NOTES, C A S E S , I N S T R U M E N T S 251

6. Haik, G. Μ., et al.: Sympathetic ophthahnia. Arch. Ophth., 47 :437, 1952. 7. Fine, M., and Goodwin, R. C.: Evaluation of local cortisone therapy in ophthalmology. Arch. Ophth.,

47 :787,1952. 8. Leopold, I. H . : Cortisone, compound F, and corticotropine in ocular disease. Arch. Ophth., 48:196,

1952. 9. Steffensen, Ε. Η. r Corticotropin, cortisone, and hydrocortisone in treatment of ocular disease.

J.A.M.-A, 150:1660 (Dec.) 1952. 10. Joy, H. H . : Sympathetic ophthalmia. J. Am. Geriatric Soc., 1:665 (Sept.) 1953.

A D D I T I O N A L U S E S F O R T H E B I N O C U L A R I N D I R E C T

O P H T H A L M O S C O P E *

R O B E R T J. B R O C K H U R S T , M.D.

Boston, Massachusetts

The binocular indirect ophthalmoscope is intended primarily for the study of retinal diseases and for fundus examination during retina detachment surgery.^'^ However, it has proved to be of value as an operating light in two ophthalmic procedures wherein good illumination is essential.

First, in performing dacryocystorhinos­tomy by the external approach, many sur­geons prefer to suture the nasal mucosa to the lacrimal sac. This usually proves to be a tedious and time-consuming portion of the operation, and often adequate visualization is not obtained due to poor illumination deep in the wound. Second, in performing goni-

Fig. 1 (Brockhurst). The instrument with sterile hemostat attached.

otomy and goniopuncture with an operating contact lens in place, good illumination and visualization of the angle are necessary. With the instrument mounted on his head, the surgeon has both hands free and obtains a binocular stereoscopic view of the operative field with intense illumination which is coaxial with his visual axis.

The indirect ophthalmoscope, placed in position on the head prior to scrubbing, is suitably adjusted. Then it is tilted up out of the way for the preliminary work. A small sterile hemostat is then attached to the inter-pupillary adjustment metal strip of the oph­thalmoscope (fig. 1) . This allows the sur­geon to tilt the instrument into position when it is needed. The condensing lens, which is held in one hand when doing oph­thalmoscopy, is not used when the instrument is utilized as an operating light in these procedures.

327 Charles Street (14).

R E F E R E N C E S

1. Schepens, C. L . : Progress in detachment sur­gery. Tr. Am. Acad. Ophth., 55 :607, 1951.

2. Manufactured by the American Optical Com­pany.

•From the Retina Service, Massachusetts Eye and Ear Infirmary.

A N Y L O N B R I D L E S U T U R E I N C A T A R A C T S U R G E R Y

A L B E R T C . E S P O S I T O , M.D.

Huntington, West Virginia

The instrumentation and technique of cata­ract surgery reveals that small improvements gathered together have generally advanced our techniques and instrumentation and made possible the most excellent results in cata­ract surgery today.

252 NOTES, CASES, I N S T R U M E N T S

For more than the last 100 cataracts which I have performed, I have been using as the bridle suture a single strand, 4-0 nylon suture. I had been using black silk but found that occasionally after the cataract procedure had been completed and the conjunctival flap had been placed in position, it was difficult to remove the black silk from the bridle suture area. A t times, even a gentle attempt to re­move the suture resulted in collapse of the air bubble from the anterior chamber.

T o alleviate this problem, Ethicon 4-0, nylon monofilament suture* with the three-eighths inch Atrolon cutting needle was chosen. The ease of insertion of this suture with the cutting needle the smoothness of the suture body itself, and the ease with which the suture can be removed after the com­pletion of the cataract procedure make it well adapted for this procedure. In over 100 cat­aract procedures, there has not been one in­stance in which the anterior chamber was lost, during the attempt to remove the bridle suture. When using nylon, the suture ac­tually slides out.

1212 First Huntington National Bank Building (1).

M A L I G N A N T T U M O R S O F T H E C O N J U N C T I V A f

REPORT OF TWO CASES

E. G . G I L L , M . D .

AND

R. B. JONES, JR., M . D .

Roanoke, Virginia

In any discussion of conjunctival tumors, corneal tumors must be included because a high percentage of both conjunctival and corneal tumors arise at or close to the limbus of the eye and involve both of these struc­tures.

* Ethicon 4-0 nylon, No. B-662. t From the Department of Ophthalmology, Gill

Memorial Eye, Ear, and Throat Hospital.

In adults, malignant tumors of the con­junctiva occur as frequently as benign tumors. This is most important to the physi­cian in deciding what type of therapy should be used since there is controversy as to what is best for the patient.

Epitheliomas or epidermoid carcinomas are most frequently seen at the limbus but they do occur at the caruncle and in the bul­bar and palpebral conjunctiva. The reported cases of epitheliomas are few and the site of origin in almost all cases was either directly or indirectly connected with the limbus. They can be associated with pterygia, corneal ulcers, Pinguecula, with pannus or the scars of old injuries. W e are of the opinion that these tumors were originally benign lesions, probably papillomas, and in the interval have undergone malignant change.

Epitheliomas usually occur in adults in the fifth, sixth, and seventh decades of life. The site o f origin is usually at the limbus but they may occur away from the limbus. In the cases studied, one tumor was located at the limbus and the other was three mm. from the limbus in the bulbar conjunctiva. Growth of these tumors, we have noted, is relatively slow. In both of our cases, the tumor itself was very vascular, resembling a mulberry type of lesion, and was considerably elevated from the conjunctival surface.

CASE REPORTS

CASE 1

A white man, aged 61 years, was seen in the out-patient department, coinplaining of a growth on the white part of his eye for the past 17 months. His uncorrected visual acuity was 20/20 in each eye. He stated that his mother had died of cancer. A tentative diag­nosis of epithelioma of the bulbar conjunctiva was made and excision of the tumor mass was recommended. The mass was removed with wide excision of the surrounding con­junctiva and the pathologic report was cancer of the conjunctiva (epithelioma), grade II.

The patient has been followed for the past six months in our out-patient department and