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The heart may be unable to maintain a satisfactory circulation when part of its muscle has been permanently replaced by fibrous tissue or when the myocardium has been temporarily weakened by congestive heart failure of diverse etiology. Surgical successes that restore the normal mechanics of circulation are manifold. Replacement of stenosed and incompetent cardiac valves with prosthetic counterparts, the correction of congenital cardiac defects, the successful implantation of internal mammary and other arteries in cases of cardiac ischemia resulting from a coronary occlusion are today routine procedures in all cardiac units. The use of pacemakers has prolonged many lives in cases of auriculoventricular block caused by interference with conduction along the bundle of His. Despite the many triumphs of cardiac surgery, the problem of the inadequate or irreversibly damaged myocardium remains largely unsolved. The myocardium may only require temporary assistance in order to allow time for the natural restoration of tissues and function. It is, however, the case of progressive heart failure in which the myocardium is irreparably impaired, that is our most urgent and pressing concern. Replacement with a normal heart or some form of permanent assistance to the damaged heart become the only treatments of choice. [ABSTRACT FROM AUTHOR]

An inverted V-shaped cataract incision with a scleral tunnel entry into the anterior chamber was used in 700 eyes. Two details distinguish this incision from other sutureless closures: the fulcrum in the crotch of the V provides easier access to the anterior chamber for instrument manipulation, and the termination of the scleral tunnel entry posterior to the cornea lessens the likelihood of corneal folds that may interfere with visualization during surgery. The surgical results in a preliminary survey show minimal iatrogenic change in corneal toricity and the type of complications usually associated with conventional cataract surgery.

Informal allusions to the widespread use of two-looped semiflexible anterior chamber lens implants as "back-up" lenses in patients originally selected for posterior chamber implantation led the authors to do a retrospective study of complicated cases in their practice during a two-year period. While there may be some surgeons who simply abort implantation in the case of loss of posterior capsule integrity, vitreous loss or vitreous instrumentation, there seems to be a trend for extracapsular surgeons to substitute an anterior chamber lens under these conditions. During the study period, no planned lens implantation procedure was aborted. The postoperative complications and visual results of those eyes in which anterior chamber lenses were substituted are the subject of this presentation. As expected, the results in patients with a surgical complication are worse than in uncomplicated cases, but the visual reduction is nominal. The prognosis if capsule disruption occurs without vitreous complication is excellent.

A patient with iatrogenic, ultrasound-induced hemi-iris atrophy complained of intraocular lens edge glare and intolerable monocular diplopia. A surgical reconstruction of the iris was undertaken utilizing a new suture manufactured by Ethicon for retention and stabilization of the pupillary lens implant during secondary procedures. A straight general surgical needle 15 mm in length swedged to a 10-0 prolene ophthalmic suture is used to cross the anterior chamber limbus to limbus. The resulting horizontal trans AC suture retains the pupillary lens in position. The McCannel suture technique is modified to produce intracameral iris repair with interrupted 10-0 prolene.

Placement of posterior chamber lens implants in the capsular bag is facilitated if the capsular fornix is maintained by Healon. The distal loop slides easily into the bag and the proximal loop can be dropped behind the elevated anterior capsule flap. This technique achieves a high degree of success with respect to good implant lens position. Use of this method avoids decentration and pupillary capture associated with placing only one loop in the capsular bag.

This paper presents an evaluation of the astigmatism induced in two groups of consecutive surgeries for cataract. At risk is the hypothesis that phacoemulsification (Group 2) induces less astigmatism than extracapsular cataract extraction (Group 1) in a series.

A history of the 2 syndromes, acute posterior multifocal placoid pigment epitheliopathy and geographic helicoid peripapillary choroidopathy is presented. A complete review of the literature is beyond the scope of this presentation, but the major contributions in recent years are cited. A more complete bibliography may be obtained from our sources. Four cases are presented, each of which fulfills some of the criteria for both syndromes. It is hypothesized that both entities may be variants of one disorder with an obscure etiology.