In Reply.\p=m-\In preparing our article, we performed a computerized literature search of English and foreign language ophthalmology journals using several search strategies. None of them revealed the two articles cited by Nishi et al. We are all describing the same entity. We believe Thomas and co-authors, Nishi et al, and McManus are incorrect in referring to blood confined to the capsular bag as a "hyphema." Hyphema refers to blood in the anterior chamber. We believe the more precise term is the one we used: endocapsular hematoma. Posterior capsular neovascularization due to rubeosis iridis can be added to the causes of blood within the capsular bag. It should be easily distinguishable from the cases we described. The association of glaucoma with endocapsular hematoma in some of the reported cases invites conjecture. Definite conclusions cannot be made with such a small number of cases. We do not believe that postoperative hypotony or preoperative clotting problems are important predisposing factors. "Posterior capsule blood staining" is most likely not a sepa¬ rate entity. The appearance Balyeat describes is a function of the amount of blood located between the anterior surface of the posterior capsule and the posterior surface of the implant optic, the pressure it is subjected to, and different absorptive properties of the posterior capsule. Our patient 3 now has a blood-stained appearance of the posterior capsule although vision remains excellent. The two cases reported by Balyeat are informative since they occurred after phacoemulsification, biconvex posterior chamber intraocular lens implantation, and small incision closure. Endocapsular hematoma is described in a new text¬ book1 on advanced phacoemulsification. Endocapsular hema¬ tomas can occur with both planned extracapsular surgery and phacoemulsification and with planoconvex and biconvex pos¬ terior chamber intraocular lenses. Lens type and method of surgical removal of the cataract may not be critical factors. Besides these cases, we have received anecdotal reports about endocapsular hematomas from other ophthalmologists. We believe that the entity is not, as Thomas and coauthors, Nishi et al, and McManus say, a "rarity." We appreciate the comments and contributions of Nishi et al, McManus, and Balyeat toward a better understanding of endocapsular hematoma. John C. Hagan III, MD Douglas E. Gaasterland, MD North Kansas City, Mo
Rose Bengal dye becomes trapped in enamel pits and enhances their recognition in an adult patient with tuberous sclerosis. The pits may vary greatly in size. Some are labeled with arrows.
ing used by Mlynarczyk in patients he examined is well known to dentists, as it is commonly used to help identify the pres¬ ence of dental plaque (dental plaque-disclosing solution). Since ophthalmologists are not likely to have this solution in their offices, Rose Bengal ophthalmic strips (Barnes-Hind Pharmaceuticals Ine, Sunnyvale, Calif) are commonly avail¬ able in ophthalmologists' offices, and can be used in place of the dental plaque-disclosing solution. After drying the labial surfaces of the premolar teeth with a cotton-tipped applica¬ tor, a moistened Rose Bengal strip is applied to the labial surfaces of the teeth. Any excess dye is then removed with a cotton-tipped applicator, and the teeth can be examined grossly or with the aid of the slit-lamp biomicroscope. The colored pits will contrast dramatically with the white enamel (Figure). Like hypomelanotic macules and shagreen patches of the skin, pits of the dental enamel represent criteria sug¬ gestive of the diagnosis of tuberous sclerosis. Dennis M. Robertson, MD Rochester, Minn
This research was supported in part by funds from Research to Prevent Blindness, New York, NY. Reprint requests to the Mayo Clinic, 200 First St SW, Rochester, MN 55905
1. Davison JA. IOL Insertion and Wound Closure. In: Koch PS, Davison JA, eds. Textbook of Advanced Phacoemulsif\l=i"\cation.Thorofare, NJ: Slack Inc; 1991:379.
(Dr Robertson).
Dental Enamel Pits in Tuberous Sclerosis
1. Mlynarczyk G. Enamel pitting: a common sign of tuberous sclerosis. Ann N Y Acad Sci. 1991;315:17-25. 2. Caballero LR, de Robles JL, CaballeroCR, Yus SE, Moro HB. Tooth pits: an early sign of tuberous sclerosis: short reports. Acta Derm Venereol
To the Editor. \p=m-\Ata symposium of tuberous sclerosis and allied disorders, held under the auspices of the New York Academy of Sciences in April 1990, dental enamel pitting was reported to occur in 100% of 29 consecutively examined adult patients with tuberous sclerosis, in 76% (16) of 21 consecutively examined children, and in 8% of a control group of 250 patients without tuberous sclerosis.1 See also p 410.
Although an association between enamel pitting and tubersclerosis has been reported previously,2,3 the incidence of pit recognition in patients with tuberous sclerosis has never been reported to approach 100%. Mlynarczyk1 attributed the high incidence of enamel pitting in patients with tuberous sclerosis to the use of a red food coloring that, when applied to the labial surfaces of the premolar teeth, becomes trapped in the pits, and thus, enhances their recognition. The food colorous
The author has no commercial or proprietary interest in the Rose Bengal ophthalmic strips or Barnes-Hind Pharmaceuticals Inc.
(Stockh). 1987;67:457-459.
