Letters to the Editor
Eye Injuries Caused by Bungee Cords
Dear Editor:
Recently, Cooney and Pieramici published an article on
the potential source of severe “Eye injuries caused by
bungee cords” (Ophthalmology 1997; 104:1644-7). The
authors advocate the use of printed warnings on the pack-
aging of bungee cords and extreme caution by those who
use them. The authors believe that a modification in de-
sign and the use of certified safety glasses may help to
decrease the incidence of bungee cord-related ocular
trauma. I fully agree that users of this product should be
warned of their potential danger. However, I do not be-
lieve that users of this product will use safety glasses at
the moment that it is necessary. In our study of 22 patients
with this type of predictable and preventable ocular injury,
13 (59%) patients had permanent visual impairment (vi-
sual acuity ~6/10, or aphakia) at the end of the follow-
up period.’ Therefore, I believe that loose elastic cords
with metal hooks should not be used at all.
JOHN R. M. CRUYSBERG, MD, PhD
Nijmegen, The Netherlands
Reference
1. Cruysberg JRM, Pinckers A, Catelijns HEJM, et al. A spider
hits the eye. Acta Ophthalmol Stand 199.5;73:571-3.
Author’s reply
Dear Editor:
Indeed, a significant number of patients in Dr. Cruys-
berg’s study had permanent, needless visual impairment
from elastic cords. Although we believe that elastic cords
have the potential to cause significant ocular morbidity,
we do not believe it is realistic to expect that they would
not continue to be used. As such, the universal use of
certified safety glasses and modification in design may
help to reduce the incidence of ocular injuries.
MICHAEL J. COONEY, MD
Baltimore, Maryland
Retinopathy of Prematurity Guidelines
Dear Editor:
We have become aware of an inadvertent ambiguity in
our guidelines for screening for retinopathy of prematurity
(ROP)’ concerning the monitoring of cases of zone I ROP.
Zone I ROP can progress with dramatic speed. Guideline
#5 states, “Infants with ROP or immature vessels de-
tected in zone I should be seen every 1 to 2 weeks until
normal vascularization proceeds to zone III or the risk of
attaining threshold conditions is passed.” It should be
interpreted as follows: It is frequently necessary to exam-
ine zone I ROP at intervals as close as a few days, up to
1 week, not as long as 2 weeks. Even in zone I eyes
without ROP the interval should be 2 weeks or less.
The ambiguously worded guideline #5 was intended
to apply to zone I immature vessels and zone II ROP, not
zone I ROP. Guideline #5 should read “Infants with ROP
detected in zone I should be seen at least every week
until involution of ROP occurs and normal vasculariza-
tion proceeds to zone II, or with immature vessels (with-
out ROP) detected in zone I, should be seen at least every
I to 2 weeks . . .“.
WALTER M. FIERSON, MD, Chair
EARL A. PALMER, MD
ALBERT W. BIGLAN, MD
JOHN T. FLYNN, MD
ROBERTA. PETERSEN,MD
DALE L. PHELPS,MD
Reference
1. Screeningexaminationof prematureinfantsfor retinopathy
of prematurity. A joint statementof the AmericanAcademy
of Pediatrics,the American Associationfor PediatricOph-
thalmologyand Strabismus,andthe AmericanAcademy of
Ophthalmology.Ophthalmology1997;104:888-9.
Surgical Treatment of Parasitic Cysts
Dear Editor:
In the article regarding orbital cysticercosis (Ophthalmol-
ogy 1997;104:1599-1604), Drs. Sekhar and Lemke ac-
knowledge that the fluid of the cysticercus cellulosae cyst
is very toxic, but they surprisingly take few precautions
to protect the ocular adnexae during excision of the cysts.
The recommended technique of dealing with cysts
should include isolation of surrounding tissues with dry
gauze. A fine needle is then inserted into the cyst and the
fluid aspirated. Care is taken to prevent spillage of the
fluid. A 2-cm incision is then made into the capsule, and
the white ectocyst and endocyst are gently teased out
from the capsule with nontoothed rubber-tipped forceps.
The opening of the capsule is then stitched. The capsule
is not dissected from surrounding tissue, as the capsule
collapses and absorbs spontaneously.
This technique prevents toxic fluid from the cyst caus-
ing a virulent inflammation and allows for complete re-
moval of the ecto/endocyst and the scolices, and by not
excising the outer capsule, it does not disturb adjacent
orbital structures. The outer capsulehasbeen shown histo-
logically to be compressedorbital tissue.
DAVID SEVEL, MD, PhD
La Jolla, California
Authors’ reply
Dear Editor:
We thank Dr. Sevel for highlighting the precautions to
be taken while surgically treating parasitic cysts. The rec-
ommendations suggestedby Dr. Sevel have been reported
for the management of hydatid cyst. This type of cyst
may contain a number of daughter cysts that can poten-
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