[Diabetic retinopathy. Facts and speculations].
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Blindness↗
Biomedical subjects
H Freyler
Publications and source records attributed to H Freyler.
[Healing of lamellar corneal grafts in rabbit eyes after gluing with highly concentrated fibrinogen].
24 rabbit eyes were submitted to lamellar corneal keratoplasty, the grafts being fixed by highly concentrated fibrinogen. Adhesion of the graft seemed satisfactory after 5 min, and the postoperative oedema cleared within 2 weeks. However, biomicroscopy and histology revealed a limited axial cicatrization while in the majority of cases marginal wound adaptation was insufficient. In 5 of 8 eyes followed up more than one week clear grafts were obtained, surrounded by a low marginal step.
Adhesives↗
[Relationship between loss of sight and mortality in diabetics with retinopathy (a retrospective study over the terminal 5 years) (author's transl)].
1642 diabetics with retinopathy were controlled at half-yearly intervals over 4 to 10 years (6 years on average) using fundus photography, fluoresceinangiography and measurement of visual acuity. 83 of these patients died and the data documented in 43 patients over a mean period of 5.2 years prior to death allowed a retrospective evaluation of the clinical findings and therapeutic results. 27 patients had undergone bilateral and 16 unilateral photocoagulation at the beginning of the observation period. 9 patients were blind already at the outset. Of 13 patients who became blind during the observation period 10 had not undergone photocoagulation of the affected eye. The time span between blindness and death was shorter (1.5 years) in the 3 patients (5 eyes) who had undergone photocoagulation than in the untreated diabetics (4.3 years). All 23 patients in whom the initial visual acuity was maintained had undergone photocoagulation. Presence of florid diabetic retinopathy or nephropathy adversely influenced the results of photocoagulation.
Adult↗
[Echoculometry of the scleral buckle after retinal detachment surgery with and without subretinal drainage (author's transl)].
In a series of 32 eyes, the elevation of the scleral buckle was measured by means of A-scan echo-oculometry at the end of retinal detachment surgery, 6 and 10 h later, and 2, 3, 4, 8, 14, and 21 days after cryopexy and plombage with a 5 mm diameter silicon sponge. Subretinal drainage was applied in 50% of the cases. In more than 50% maximal indentation was found 2 days postoperatively; in less than 50%, 3 days postoperatively. Statistically significant, this maximum appeared earlier in cases with subretinal drainage than in cases without drainage. The highest elevation of the buckle persisted from one to two weeks and decreased during the third week.
Drainage↗
[Aqueous outflow following seton operations (author's transl)].
In 6 rabbits which had been submitted to a seton operation 2--6 months previously, the mode of aqueous outflow has been documented photographically after injection of fluorescein into the anterior chamber. In all 6 cases the catheter allowed direct passage of aqueous humour through its lumen into the subconjunctival space; further sources of diffuse aqueous egress were provable at the site of the corneo-slceral wound, either next to the catheter or aside from it. Additional drainage via preformed channels occurred through lymphatic vessels as well as through secondary aqueous veins.
Animals↗
[Fluorescence-angiography, infrared-photography and histology in malignant melanoma of the papilla (author's transl)].
In a 60-year-old female a juxtapapillary malignant melanoma of the choroid invading and strangling the prelaminary section of the optic nerve head, and being masked by a massive papilledema, could be revealed by combined application of ultrasonography, fluorescenceangiography and infrared-photography. The histological examination confirmed the clinical diagnosis.
Cranial Nerve Neoplasms↗
[Retinal detachment with unfavorable prognosis].
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Female↗
[The usefulness of echography in retinal surgery (author's transl)].
Upon utilization of echography one certainly will not be able to detect retinal defects; however, other parameters of retinal detachment which by means of solely optical examination techniques may remain undiagnosed can be evaluated successfully. This concerns not only the diagnosis of retinal detachment alone but also the measurement of the height of the detachment including its possible variations, the accuracy of this method being up to 0.1 mm. This will also apply to the distinction of serous, haemorrhagic and solid detachment of the choroid, the amount of liquefaction of a subchorioidal haemorrhage as well as the assessment of the relationships between vitreous membranes and retinal detachment: this applies especially to cases with hazy media and decreased visibility of the fundus. Accordingly clinical echography may be successfully applied, prior to retinal surgery, during the operation and during the postoperative follow-up.
Humans↗
[Diabetic retinopathy: 10 years after light-coagulation (author's transl)].
A retrospective study of 19 patients, who suffered from diabetic retinopathy, were submitted to a xenon-light-coagulation 10 years ago and have been regularly checked, shows better results in the treated eyes than in the untreated fellow-eyes in regard to visual acuity and background morphology. In cases of poorly controlled metabolism, heavy smoking and simultaneous suffering from hypertension and nephropathy the prognosis of the treated eyes is unfavourably affected.
Diabetic Retinopathy↗
Limitations of successful photocoagulation in proliferative diabetic retinopathy.
