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decreased visual acuity in the left eye for several months. Examination disclosed visual acuity of R.R.: 6/15+ (20/50+) and L.E.: light perception. Results of external examination were unremarkable. Motility was within normal limits. Pupils dilated to 6 mm in both eyes. Slit-lamp examination disclosed minimal nasal band keratopathy, minimal cortical cataracts, and posterior vitreous detachment in both eyes. The vitreous flow time in the left eye was markedly reduced. Tension by applanation was 20 mm Hg in both eyes. Retinal examination of the right eye disclosed lattice degeneration inferiorly. The left eye revealed a total rhegmatogenous retinal detachment. A horseshoe retinal break was noted superiorly. Multiple white cascading folds indica tive of massive periretinal proliferation were seen. The surgery consisted of 360-degree cryotherapy, the drainage of subretinal fluid, and scleral buckling with a 4-mm silicone band. The band was cut so that its length was equal to the circumference of the undrained globe. After drainage, the ends of the band were overlapped 22 mm in an attempt to create a high 360-degree buckle. The posterior margin of the band was 16 mm posterior to the corneoscleral limbus and just anterior to the exit of the vortex veins. The patient's postoperative course was com plicated by moderate choroidal detachment, but this resolved within three weeks. One month after sur gery, the retina was completely reattached but mas sive subretinal exudation was noted. It was yellow in color and appeared in all four quadrants. Visual field examination did not reveal any impairment of peripheral vision caused by the subretinal exuda tion. Fluorescein angiography and angioscopy did not show any areas of retinal telangectasis or incom petence of the retinal vessels. In the ensuing months, the subretinal exudate underwent gradual resolution. By the sixth month after surgery, most of the subretinal exudate was reabsorbed. DISCUSSION
Massive subretinal exudation is a com plication of successful retinal reattachment surgery. The absence of significant fluorescein leakage or visible areas of retinal telangiectasis make a retinal source of the subretinal exudate unlikely. Large areas of cryotherapy, the hypotony during drainage of subretinal fluid, a high encircling scleral buckle, and postopera tive choroidal detachment make a choroi dal source of the subretinal exudate more likely. We believe the cause of the choroi dal detachment and exudation was vortex ampulla obstruction resulting from the encircling band. 4 ' 5 The subretinal exu date underwent gradual resolution and did not influence the anatomic result of the surgical procedure.
SUMMARY
A 70-year-old woman developed mas sive subretinal exudation after surgical repair of a rhegmatogenous retinal de tachment. Postoperative choroidal de tachment suggested a choroidal source of the subretinal exudate. We believe the cause of the choroidal detachment and exudation was vortex ampulla obstruction resulting from the encircling band. The subretinal exudate underwent gradual resolution and did not influence the ana tomic result of retinal reattachment. REFERENCES 1. Coats, G.: Forms of retinal disease with mas sive exudation. Roy. London Ophthal. Hosp. Rep. 17: 440, 1908. 2. Blair, C. J., and Aaberg, T. M.: Massive subret inal exudation associated with senile macular de generation. Am. J. Ophthalmol. 71:639, 1971. 3. Aaberg. T. M., and Pawlowski, G. J.: Exuda tive retinal detachments following scleral buckling with cryotherapy. Am. J. Ophthalmol. 74:245,1972. 4. Aaberg, T. M.: Experimental serous and hemorrhagic uveal edema associated with retinal detach ment surgery. Invest. Ophthalmol. 14:243, 1975. 5. Hayreh, S. S., and Baines, J. A. B.: Occlusion of the vortex veins. Br. J. Ophthalmol. 57:217,1973.
A WIREFORM SURGICAL DRAPE-RETRACTOR H E R B E R T J. N E V Y A S , Philadelphia,
M.D.
Pennsylvania
The presence of surgical drapes cover ing the nose and mouth can cause the patient to feel suffocation. Although this sensation is mainly psychological, it can cause the patient to become dyspneic, anxious, and restless. Patient discomfort is compounded by the moist warmth re tained by the newer waterproof plastic drapes. From the Department of Ophthalmology, Uni versity of Pennsylvania School of Medicine and the Scheie Eye Institute, Philadelphia, Pennsylva nia. Reprint requests to Herbert J. Nevyas, M.D., 1930 Chestnut St., Philadelphia, PA 19103.
124
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JULY, 1979
patient comfort during surgery by keep ing drapes off the nose and mouth. It is small and does not interfere with the surgeon's hand movements.
