Diplopia and ptosis following injection of local anesthesia without hyaluronidase.

In a university ophthalmology department, a cluster of postoperative diplopia and ptosis cases occurred in the initial 3 months after hyaluronidase (Wydase) became unavailable for use with injection anesthesia. These cases suggest that hyaluronidase, when used with injection anesthesia, may protect extraocular muscles and nerves from the toxic effects of local anesthetic agents. The spreading action of hyaluronidase facilitates uniform diffusion of anesthetic agents. This prevents elevated extracellular tissue pressure, a cause of ischemic damage to extraocular muscles or nerves. Hyaluronidase may also prevent focal accumulations and concentrations of local anesthetic agents, which at high enough levels may cause myotoxic or neurotoxic damage, fibrosis, and contracture of extraocular muscles or nerves.

Initial experience with the MONARCH IOL delivery system for insertion of the 5.5 mm. ACRYSOF intraocular lens.

This paper reports the initial 100 clinical cases with the MONARCH IOL Delivery System ("the Monarch") for insertion of a 5.5 mm ACRYSOF foldable intraocular lens (IOL) into the capsular bag following small incision cataract surgery by phacoemulsification. There were no cases of capsular tears, vitreous loss, IOL dislocation or decentration or placement outside the capsular bag. There was one case of haptic entrapment within the cartridge requiring use of a second IOL and cartridge. There was one case in which the surgeon placed the IOL in the wrong anterior-posterior direction requiring a 180 degree re-orientation. The MONARCH IOL Delivery System is extremely convenient, reliable and is highly recommended.

Clinical comparison of the Alcon 20,000 Legacy and 10,000 Master phacoemulsification units.

PURPOSE: To determine whether the use of the Alcon 20,000 Legacy phacoemulsification unit requires less phacoemulsification time and causes fewer intraoperative complications than the Alcon 10,000 Master unit. SETTING: Private practices in Kansas City, Missouri, and Marshalltown, Iowa, USA. METHODS: This prospective study comprised 400 consecutive cases of phacoemulsification with intraocular lens (IOL) implantation performed using the Alcon 20,000 Legacy unit by a high-volume phacoemulsification surgeon (n = 200) and a moderate-volume surgeon (n = 200). Data included age, phacoemulsification time, and surgical complications. The control study was a retrospective review of the same data from the previous 200 cases done by each surgeon with the Alcon 10,000 Master unit. RESULTS: In the combined series of 400 cases done with the 10,000 Master unit, mean age was 72.7 years and mean phacoemulsification (i.e., ultrasound) time, 1.97 minutes. There were 2 cases (0.50%) of vitreous loss and 3 cases (0.75%) of posterior capsule tear without vitreous loss. The total complication rate for both surgeons was 1.25% with the 10,000 Master. In the combined series of 400 cases done with the 20,000 Legacy unit, mean age was 72.5 years and mean phacoemulsification time, 1.50 minutes. There were no cases of vitreous loss and 1 case (0.25%) of posterior capsule tear without vitreous loss. The total complication rate for both surgeons was 0.25% with the 20,000 Legacy. The difference in complication rates between the two machines was not significant. Phacoemulsification time with the 20,000 Legacy unit was significantly less than with the 10,000 Master unit for both surgeons (P < or = .001 and .05, respectively). CONCLUSION: The Alcon series 20,000 Legacy unit proved to be a safe, reliable, and highly effective instrument for modern cataract extraction and IOL implantation that required significantly less phacoemulsification time than the 10,000 Master unit.