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Purpose: To compare the self-sealing ability of temporal clear corneal incisions for phacoemulsification using conventional stromal hydration (CH) with two modified methods: the anterior stromal pocket hydration (ASPH) and the modified stromal pocket hydration (MASH). Methods: Patients undergoing routine phacoemulsification surgeries were randomized to receive the CH, ASPH, and MASH (n = 30 eyes in each group). In the ASPH, an anterior stromal pocket was created superficial and parallel while in the MASH; it was superficial and perpendicular to the plane of the main incision. The primary outcome measure was wound leakage assessed after applying firm downward pressure on the posterior lip of the main corneal incision, simulating eye rubbing. Results: On application of pressure to the posterior lip, leakage was seen from 19 eyes (63%) in the CH group, while this was seen in only two eyes (7%) each in the ASPH and MASH groups (P < 0.001). The likelihood of wound leak after applying pressure to the posterior lip reduced by 86% in the ASPH and MASH groups compared to CH (Odds ratio = 0.14, 95% CI = 0.05 – 0.35, P < 0.001). The mean surgically induced astigmatism was 0.18 ± 0.14D and there were no differences in SIA across the three groups (P = 0.42). More eyes in the ASPH required conversion to CH (n = 4, 13%) due to difficulty in localizing the pocket compared to MASH (n = 0, P = 0.03) Conclusion: Both, the ASPH and MASH techniques reduce the risk of wound leakage and do not induce astigmatism. The MASH technique makes it easier to consistently localize the pocket.

Purpose: To study the safety of sutureless cataract surgery and risk factors for wound leak of clear corneal incision in children affected with congenital or developmental cataract. Methods: It is a retrospective, noncomparative interventional case study involving children in the age group of 2 to 16 years, who underwent cataract surgery with intraocular lens implantation with the minimum follow up of 1 month. Results: Out of 1000 eyes studied, lens matter aspiration with intraocular lens implantation with or without primary posterior capsulorhexis and anterior vitrectomy was done in 609 and 391 eyes, respectively. Incisions of 943 eyes did not require sutures while sutures were applied for wound leak in 57 eyes on the table and in 5 eyes on postoperative day 1. Risk of wound leak for suture application was found to be greater in patients; having age less than 5 years (P < 0.0001), surgeries performed by junior surgeons (P < 0.0003), wound problems (P < 0.0001), intraocular lens (IOL) related factors (P < 0.0001), use of iris hooks (P < 0.0001), and anterior capsulorhexis extension (P < 0.0001). On the first postoperative day, anterior chamber reaction (P < 0.0001) and fibrinous membrane (P = 0.0007) were significantly more in the sutured group. Incidence of postoperative complications was 0.98 per sutured eyes (59 complications in 60 eyes). One patient developed endophthalmitis after suture removal. Conclusion: Sutureless clear corneal incision in pediatric patients undergoing cataract surgery can achieve stable wound. However, after hydro closure, every wound should be checked for water tightness and the leaky wound should be sutured.

When capsular support is inadequate in complicated cataract, scleral fixated IOL (SFIOL) has its advantage whereby it is nearer to physiological nodal point when compared to other types of IOL implantation. Scleral tunnel fixated intraocular lens (STFIOL) technique is gaining popularity due to its simplicity and ease of placement compared to sutured IOL. We report our experience with eight cases of STFIOL implantation from September 2016 to May 2018 in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). All patients had improvement of vision except one case who had unchanged vision. Mean post-operative BCVA was logMAR 0.57±1.13 (which is almost equivalent to 6/21) and improved to logMAR 0.37±0.43 (which is almost equivalent to 6/12) excluding one patient with chronic RRD with band keratopathy. Post-op complications include raised intraocular pressure, cystoid macular oedema, hyphaema, and wound leak. However, all complications were not severe and responded to topical eyedrops. In conclusion, STFIOL insertion technique is safe and works well to restore vision in majority of patients operated with this technique.

