In the November 1998 issue, the techniques section included 2 papers that represent an ongoing problem in ophthalmology—one that I hoped was improving prior to reading these articles. Authors must refrain from claiming innovation and novelty with small variations in techniques. True breakthroughs are rare; there is much honor in recognizing the contributions of true innovators while making refinements.
In the article on a viscoelastic-injecting cystotome, Teus and coauthors1 describe attaching the cystotome cannula to the viscoelastic syringe. This technique has been widely used at numerous hospitals and surgery centers for more than a decade.
In the article about single-suture loop pupilloplasty for an atonic pupil, Behndig2 claims to have a “new method.” In the discussion section but not in the introduction, he does acknowledge the contribution of Pius Bucher, MD, but describes this as a “closed-system technique … used to compress each of the 4 iris quadrants separately.” Dr. Bucher did, however, describe the iris circlage technique at least 4 years ago, which was virtually identical to the technique described by Dr. Behndig. This technique was widely disseminated in the Audio-Visual Journal of Ophthalmology at that time. Moreover, I included and acknowledged Dr. Bucher's technique in my videotape, “Reconstructing the Iris,” presented at the 1998 Symposium on Cataract, IOL and Refractive Surgery.
The reader should also be aware of a technical problem in the technique description. As shown in Figure 4, when the iris suture is placed close to the sphincter, as advocated by Dr. Behndig, the suture will span the tented-up iris into the clear pupillary zone. If the iris suture bites are placed 1.0 to 1.5 mm peripheral to the edge of the sphincter, the suture material will not intrude on the optical zone. The result will be cosmetically superior and the suture material, less likely to cheesewire through the fragile iris tissue postoperatively.
Roger F. Steinert MD
Boston, Massachusetts, USA
1. Teus MA, Fagúndez-Vargas MA, Calvo MA, Marcos A. Viscoelastic-injecting cystotome. J Cataract Refract Surg 1998; 24: 1429-1431
2. Behndig A. Small incision single-suture-loop pupilloplasty for postoperative atonic pupil. J Cataract Refract Surg 1998; 24: 1432-1433