Betagan, Betoptic, Timoptic, lopidine, Diamox, Pi­lopine Gel, and Miostat. J Cataract Refract Surg 1992; 18:14-19) but not focused upon. My expe­rience is with Viscoat and Occucoat, used in extra­capsular surgery. I am not sure this would be of value after A/I. It is now unusual for me to see a postoperative pressure rise. I urge you to empha­size this point in a future discussion as the oppor­tunity arises. In the meantime I will take your advice and add an anti-glaucomatous drop to my regimen.

Keith S. McKenzie, M.D. Santa Cruz, California

TEMPORARY WOUND CLOSURE

To the Editor: I read with great interest the article by Hara and

Hara describing temporary wound closure with used needles (J Cataract Refract Surg 1992; 18: 200-201).

Dr. Daljeet Singh ofIndia has used this technique for several years to rapidly close the eye while fac­ing expulsive choroidal hemorrhage during sur­gery. He has successfully used this technique in over 50 cases. After stapling the eye with needles, he waits about 30 minutes. The eye becomes soft and he is able to finish the operation. No sclerotomy or other procedure is done to reduce increased intraocular pressure.

I believe Dr. Singh's success in treating this very difficult emergency is quick closure using needles. Figure 1 is a representation of his technique.

Jaswant Singh Pannu, M.D. Lauderdale Lakes, Florida

Fig. 1. (Pannu) Closure technique used by Daljeet Singh, M.D.

INFLAMMATION AFTER LENS IMPLANTATION

To the Editor: I read with interest the editorial and the article

by Monson et al. on inflammation after surgery in the March issue (Obstbaum SA. Inflammation as­sociated with cataract surgery and intraocular lens implantation: a recurring theme. 1992; 18:119; Monson MC, Mamalis N, Olson RJ. Toxic anterior segment following cataract surgery. 1992; 18: 184-189). I have had one case such as this and in trav­eling around America, I have met three other surgeons with similar cases.

I think the cause of this problem is the rust re­moval solution not being adequately removed from the instruments after they have had this treatment. Certain of the older instruments do go rusty after numerous autoclaves and I note that some scrub nurses use rust remover to clean them. If the rust removal solution is not scrupulously removed fol­lowing this treatment, a very toxic chemical is put into the eye. Eric J. Arnott, M.D. London, England

ARE LENS EXCHANGES AND "T" CUTS OBSOLETE?

To the Editor: The excimer laser, currently under FDA inves­

tigation, is changing the way we have traditionally viewed corneal procedures.

Modern cataract surgery has bestowed many mir­acles upon its recipients. Today's surgery is painless, precise, and rarely incurs morbidity. Occasionally, one can expect good near and distance vision with­out spectacles. However, there are a few clouds in paradise: either faulty lens selection causing exces­sive myopia or surgically induced astigmatism may diminish the magic of modern cataract surgery.

Rather than the invasive lens exchange for pseudophakic anisometropia, the current state of excimer refractive technology offers an alterna­tive-pseudophakic photorefractive keratectomy (PPK). Consider the nearly full thickness invasion of the cornea with "T" cuts to modulate surgically in­duced astigmatism. Would it not be better to at­tempt a procedure that ablates only 1 0 to 20 J.lm to effect a result of 1 or 2 diopters of cylinder or sphere?

In this context, the technology is here to relegate "T" cuts and lens exchanges to obsolescence.

Charles H. Cozean, Jr., M.D. Cape Girardeau, Missouri

424 J CATARACT REFRACT SURG-VOL 18, JULY 1992