3. Lygidakis NA, Lindenbaum RH. Pitted enamel hypoplasia in tuberous sclerosis patients and first-degree relatives. Clin Genet. 1987;32:216-221.
Discoloration of Silicone Intraocular Lenses To the Editor. \p=m-\Milauskas1 recently reported the presence of brown discoloration in 15 silicone intraocular lenses implanted between March 1986 and December 1989. The lens manufacturers were IOLAB Corp, Claremont, Calif, and STAAR Surgical Co, Monrovia, Calif. We have been following up two patients with brown discoloration of the central region of their Allergan Medical Optics SI18NB lens. Report of Cases. \p=m-\Case1. \p=m-\A40-year-old white man was referred to one of us (D.D.K.) with a diagnosis of probable steroid-related cataracts. He had Churge-Strauss syndrome with pulmonary, cardiac, peripheral nervous system, and testicular involvement. On March 20, 1991, we performed phacoemulsification of the left eye with
Downloaded From: http://archopht.jamanetwork.com/ by a University of British Columbia Library User on 06/19/2015
Rose Bengal dye becomes trapped in enamel pits and enhances their recognition in an adult patient with tuberous sclerosis. The pits may vary greatly in size. Some are labeled with arrows.
ing used by Mlynarczyk in patients he examined is well known to dentists, as it is commonly used to help identify the pres¬ ence of dental plaque (dental plaque-disclosing solution). Since ophthalmologists are not likely to have this solution in their offices, Rose Bengal ophthalmic strips (Barnes-Hind Pharmaceuticals Ine, Sunnyvale, Calif) are commonly avail¬ able in ophthalmologists' offices, and can be used in place of the dental plaque-disclosing solution. After drying the labial surfaces of the premolar teeth with a cotton-tipped applica¬ tor, a moistened Rose Bengal strip is applied to the labial surfaces of the teeth. Any excess dye is then removed with a cotton-tipped applicator, and the teeth can be examined grossly or with the aid of the slit-lamp biomicroscope. The colored pits will contrast dramatically with the white enamel (Figure). Like hypomelanotic macules and shagreen patches of the skin, pits of the dental enamel represent criteria sug¬ gestive of the diagnosis of tuberous sclerosis. Dennis M. Robertson, MD Rochester, Minn
This research was supported in part by funds from Research to Prevent Blindness, New York, NY. Reprint requests to the Mayo Clinic, 200 First St SW, Rochester, MN 55905
1. Davison JA. IOL Insertion and Wound Closure. In: Koch PS, Davison JA, eds. Textbook of Advanced Phacoemulsif\l=i"\cation.Thorofare, NJ: Slack Inc; 1991:379.
(Dr Robertson).
Dental Enamel Pits in Tuberous Sclerosis
1. Mlynarczyk G. Enamel pitting: a common sign of tuberous sclerosis. Ann N Y Acad Sci. 1991;315:17-25. 2. Caballero LR, de Robles JL, CaballeroCR, Yus SE, Moro HB. Tooth pits: an early sign of tuberous sclerosis: short reports. Acta Derm Venereol
To the Editor. \p=m-\Ata symposium of tuberous sclerosis and allied disorders, held under the auspices of the New York Academy of Sciences in April 1990, dental enamel pitting was reported to occur in 100% of 29 consecutively examined adult patients with tuberous sclerosis, in 76% (16) of 21 consecutively examined children, and in 8% of a control group of 250 patients without tuberous sclerosis.1 See also p 410.
Although an association between enamel pitting and tubersclerosis has been reported previously,2,3 the incidence of pit recognition in patients with tuberous sclerosis has never been reported to approach 100%. Mlynarczyk1 attributed the high incidence of enamel pitting in patients with tuberous sclerosis to the use of a red food coloring that, when applied to the labial surfaces of the premolar teeth, becomes trapped in the pits, and thus, enhances their recognition. The food colorous
The author has no commercial or proprietary interest in the Rose Bengal ophthalmic strips or Barnes-Hind Pharmaceuticals Inc.
(Stockh). 1987;67:457-459.
3. Lygidakis NA, Lindenbaum RH. Pitted enamel hypoplasia in tuberous sclerosis patients and first-degree relatives. Clin Genet. 1987;32:216-221.
Discoloration of Silicone Intraocular Lenses To the Editor. \p=m-\Milauskas1 recently reported the presence of brown discoloration in 15 silicone intraocular lenses implanted between March 1986 and December 1989. The lens manufacturers were IOLAB Corp, Claremont, Calif, and STAAR Surgical Co, Monrovia, Calif. We have been following up two patients with brown discoloration of the central region of their Allergan Medical Optics SI18NB lens. Report of Cases. \p=m-\Case1. \p=m-\A40-year-old white man was referred to one of us (D.D.K.) with a diagnosis of probable steroid-related cataracts. He had Churge-Strauss syndrome with pulmonary, cardiac, peripheral nervous system, and testicular involvement. On March 20, 1991, we performed phacoemulsification of the left eye with
Downloaded From: http://archopht.jamanetwork.com/ by a University of British Columbia Library User on 06/19/2015