PURPOSE To compare clinical outcomes using angled versus straight trocar insertion during 27-gauge pars plana vitrectomy for epiretinal membrane. METHODS Pilot randomized controlled trial. Thirty eyes of 30 patients undergoing 27-gauge pars plana vitrectomy with membrane peeling for epiretinal membrane were randomized 1:1 to receive angled or straight trocar insertion. Intraocular pressure (IOP) and postoperative wound-related complications were compared. RESULTS Fifteen eyes were randomized to each the angled and straight incision groups. No significant difference in phakic status (P = 0.71) or preoperative IOP (15.1 ± 3.4 vs. 14.6 ± 3.0 mmHg, P = 0.67) existed between groups. On postoperative Day 1, eyes in the straight group had lower IOP compared with the angled group (11.8 ± 3.9 vs. 15.3 ± 5.2 mmHg, P = 0.04) and a relative decrease in IOP compared with preoperative values (11.8 ± 3.9 vs. 15.1 ± 3.4 mmHg, P < 0.01). No IOP difference between groups was present at Day 7 (P = 0.43) or Day 30 (P = 0.42). Postoperative complications included transient hypotony (1 eye, straight group) and serous choroidal detachment (1 eye, angled group). CONCLUSION Eyes with straight incisions had transiently lower IOP on postoperative Day 1, possibly suggestive of subclinical wound leak in the very early postoperative period. Overall, rates of hypotony and sclerotomy-related complications were similarly low between wound construction strategies.

This case highlights the postoperative management of a patient with hypotony who masqueraded as wound leak following manual small-incision cataract surgery (MSICS). A 66-year-old male patient underwent uneventful MSICS in the left eye. He developed postoperative hypotony following surgery. B-scan revealed a small peripheral shallow serous choroidal detachment. There was a mild conjunctival retraction which masqueraded as postoperative wound leak. Postoperative hypotony resolved after conservative management.

Phacotrabeculectomy is the preferred surgical management of coexisting visually significant cataract and moderate to advanced glaucoma. We report the surgical technique of a new modified fornix-based separate-site phacotrabeculectomy, with mitomycin C (MMC) application, in both primary open angle and angle closure glaucoma. In this new separate-site technique, both phaco and filtration are accommodated superiorly, side by side, hence called twin-site. This was achieved in an efficacious and safe manner with sparing of limbal stem cells without compromising safety. It is not only MMC-compatible but also has a low incidence of wound leak. The technique has no adverse consequence on the survival of the bleb, and we achieved complete success in 79.2% and total success in 93.1% in 130 eyes of 117 patients, in the intermediate term. Furthermore, the time taken for this separate-site surgical technique is comparable to published one-site procedures.

We would like to describe a common observation as a new sign ‘Bloody Seidel’s’. Seidel’s test, named after the German ophthalmologist Erich Seidel, is used to reveal leaks of intraocular fluid from the cornea, sclera or conjunctiva following injury or surgery. The principle of the Seidel’s

Introduction Surgical site infections (SSIs) are of profound significance in neurosurgical departments, resulting in high morbidity and mortality. There are limited public data regarding the incidence of SSIs in neurosurgery. The aim of this study was to determine the rate of SSIs (particularly those requiring reoperation) over a seven-year period and identify factors leading to an increased risk. Methods An age matched retrospective analysis was undertaken of a series of 16,513 patients at a single centre. All patients who required reoperation for suspected SSIs within a 7-year period were identified. Exclusion criteria comprised absence of infective material intraoperatively and patients presenting with primary infections. Clinical notes were reviewed to confirm presence or absence of suspected risk factors. Results Of the 16,513 patients in the study, 1.20% required at least one further operation to treat a SSI. Wound leak (odds ratio [OR]: 27.41), dexamethasone use (OR: 3.55), instrumentation (OR: 2.74) and operative duration >180 minutes (OR: 1.85) were statistically significant risk factors for reoperation. Conclusions This is the first UK study of such a duration that has documented a SSI reoperation rate in a cohort of this size. Various risk factors are associated with the development of SSIs, making it essential to have robust auditing and monitoring of high risk patients to ensure excellent standards of healthcare. Departmental and public registers to record all SSIs may be beneficial, particularly for those treated solely by general practitioners, allowing units to address potential risk factors prior to surgical intervention.