A R E T E N T I O N MODIFICATION FOR T H E LIMBAL RING M E T H O D O F F O R E I G N BODY LOCALIZATION Fig. 1 (Nevyas). Wireform drape-retractor.
M. B E L K I N , Jerusalem,
I devised a simple, face-fitting mallea ble plastic-coated metal wireform draperetractor* to keep drapes off the patient's nose and mouth (Figs. 1 and 2). It can be rebent easily to conform to each patient's facial contours. This device is secured to the patient by two pieces of adhesive tape placed on each end of it, and keeps an air pocket open over the patient's nose and lower face regardless of head position. It protrudes only slightly beyond the tip of the nose and does not interfere with the surgeon's manipulations. SUMMARY
I devised a malleable plastic-coated wireform drape-retractor that increases *Manufactured by Diversatronics, Inc., 456 Park way, Broomall, PA 19008.
Fig. 2 (Nevyas). The drape-retractor in position before draping.
M.D. Israel
Two principal methods are available for radiologic localization of intraocular foreign bodies: the geometric construc tion method of Sweet 1 ' 2 and the limbal ring method, with the ring either incorpo rated in a contact lens 3 or sutured to the corneoscleral limbus. 4 Sweet's method provides only lateral views of the orbit, requires expert technicians and full coop eration of the patient, and takes a long time to complete. Therefore, this tech nique is not always practical, especially when the surgeon is faced with many multiple-injury patients. Comberg's contact lens method is equally reliable, 5 simpler, less timeconsuming, and it requires less patient cooperation. The use of a contact lens, however, especially the low vacuum types, 6 is contraindicated in severely trau matized eyes. Suturing of the ring of the conjunctiva is disagreeable to the pa tient, time-consuming, and requires a sur geon. Our wartime experience in treating many freshly injured eyes containing intraocular foreign bodies led us to seek a way of simplifying the procedure. Essentially, we use the limbal ring From the Rothschild Hadassah University Hospi tal, Jerusalem, Israel. Reprint requests to M. Belkin, M.D., Rothschild Hadassah University Hospital, Kiryat Hadassah, Je rusalem, Israel.
123
NOTES, CASES, INSTRUMENTS
decreased visual acuity in the left eye for several months. Examination disclosed visual acuity of R.R.: 6/15+ (20/50+) and L.E.: light perception. Results of external examination were unremarkable. Motility was within normal limits. Pupils dilated to 6 mm in both eyes. Slit-lamp examination disclosed minimal nasal band keratopathy, minimal cortical cataracts, and posterior vitreous detachment in both eyes. The vitreous flow time in the left eye was markedly reduced. Tension by applanation was 20 mm Hg in both eyes. Retinal examination of the right eye disclosed lattice degeneration inferiorly. The left eye revealed a total rhegmatogenous retinal detachment. A horseshoe retinal break was noted superiorly. Multiple white cascading folds indica tive of massive periretinal proliferation were seen. The surgery consisted of 360-degree cryotherapy, the drainage of subretinal fluid, and scleral buckling with a 4-mm silicone band. The band was cut so that its length was equal to the circumference of the undrained globe. After drainage, the ends of the band were overlapped 22 mm in an attempt to create a high 360-degree buckle. The posterior margin of the band was 16 mm posterior to the corneoscleral limbus and just anterior to the exit of the vortex veins. The patient's postoperative course was com plicated by moderate choroidal detachment, but this resolved within three weeks. One month after sur gery, the retina was completely reattached but mas sive subretinal exudation was noted. It was yellow in color and appeared in all four quadrants. Visual field examination did not reveal any impairment of peripheral vision caused by the subretinal exuda tion. Fluorescein angiography and angioscopy did not show any areas of retinal telangectasis or incom petence of the retinal vessels. In the ensuing months, the subretinal exudate underwent gradual resolution. By the sixth month after surgery, most of the subretinal exudate was reabsorbed. DISCUSSION
Massive subretinal exudation is a com plication of successful retinal reattachment surgery. The absence of significant fluorescein leakage or visible areas of retinal telangiectasis make a retinal source of the subretinal exudate unlikely. Large areas of cryotherapy, the hypotony during drainage of subretinal fluid, a high encircling scleral buckle, and postopera tive choroidal detachment make a choroi dal source of the subretinal exudate more likely. We believe the cause of the choroi dal detachment and exudation was vortex ampulla obstruction resulting from the encircling band. 4 ' 5 The subretinal exu date underwent gradual resolution and did not influence the anatomic result of the surgical procedure.
