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I continue to do intracapsular cataract surgery under general anaesthesia and use a standardized surgical plan evolved over a period of 12 years with a 4-loop Rayner-Binkhorst lens, because: Results do not justify change. The incidence of ECD, CMO and RD is low. Re-operation is seldom needed. No alternative choice seems valid. Modifications are too frequent. Results are claimed on very short experience. Intracapsular surgery gives a higher proportion of 6/5 visual acuity. I mistrust commercial pressures.

Once accurate corneo-scleral repair has become the rule, the management of associated iris and lens damage can be improved. Much more effective primary surgical repair has been established with the aim of preventing complications and the extra hazards of a difficult secondary procedure. Adequate examination of the injured eye is essential. Much may be obscured at the initial examination. There should be no hesitation in dilating the pupil as this will permit a more satisfactory assessment of the extent of damage behind the iris diaphragm. Before commencing surgery, it must be established whether the lens is damaged or not. Hypotony and fibrin on the lens surface can both cause an appearance suggestive of cataract. Lens surgery is needed at the primary repair only when the capsule is torn.

There has been much interest in the value of sodium hyaluronate during cataract surgery. It may have even greater advantage in the management of severe ocular trauma, offering safety margins not otherwise available. This discussion of the use of visco elastic materials in the surgery of ocular trauma is limited to experience with sodium hyaluronate. Reports of results with other products are centred on their advantages for intra-ocular lens surgery.

Excellent results are obtainable with well-proved lenses. For those using intracapsular methods, I can give assurance that it is not necessary to change in order to use intraocular lenses safely. The prerequisites are an established safe technique for routine cataract surgery with good visual results. Proper wound closure should be demonstrated by an absence of cases of shallow or absent anterior chamber, of iris prolapse, or postoperative hyphaema. No intraocular lens of any kind should be used unless the quality of routine cataract surgery is high in these respects as well as in avoiding damage to the corneal endothelium. The choice of intraocular lens should be one which can be applied to the surgeon's well-established method and it should also be a well-established lens which has a safe long-term record.

Twenty-five patients with Binkhorst 4-loop intraocular lenses were studied to assess the ease of visualization of their fundi, and the feasibility of treating diabetic retinopathy. All patients had fulfilled several pre-operative selection criteria. Visualization with the direct ophthalmoscope and posterior pole contact lens was good in most cases through undilated pupils. Documentation of fundus abnormalities by fundus photography and fluorescein angiography was possible only if the pupils were dilated. Retinal photocoagulation with argon laser could be carried out through the intraocular lenses in all patients requiring treatment. Iris clip lenses should not be regarded as contraindicated in selected diabetic patients.