Biomedical subjects
Publications and source records attributed to D Sevel.
An analysis of 56 patients with congenital cataracts was made to determine which factors played a role in the causation of these lenticular defects in Cape Town. There is good evidence that 16% of the defects were caused by intra-uterine rubella virus infection and that a further 30% were hereditary in origin.
The histological sections of 74 retinoblastoma patients were reviewed. The extent of optic nerve invasion was correlated with choroidal/scleral extension. Choroidal invasion carries 100% survival provided that the sclera, iris, and whole optic nerve are not also involved. Invasion of the optic nerve beyond the lamina cribrosa also carries 100% survival provided that the resection line is free and that invasion does not involve the sclera or iris. Plentiful rosettes were usually found in those tumours that had not extended beyond the choroid or as far as the resection line of the optic nerve and were therefore associated with a good prognosis. The absence of rosettes did not necessarily indicate a poor prognosis. The site of metastases was related to optic nerve and scleral/extrascleral extension. The various systems of staging retinoblastoma are compared, and a new system is proposed to cover the whole spectrum of the disease and to offer a reliable guide to prognosis and treatment.
The modified Wright technique for lateral orbitotomy is described, based on 57 orbitotomies. This allows for excellent exposure of the orbit for an area lateral to a line joining the superior orbital foramen to the inferior orbital foramen.
A nationwide survey of pellet gun injuries to the eye, sustained over a 5-year period, was carried out. Eighty-seven cases were reported. Seventy-seven per cent were found to have a final visual acuity of 6/60 or worse on the Snellen chart. The pathological findings and possible steps to reduce the incidence of these injuries are discussed.
A blood cyst of the orbit is an unusual cause of proptosis and most likely arises in a pre-existing haemangioma. If the cyst occurs at the apex of the orbit the blood should be aspirated. This is followed by excision of the cyst wall, the dissection being done with the aid of an operating microscope. If there is evidence of intracranial connection of the blood cyst, namely, splayed superior orbital fissure or cerebrospinal fluid leak, then the patient should be treated with an antibiotic to prevent intracranial infection.
Forty-two chronic asthmatic children, including 10 with associated eczema, were examined for lenticular complications. The children had received oral corticosteroids for a minimum of 3 years. Twelve were treated with beclomethasone inhalant therapy, and the children with eczema had had topical corticosteroids. Only one child was found to have cataracts commensurate with corticosteroid therapy. Possible reasons for the low incidence of cataracts in this study are discussed.
Oscular and orbital injuries due to stab wounds may mask underlying serious intracranial damage. The correct clinical assessment and treatment of such cases require the attention of a team comprising a neurosurgeon, ophthalmologist, otolaryngologist, and plastic surgeon.
When echinococcosis (hydatid disease) attacks the orbit, surgical treatment is required. Although complications of the transcutaneous approach have been disastrous, a lateral orbital approach, removing the ectocyst from within the capsule, has been successful. Epidemiological, clinical and pathological features of 11 cases of echinococcosis of the orbit are described, and the recommended surgical procedure is outlined.