Preoperative assessment of secondary intraocular lens implantation for aphakia: a comparison of 2 techniques.

PURPOSE: To compare the preoperative evaluation of secondary intraocular lens (IOL) implantation in aphakic adults following cataract extraction in childhood using slitlamp examination and high-frequency ultrasound (HFU). METHODS: In a prospective case series, patients who had had lensectomies for congenital cataracts without primary implantation IOL were evaluated for secondary IOL insertion. Slitlamp examination and HFU were performed to study the degree of ciliary sulcus support and iridocapsular adhesions. The choice of IOL (posterior sulcus supported or anterior chamber) was compared using the 2 techniques. RESULTS: Nine eyes of 5 patients (3 men and 2 women aged 15 to 40 years) were assessed for secondary IOL insertion. Clinical slitlamp examination suggested that 3 of 9 eyes had inadequate sulcociliary support, but HFU of these eyes revealed more than adequate capsular remnants. In all 9 eyes, sulcus-supported posterior chamber IOLs were implanted. No postoperative complications were observed, and no patients required surgery for dislocated IOL. CONCLUSIONS: High-frequency ultrasound is a useful adjunct for the preoperative assessment of secondary ciliary sulcus-supported IOL implantation in aphakic patients who had congenital cataract extraction without IOL implantation. In patients in whom inadequate dilation precludes the detection of capsular support, posterior ciliary sulcus-supported secondary IOL implantation should be considered preoperatively. Although the technique enhances surgical planning and informed patient consent, the final decision occurs at the time of surgery with direct visualization of the ciliary sulcus support.

In malignant choroidal melanoma will a delay in radical treatment influence prognosis?

In a series of 568 patients with choroidal malignant melanoma some 36 were found to have a history of at least 4 years prior to enucleation. Of these, 20 had actually been observed for a period of 3 years or more before such treatment was deemed necessary. Computer analysis of a series of risk factors and their effect on prognosis showed that there was no worsening of mortality as compared to the series as a whole and further that the post enucleation peak of mortality was the same in this small group as in the whole series.

Local recurrence of choroidal malignant melanoma following enucleation.

542 cases of choroidal malignant melanoma were reviewed. Local recurrence occurred in only 6 patients (1.11%). Five of the 6 patients had distant metastases when the local recurrence was diagnosed, and the remaining patient also developed metastases after a passage of time. These figures do not support the concept of withholding a primary implant at the time of enucleation.

Poly-HEMA as a material for intraocular lens implantation: a preliminary report.

A soft material (poly-HEMA) has been implanted into a number of rabbit eyes in order to evaluate its use in lens implantation following cataract surgery. No reaction to the implant was seen on light microscopy of the sectioned enucleated eyes.

Choroidal neurilemmoma--an unusual clinical misdiagnosis.

A case of choroidal neurilemmoma is reported. After a period of clinical observation which included serial fundus photography and fluorescein angiography, during which time active growth was seen, the tumour was thought to be a malignant melanoma, and enucleation was considered the treatment of choice. Subsequent histological study revealed a neurilemmoma. Important points relating to the clinical diagnosis of lesions presenting in this way are discussed.

Pattern of mortality in choroidal malignant melanoma.

A large series of cases of malignant choroidal melanoma has been reviewed. Certain risk factors have been related to prognosis by means of actuarial life tables. With information from these tables to calculate mortality rates graphs were drawn for various risk factors to demonstrate the differing pattern in tumours of varying size, degree of pigment, position of anterior border, etc. Further, a discriminant analysis was carried out in relation to differing cell types of tumour. It was concluded that tumour size overall was most important for assessing prognosis, and for small tumours the type of treatment seems not to influence survival. The presence of an early mortality peak is found, as suggested in other series, but a second peak is also present. A possible cause of this later peak is suggested.