This case report aims to share the successful management of Epithelial Downgrowth (ED) which occurred following persistent wound leak, after Removal of Silicone Oil (ROSO) via the anterior chamber. A teenage male with history of high myopia underwent bilateral phacoemulsification and implantation of Multifocal Intraocular Lens (MFIOLs). Four months later, he complained of left eye floaters and blurring of vision. Fundus showed left vitreous haemorrhage with lens subluxation. Left 23 gauge pars plana vitrectomy revealed multiple retinal tears. Endolaser and gas injection with MFIOL repositioning was done. Retinal redetachment and MFIOL subluxation occurred six weeks postoperatively. Revision vitrectomy with silicone oil and explantation of MFIOL was performed rendering left eye aphakic. Four months later, he underwent ROSO via a superior corneal incision. Positive Seidels was seen two weeks post-ROSO and resuturing was performed. Unfortunately, advancing ED was noted at the superior cornea. One month after ROSO, scleral fixated IOL implantation with manual removal of ED and intracameral injection of 5-fluorouracil (5-FU) were performed. Twelve months postoperatively, cornea remained clear with a pinhole vision of 6/7.5 and retina was flat. In conclusion, wound leak after ROSO via the anterior chamber in aphakic individuals may predispose to ED. Key to treatment of this sight threatening condition is thoughtful anterior segment examination. Manual removal of the membrane combined with 5-FU injection during secondary lens implantation surgery is an effective treatment.

Letter to the Editor

A 28-year-old man presented with a Zone I open globe injury and an intraocular metal foreign body in the left eye. The metal foreign body was removed and the open globe was repaired. At the end of the case a slow wound leak was noticed and a bandage contact lens was placed. On post-operative day 1 the anterior chamber was shallow and the wound leak was sealed with corneal glue. Two weeks later the glue came loose and the wound leak persisted necessitating repeat corneal glue. Eight weeks post-operatively, the glue loosened and was removed along with the underlying sutures, and a wound leak was still present. The patient was taken to the operating room where the wound edges and overlying epithelium were debrided and the wound was re-sutured. After re-suturing, the wound remained watertight. Ten weeks after re-suturing, the corneal sutures were removed without complications, with a final visual acuity of 20/15.

PURPOSE To describe the demographics, characteristics, management, and visual outcomes of eyes diagnosed with endophthalmitis after open globe injury. METHODS Retrospective cohort analysis of all patients diagnosed with endophthalmitis after open globe injury from 1997 to 2015 at University Hospital, Newark, NJ. RESULTS Twenty-six eyes were identified (all male patients; mean age: 37 ± 15 years). Cultures were positive in 16 eyes (62%), with Staphylococcus species (7 eyes, 44%) being the most common organism. Twelve eyes (46%) presented with open globe injury and concurrent endophthalmitis; 14 eyes (54%) developed endophthalmitis a mean of 14 days after open globe repair (OGR; 1 outlier of 98 days excluded). All eyes were managed with systemic and intravitreal antibiotics. The presence of intraocular foreign body (P < 0.05) and delayed primary OGR (P < 0.03) were significantly more common with concurrent versus post-OGR endophthalmitis. Four (29%) eyes in the post-OGR endophthalmitis group had corneal wound leak after OGR. Four (15%) eyes with no light perception vision were enucleated. Ten (40%) of 25 eyes with documented best-corrected visual acuity had final best-corrected visual acuity ≥20/200; final best-corrected visual acuity ranged from no light perception to 20/20. CONCLUSION The presence of intraocular foreign body and delayed presentation were significantly more common with concurrent endophthalmitis. Twenty-nine percent of eyes that presented with endophthalmitis after OGR had a wound leak. Final best-corrected visual acuity ≥20/200 was achieved in 40% of cases.

Aims The spinal stab injuries being very rare, there have been no established management guidelines. Our aim is to establish an algorithm for management of this injuries. Methods We in our study report three cases of spinal stab injury which were managed individually. All of them were managed by different modalities of treatment with satisfactory results. Analyzing the different management protocols applied to each case, we try to formulate an algorithm for management of these rare injuries. Results Out of three cases reported, one of the spinal stab injury patient was managed conservatively as there was no CSF leak. Other patient was managed with CSF diversion as patient had delayed wound CSF leak following wound repair. In contrast our third patient underwent direct primary repair of dural defect as he presented early with CSF wound leak. Analyzing these three patients we propose an algorithm for management of spinal stab injuries. Conclusion The spinal stab injuries are very rare without established management protocols. In this case series we emphasize on individualized management. The simple algorithm proposed here can be useful in managing spinal stab injuries. A timely appropriate intervention can improve the outcome in spinal stab injury patients and unnecessary interventions can be avoided.

