Adjunctive chemotherapy with Mitomycin C (MMC) has been used in an attempt to modulate the wound healing response in glaucoma filtration surgery. A consecutive series of 20 eyes from 18 patients undergoing trabeculectomy with MMC intraoperatively was studied. Sixteen cases were considered high risk regarding surgical success and 4 patients with low tension glaucoma (LTG) required lower intraocular pressure (IOP) to prevent further visual field loss. Surgical technique involved the use of a limbal-based conjunctival flap and MMC 0.2 mg/ml applied via a sponge (under the scleral flap) to both scleral and conjunctival surfaces for 5 minutes. The mean follow-up period was 12.7 months (range 3-24). There were 17 successful eyes. Of these, 14 are high pressure glaucoma eyes with a mean pre-operative IOP of 30.9 +/- 10.9 mmHg and a mean postoperative IOP of 15.3 +/- 5.2 mmHg (p = 0.001). The remainder of the successful cases include 4 patients with LTG with a mean preoperative IOP of 17.8 +/- 0.5 mmHg and a mean postoperative IOP of 6.8 +/- 0.7 mmHg (p = 0.001). Serious complications included chronic repeated bleb leaks (n = 2) and scleral necrosis (n = 2). There was one case of hypotonous maculopathy. These results are comparable with those of other studies. Despite a relatively low dose of MMC serious side-effects were encountered. Management of these complications is described, and how these effects may be prevented by altering scleral exposure to MMC. In addition a possible explanation for the serious side-effects of MMC-treated trabeculectomies is presented.

Over a 12 month period, we used the anterior chamber maintainer (ACM) in cataract surgery in 258 patients; ages ranged from 15 to 95 years (mean 73 years). Surgery was performed using general or local anesthesia. The procedures were standard extracapsular cataract extraction (ECCE), mini-nuc ECCE, vectis extraction of the endonucleus, manual phacofragmentation, phacoemulsification, phacotrabeculectomy, repositioning the IOL, and anterior segment revision. We recorded our subjective assessment of the degree of anterior chamber (AC) maintenance and control of the position of the posterior capsule during surgery. We also kept clinical notes of the practical aspects of the procedures. The AC was well maintained in all patients throughout the surgery; posterior position of the posterior capsule was maintained during irrigation/aspiration. Five patients required the use of a viscoelastic agent at some stage. Our subjective assessment is that use of the ACM increased surgical control of the anterior chamber depth and position of the posterior capsule during surgery. Provided that it is used correctly, the ACM may offer increased safety during anterior segment surgery and require less use of viscoelastic agents.

Aims-To assess the eYcacy of extracapsular cataract surgery using the anterior chamber maintainer (ACM) without the use of viscoelastic. To compare the eVects of this surgical technique on non-diabetic and diabetic patients. Methods-A prospective single armed clinical trial of 46 eyes in 46 patients undergoing cataract surgery using the ACM without viscoelastic. Patients were assessed preoperatively and at 3 weeks, 3 months, and 12 months postoperatively. The main outcome variables included visual acuity, surgically induced astigmatic change (SIAC), changes in endothelial cell density (ECD), and morphology aVecting the central and superior regions of the cornea. Results-Postoperatively, 56% and 70% of patients had unaided visual acuities of 6/12 or better at 3 weeks and 3 months respectively. Even after excluding those patients with pre-existing maculopathy (including diabetic maculopathy), there remains a significant diVerence between the nondiabetic and diabetic groups in terms of the proportion of patients attaining an unaided visual acuity of 6/12 or better at both 3 weeks (p=0.003) and 3 months (p=0.001). Three months postoperatively, the SIAC based upon the keratometric and refractive data was 1.1 dioptres (D) and 1.3 D respectively. There was no statistically significant diVerence in the SIAC when the non-diabetic and diabetic groups were compared. The mean central and superior endothelial cell losses at 3 months postoperatively were 16% and 22% respectively and at 12 months postoperatively were 20% and 25% respectively. The diabetic group demonstrated greater endothelial cell losses and a more marked and protracted deviation of endothelial cell morphology from normality when compared with the non-diabetic group; however, the diVerences did not reach statistical significance. Conclusions-The eYcacy of small incision cataract surgery using the ACM in terms of visual outcome and induced astigmatism is comparable with the results obtained using other techniques that utilise a similar size of incision. However, in view of the magnitude and range of the endothelial cell losses associated with this technique the concurrent use of viscoelastic is suggested. There does not appear to be a statistically or clinically significant diVerence between non-diabetic and diabetic patients in terms of the magnitude of the endothelial cell losses or in the wound healing response in the 12 months after cataract surgery using the ACM. (Br J Ophthalmol 1999;83:71-75)

Residual perfluorodecalin can induce an intraocular chronic macrophage response.

The use of intravitreal air in the treatment of retinal detachment was described by Rosengren (1938, I951), and Norton, Aaberg, Fung, and Curtin (I969) applied this technique to the treatment of giant tears. The method described in this paper differs from that of Rosengren in several features.A series of forty patients is divided into two broad groups:(A) Those appearing de novo at the Outpatient Department and undergoing a first operation for retinal detachment.(B) Relapsed detachments following some other previous operative technique. Eight aphakic patients previously described in detail (Chawla, I973) are included.The method described is used in all cases in which tears lie superiorly between the 8 and 4 o'clock meridians. If additional inferior tears exist, some other manoeuvre must be included. Method EXAMINATIONThe patient is admitted to the ward, and examination is undertaken with the binocular indirect ophthalmoscope. The periphery of both eyes is examined using transpalpebral indentation of the sclera; no local anaesthetic drops are instilled into the conjunctival sac. The patients are not compelled to rest in bed unless a functioning macula is in imminent danger of detachment. Double padding is never used.Slit-lamp examination is essential to determine the state of the vitreous. If narrow anterior chamber angles are suspected, gonioscopy is performed.In the preoperative state, a large amount of subretinal fluid is an advantage for two reasons:(i) Subretinal fluid can be released with greater safety. (2) Removal of fluid at operation makes way for the requisite I to 3 ml. air to be injected. Thus rest in bed may be unhelpful. OPERATIONThe patient is operated upon as soon as possible under general anaesthesia. A 360°limbal conjunctival incision is made and the rectus muscles are secured with 5/o silk stay sutures. The sclera is examined; any thinning and the position of the vortex veins are noted.Cryopexy to the areas of tear(s) is performed; the monitoring of each application prevents overfreezing. The onset of iceball formation is clearly seen. The cryoprobe must not be removed from the sclera until it has defrosted, thus avoiding scleral cracking (Shea, I969) and rupture of vortex veins during posterior applications.