 68-year-old women developed an unusual intraocular hemorrhage that was confined to the space between the posterior suface of the lens implant and the posterior capsule. The hemorrhage occupied the lower half of the papillary space and seriously obstructed the sight. Other than the visual symptoms the eye remained comfortable and uninflamed. The hemorrhage differed from the ordinary postoperative hyphema in that it took unusually long, four months, to spontaneously clear up. When hemorrhage cleared the posterior capsule had become opacified, the neodymium: YAG laser capsulotomy of which gave final visual acuity of 20/30 [6/9] in the involved eye. It appears that other than taking a long time to spontaneously clear up, this type of hemorrhage is not a serious complication, with a very good eventual prognosis. [Pakistan Journal of Ophthalmology 9:60, 71, July, 1993.]

Pseudo-ciliary margin after neglected long-standing orbital implant extrusion

A 73-year-old woman, a resident of a nursing home, developed slow extrusion of the orbital implant from her left socket. The left eye had been enucleated many years before, or perhaps in childhood, presumably due to trauma. Because of her deteriorating mental faculties, the patient had become extremely non-cooperative and totally oblivious to her ocular or systemic problems. Because the patient never complained about it, for years the nursing home doctors kept treating the redness of the left eye, caused by the extruding implant, as chronic conjunctivitis. Gradually, the low grade infection and discharge accumulated under the upper eyelid as a white cheesy platform which kept catching the loose eyelashes in it. The blinking motions of the eyelid brushed the caught eyelashes into a smooth row which took the shape of a pseudo-ciliary margin behind and blow the upper eyelid margin. The cleaning of the pussy discharge from the most recent flare up of conjunctival inflammation uncovered this unusual clinical situation. A closer inspection of this additional row of eyelashes and the structure to which it was attached revealed the true nature of this unique pseudo-ciliary margin. [Pakistan Journal of Ophthalmology 9:61, 72, July, 1993.]