Purpose To develop and evaluate a calibrated force gauge designed to simulate the effect of patient-induced manipulation of the eye with resultant elevation of intraocular pressure (IOP) and use the device to determine the stability of cataract incisions. Setting Three private practice study sites. Design Clinical trials. Methods A calibrated force gauge was developed to apply controlled and quantifiable amounts of force to the eye. In study 1, the calibrated force gauge was used to evaluate the change in IOP during application of 1 oz of external force in a group of healthy volunteers. In studies 2 and 3, the calibrated force gauge was used to assess wound leakage of clear corneal incisions that were subjected to stromal hydration or sutures, respectively. Results In study 1, with the application of 1.00 oz of external force, the mean IOP rose from a baseline of 17.49 mm Hg to 43.44 mm Hg. In study 2 (stromal hydration) using up to 1.00 oz of force, the leak rate was 67% for the main incision. The overall leak rate for study 3 (sutures) using up to 1.00 oz of force was 23.8%. No adverse events or serious adverse events occurred during these studies. Conclusions Study 1 confirmed that 1.00 oz of force is a realistic approximation of the amount of force a patient's eye may experience during rubbing. After clear corneal cataract surgery, the application of 1.00 oz of force to the ocular surface for approximately 2 to 3 seconds may simulate the propensity for postoperative wound leak resulting from patient manipulation. Financial Disclosure Drs. Masket, Hovanesian, and Raizman are consultants to Ocular Therapeutix. Dr. Masket is also a medical monitor for Ocular Therapeutix. Drs. Hovanesian and Masket are shareholders in Ocular Therapeutix. Drs. Wee and Fram have no financial disclosures.

Purpose:- To evaluate indications and outcome of Therapeutic Penetrating Keratoplasty(TPK) in rural population of central India. Method:- A retrospective review of 26 eyes of 26 patients who underwent TPK between January 2010 & March 2011 was done. The patients were reviewed for age, sex, indication of surgery, details of surgery, post-operative complications, anatomical integrity, visual outcome and graft clarity. Result:- Out of 26 patients, 22 were males and 4 were females, age range was between 16 -70 years and mean follow up period was 6 months. The most common indication for TPK was perforated corneal ulcer of fungal origin. Pre-operative visual acuity ranged from perception of light (PL+) to 3/60. Post-operative visual acuity remained same in 6 eyes (23.1%), improved to 6/60 in 13 eyes (50.0%), of which between 6/36 to 6/9 in 3 eyes. Anatomical integrity was achieved in all eyes (100%). Graft was clear in 13 (50%) eyes on last follow-up. Primary graft failure occurred in 3(11.5%) eyes, graft infection in 4 (15.3%) eyes and acute graft rejection in 2 (7.7%) eyes. One patient had graft dehiscence and 1 had wound leak, both required re-suturing. In 1 case re-graft was done and 1 case required Amniotic membrane transplant. Conclusion:- Therapeutic Penetrating Keratoplasty goes a long way by not only salvaging the eye and achieving anatomical integrity but also improves the patient’s vision. Del J Ophthalmol 2012;23(1):23-26.

Acute-onset endophthalmitis after intraocular lens (IOL) exchange is a rare clinical entity. The following series describes two patients who presented with endophthalmitis and light perception vision following IOL exchange and were treated with pars plana vitrectomy and intravitreal antibiotics. Wound leak from the temporal clear corneal incision was noted in both patients. Immediate intravitreal antibiotics and pars plana vitrectomy led to a favorable outcome in one of the two patients.

This is a case report of a 54-year-old woman with chronic uveitis who developed epithelial downgrowth after an Ahmed valve implantation. The epithelial downgrowth presented in an unusual fashion, as a peritubular fibrovascular membrane. Our case suggests that in patients who have undergone glaucoma drainage implantation with clinical features such as persistent hypotony and atypical inflammatory cells, high clinical suspicion for epithelial downgrowth and careful search for potential fistulas are necessary, even without an obvious wound leak.

Anterior stromal pocket hydration was compared with conventional hydration for preventing wound leak after 2.8 mm uniplanar clear corneal incisions (CCIs) in patients having routine cataract surgery. Conventional hydration involves hydration of the lateral walls of the main incision with visible whitening of the stroma. The anterior stromal pocket hydration technique involves creation of an additional supraincisional stromal pocket overlying the main incision, which is then hydrated instead of the main incision. Sixty-six eyes of 48 patients were included in the data analysis with 33 assigned to each study group. The anterior stromal pocket hydration technique was significantly better than conventional hydration in preventing wound leak due to direct pressure on the posterior lip of the incision.