SUMMARY
A 70-year-old woman developed mas sive subretinal exudation after surgical repair of a rhegmatogenous retinal de tachment. Postoperative choroidal de tachment suggested a choroidal source of the subretinal exudate. We believe the cause of the choroidal detachment and exudation was vortex ampulla obstruction resulting from the encircling band. The subretinal exudate underwent gradual resolution and did not influence the ana tomic result of retinal reattachment. REFERENCES 1. Coats, G.: Forms of retinal disease with mas sive exudation. Roy. London Ophthal. Hosp. Rep. 17: 440, 1908. 2. Blair, C. J., and Aaberg, T. M.: Massive subret inal exudation associated with senile macular de generation. Am. J. Ophthalmol. 71:639, 1971. 3. Aaberg. T. M., and Pawlowski, G. J.: Exuda tive retinal detachments following scleral buckling with cryotherapy. Am. J. Ophthalmol. 74:245,1972. 4. Aaberg, T. M.: Experimental serous and hemorrhagic uveal edema associated with retinal detach ment surgery. Invest. Ophthalmol. 14:243, 1975. 5. Hayreh, S. S., and Baines, J. A. B.: Occlusion of the vortex veins. Br. J. Ophthalmol. 57:217,1973.
A WIREFORM SURGICAL DRAPE-RETRACTOR H E R B E R T J. N E V Y A S , Philadelphia,
M.D.
Pennsylvania
The presence of surgical drapes cover ing the nose and mouth can cause the patient to feel suffocation. Although this sensation is mainly psychological, it can cause the patient to become dyspneic, anxious, and restless. Patient discomfort is compounded by the moist warmth re tained by the newer waterproof plastic drapes. From the Department of Ophthalmology, Uni versity of Pennsylvania School of Medicine and the Scheie Eye Institute, Philadelphia, Pennsylva nia. Reprint requests to Herbert J. Nevyas, M.D., 1930 Chestnut St., Philadelphia, PA 19103.
124
AMERICAN JOURNAL OF OPHTHALMOLOGY
JULY, 1979
patient comfort during surgery by keep ing drapes off the nose and mouth. It is small and does not interfere with the surgeon's hand movements.
A R E T E N T I O N MODIFICATION FOR T H E LIMBAL RING M E T H O D O F F O R E I G N BODY LOCALIZATION Fig. 1 (Nevyas). Wireform drape-retractor.
M. B E L K I N , Jerusalem,
I devised a simple, face-fitting mallea ble plastic-coated metal wireform draperetractor* to keep drapes off the patient's nose and mouth (Figs. 1 and 2). It can be rebent easily to conform to each patient's facial contours. This device is secured to the patient by two pieces of adhesive tape placed on each end of it, and keeps an air pocket open over the patient's nose and lower face regardless of head position. It protrudes only slightly beyond the tip of the nose and does not interfere with the surgeon's manipulations. SUMMARY
I devised a malleable plastic-coated wireform drape-retractor that increases *Manufactured by Diversatronics, Inc., 456 Park way, Broomall, PA 19008.
Fig. 2 (Nevyas). The drape-retractor in position before draping.
M.D. Israel
Two principal methods are available for radiologic localization of intraocular foreign bodies: the geometric construc tion method of Sweet 1 ' 2 and the limbal ring method, with the ring either incorpo rated in a contact lens 3 or sutured to the corneoscleral limbus. 4 Sweet's method provides only lateral views of the orbit, requires expert technicians and full coop eration of the patient, and takes a long time to complete. Therefore, this tech nique is not always practical, especially when the surgeon is faced with many multiple-injury patients. Comberg's contact lens method is equally reliable, 5 simpler, less timeconsuming, and it requires less patient cooperation. The use of a contact lens, however, especially the low vacuum types, 6 is contraindicated in severely trau matized eyes. Suturing of the ring of the conjunctiva is disagreeable to the pa tient, time-consuming, and requires a sur geon. Our wartime experience in treating many freshly injured eyes containing intraocular foreign bodies led us to seek a way of simplifying the procedure. Essentially, we use the limbal ring From the Rothschild Hadassah University Hospi tal, Jerusalem, Israel. Reprint requests to M. Belkin, M.D., Rothschild Hadassah University Hospital, Kiryat Hadassah, Je rusalem, Israel.