To review the outcomes of 23-gauge transconjunctival vitrectomy in patients with postoperative endophthalmitis. Non-randomized, interventional case series of patients with postoperative endophthalmitis over a 1-year period. 23-gauge transconjunctival vitrectomy was performed on 6 patients with a mean age of 67.7 years without intraoperative or postoperative complications. There were no cases of postoperative hypotony or wound leak. The mean change in IOP was −4.2 mmHg compared to the preoperative IOP (P=0.239). Final VA improved significantly compared to preoperative VA (P=0.062), with VA of at least 20/40 in 5 of 6 patients (83.3%). 23-gauge transconjunctival vitrectomy is a useful technique for treating postoperative endophthalmitis.

Purpose. To describe a technique and report results of tectonic lamellar keratoplasty using tissue harvested with a microkeratome from a corneoscleral rim mounted in an artificial anterior chamber system. Methods. A donorlenticule was prepared from a corneoscleral rim utilizing the Moria LSK-1 (Moria/Microtek Inc., Doylestown, PA, U.S.A.) microkeratome and artificial anterior chamber. This tissue was used in the procedures of 6 eyes of 6 patients requiring tectonic lamellar keratoplasty. Three eyes were in danger of imminent perforation due to corneal ulceration. Other indications for lamellar engraftment include persistent wound leak following cataract extraction, persistent epithelial defect following a Grade 4 chemical burn, and limbal dermoid. Results. A successful outcome, defined as restoration or preservation of globe integrity, vision, and intact epithelium, was achieved in all patients. Follow-up ranged from 2-8 months with a mean of 4.5 months. Conclusions. Donor lenticules prepared with the ALTK (Moria/Microtek Inc.) system can be used in the successful management of eyes requiring tectonic lamellar keratoplasty.

PURPOSE: To report the effect of 5-fluorouracil on the outcome of a single case of epithelial ingrowth secondary to a wound leak after a complicated penetrating keratoplasty. DESIGN: Case report. METHODS: A 44-year-old man with extensive epithelial ingrowth after trauma and a penetrating keratoplasty received a fluid-gas exchange followed by two injections of 500 μg of 5-fluorouracil into the anterior chamber. RESULTS: Two weeks after receiving the 5-fluorouracil injections, complete disappearance of the epithelial ingrowth from the anterior chamber occurred. No evidence of recurrence was detectable at 5 months. CONCLUSION: Use of 5-fluorouracil is a potentially effective treatment of epithelial ingrowth, particularly in eyes with extensive involvement, in which the risks of traditional ablative therapeutic modalities are considerable.

BACKGROUND: Macroperforation of the cornea during refractive keratotomy can result in persistent wound leak and may need treatment by suturing. METHODS: We describe two eyes that developed a mac roperf oration during radial keratotomy with persistent leakage of aqueous. The wounds were sutured with 10-0 and 11-0 nylon sutures. RESULTS: The sutures induced irregular astigmatism as shown by corneal topography. Removal of sutures improved the topography and led to an acceptable outcome. CONCLUSION: Macroperforations with persistent aqueous leaks should be sutured. Suture removal within a few weeks after surgery can avoid persistent irregular astigmatism and lead to a good refractive result. Refract Corneal Surg 1993;9:62-64.)

PURPOSE: To report an occurrence of wound leak from the injection site after intravitreal injection of bevacizumab. A possible underlying etiology is discussed. METHODS: A single injection of bevacizumab was given for treatment of choroidal neovascularization complicating previous choroidal rupture. RESULTS: A reduction in vision and hypotony were noted 1 day after injection. With conservative management, there was spontaneous resolution of the wound leak. CONCLUSION: The risk of wound leak after intravitreal injection may be higher for younger patients and those who have undergone vitrectomy. All patients and clinicians, however, should be alert to vision decline after injection, and prompt evaluation should be performed to ascertain the cause. For patients with persistent wound leak, surgical intervention may be required.

Control of intraocular pressure (IOP) is the goal of trabeculectomy, and pursuit of this goal does not end with the completion of the surgical procedure. Proper postoperative management of the trabeculectomy patient requires an understanding of possible events that alter IOP and knowledge of the treatments to control IOP. Recent changes in surgical technique, including the use of antimetabolites, have provided new challenges in the postoperative management of trabeculectomy patients. Interventions are described to restore the flow of aqueous to the filtering bleb in the early postoperative period, to manage flat anterior chambers with both high and low intraocular pressures, to manage a failing filtering bleb, and to manage hypotony. Herein we discuss current methods for controlling IOP in the postoperative period.

Purpose. To report a case of fragile cornea associated with osteogenesis imperfecta type I in which primary penetrating keratoplasty was done as a tectonic procedure. Methods. A 6-year-old boy with osteogenesis imperfecta type I presented with a corneal laceration in his right eye following minor trauma. Since wound repair was not possible due to tissue loss, he underwent a primary penetrating keratoplasty. Results. Postoperatively, the eye healed well without any wound leak. The boy had uneventful suture removal 10 weeks following surgery. Conclusion. Primary penetrating keratoplasty is a viable option to restore ocular integrity in fragile corneas following trauma when tissue loss precludes simple repair.

A technique is herein presented of penetrating keratoplasty with the use of through-and-through suturing of the cornea with continuous 10-0 nylon monofilament fiber. Rabbits, dogs, and monkeys were studied. Good apposition of the wound edge is the principal advantage of this technique. There were no instances of wound leak, flat anterior chamber, or epithelial downgrowth into the anterior chamber in a sequence of keratoplasties in rabbits, dogs, and 33 monkeys.

The causes of wound leak are the following: 1. A perforating suture. Edema of the wound lips may initially prevent the escape of aqueous. 2. A deep suture, which may become perforating due to necrosis (Fig. 1). 3. A superficial suture which may cause posterior gaping (Fig. 2). 4. Deficient coaptation of the wound edges. 5. Incarcerations of extraneous material in the wound e.g. lint, fragments of glass or rubber, suture material, lens capsule, iris, vitreous, conjunctiva, and eyelashes. This may cause excessive granulation tissue or a filtering cicatrix. 6. Excessive cauterization of the wound edges. 7. An irregular incision and undue trauma to the wound lips by unsuitable or defective instruments (1). 8. Accidental trauma, which ruptures a suture. 9. Increased intraocular pressure. Its effect may be similar to that of trauma. An abrupt increase in ocular tension is usually due to pupillary block. The wound may reopen and the iris may prolapse (Fig. 3). 10. Delayed wound healing, which may be responsible for prolonged filtration or fistulization due to any of the above mechanical factors.

To the Editor: In theArchivesof January 1965, Dr. L. M. Fine discussed the treatment of postoperative absent anterior chamber. It is concluded that an absent anterior chamber is caused ( a ) by a pupillary block, and ( b ) by a leaking wound. In his series, a wound leak was always demonstrable in cases of absent chamber and in hypotonous eyes by injecting two drops of 1% fluorescein diluted in 1 cc sterile saline directly into the anterior chamber. In this connection the following case may be of interest: An 84-year-old male had been operated on for glaucoma in 1940 on the left eye by a total iridectomy. After the operation tension remained normal. Lenticular opacities developed and at the time of admission vision was about 1/6 (with sph±1). The right eye, which had always been free from glaucoma, was operated on for cataract by his ophthalmologist in 1961. With correction

Manual of Corneal Surgery , edited by Bruner, Stark, and Maumenee, is a well-organized, concise overview of surgical techniques, useful to the general ophthalmologist as well as corneal surgeons, students, residents, and fellows. The book is divided into 13 chapters written by 17 acknowledged experts. "... it is the best medical textbook buy of the year." Anatomy, with its clinical relevance, is well covered. A practical chapter on preoperative evaluation includes excellent discussions of potential acuity tests, prognostic factors, and the recipient environment, both physical and socioeconomic. Five chapters are devoted to keratoplasty. The chapter on penetrating keratoplasty contains many very practical details and pearls of advice carefully elucidated by the very experienced authors. They adequately illustrate such points as tying the running suture and reforming the anterior chamber. My major criticism of the entire book lies in these authors' startling and highly questionable statement: "A small wound leak or a leakage

Dr. Hagedoorn's letter was referred to Dr. Fine who offers the following reply: To the Editor: I certainly agree with Dr. Hagedoorn that his patient's absent anterior chamber was due to a pupillary block from posterior synechias to the vitreous face. In such a case, I would expect aqueous secretory inhibitors to be of no value in reforming the anterior chamber. In our experience, a wound leak has been by far the most frequent cause of postoperative absent anterior chamber. In some instances the elevated intraocular pressure resulting from a transient pupillary block may cause a wound separation. As aqueous accumulates in the posterior chamber, the pressure there increases until aqueous may dissect its way between the vitreous fact and iris. The pupillary block is then spontaneously broken, and aqueous will flow into the anterior chamber and out the wound separation. In such a case, the absent anterior chamber will