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Blindness↗
[Gluing with fibrin in corneal surgery. An experimental study (author's transl)].
Penetrating corneal incisions of various sizes and forms were microsurgically glued onto 48 rabbit eyes by means of fibrinogen-plasma cryoprecipitate with or without 10x0 nylon sutures. Linear or curved penetrating corneal cuts up to 4 mm in length could be immediately closed water tight by pure gluing and without development of anterior synechiae. The suturing of oblique cuts may prove problematic. The more oblique such cuts were, the better the results they yielded after gluing. In cases of linear penetrating corneal incisions exceeding 4 mm in length, and in star-shaped wounds with radiants over 3 mm in length, anterior synechiae could only be avoided by application of additional sutures. Pure or additional gluing of corneal penetrating cuts accelerated wound healing, but was followed by broader scars than after pure suturing. Hence, the gluing of certain types of penetrating corneal wounds by means of fibrin can be applied only as an auxiliary procedure to microsurgical wound closure with sutures.
Animals↗
[Erosive-ulcerative type of herpes simplex of the lids (author's transl)].
In 14 patients the diagnosis of an erosive-ulcerative type of herpes simplex of the lids was made. It is characterized by erosions of the intermarginal portion of the lid or by erosions or ulcers of the skin, especially close to the lid margin. A combination of both clinical forms is possible. Characteristic herpetic vesicles have been observed only in one case, being situated in close proximity to the erosive lesion of the lid margin. The visualisation of erosions located at the intermarginal portion of the lid can be facilitated by staining with fluorescein. The lack of vesicular eruptions impedes a proper diagnosis; hence one should search for the history of recurrent herpetic infections. A presumptive diagnosis can be confirmed by the immunofluorescence technique. For treatment, topical application of virustatic and antibiotic ointment is recommended.
Blister↗
[Growth hormone and diabetic retinopathy (author's transl)].
Changes in the serum level of growth hormone have been studied in 28 diabetics (6 exhibiting no diabetic retinopathy (d. r.), 10 displaying a non proliferative d. r., 6 having proliferative d. r., and 6 Brittle-diabetes) together with a control group consisting of 11 subjects (5 being totally healthy, and 6 having acromegaly without d. r.). Blood samples were obtained before and after arginine and glucagon administration and also following controlled exercise on the ergometer with 50% of the actual working capacity during 20 minutes. The presence of d. r. and its stage has been determined by fluorescein angiography. Our results demonstrate that an increased secretion of growth hormone in diabetics actually constitutes a manifestation of metabolic instability. Apparantly no correlation exists between the appearance of d. r. or its stage and the degree of growth hormone release.
Acromegaly↗
[10 years' experience with our department for diabetic retinopathy (author's transl)].
A report is given on 10 year's experience with 2500 diabetic patients, who were followed up and treated in a special department for diabetic retinopathy at the 1st Vienna University eye clinic. The criteria for treatment of diabetic retinopathy by means of photocoagulation, intrascleral diathermy-coagulation and vitrectomy or a combination of these treatment methods are outlined. The fluorescein angiogram served as the basis for the technic of photocoagulation used in a particular case of diabetic retinopathy and for the evaluation of the success of this treatment.
Ambulatory Care↗
[Siderosis bulbi et lentis produced by intralenticular rust (author's transl)].
A 17-year-old apprentice affected with siderosis bulbi and lentis of his right eye, was examined by biomicroscopy, ultrasonography and x-rays without evidence of an i.o. foreign body. After extraction of the cataractous lens all signs of siderosis disappeared within six weeks. The histologic examination of the lens showed a small particle of subcapsular rust.
Adolescent↗
[Fluorescence angiography as a basis for successful prophylactic and therapeutic light coagulation for diabetic retinopathy (author's transl)].
The fluorescence angiogramme served as a basis for the plan of treatment and as a criterion of treatment success in 192 patients with diabetic retinopathy who underwent xenon-light coagulation between January 1971 and October 1972. In 64 patients this success could be statistically evaluated comparing the untreated partner eye according to the exact Fisher-test. The rate of success of light coagulation showed itself to be statistically highly significant (p less than 0.01%) with regard to retinal morphology and haemodynamics, but with regard to visual acuity only statistically barely significant (p less than 5%). For the influencing of the capillary occlusion process with light coagulation no statistical significance (p = 25.19%) was found, and for the influencing of the capillary permeation disturbances with light coagulation a slight statistical significancing of the capillary permeation disturbances with light coagulation a slight statistical significnace (p less than 5%) was calculated. For avoiding or hindering present or threatened new vessel formation with light coagulation we calculated a statistical significance of p less than 1%.
Capillaries↗
[Modern trends in the treatment of diabetic retinopathy (author's transl)].
Adequate control of diabetic patients may not only delay the appearance of diabetic retinopathy, but may, moreover, effect the regression of fundus changes at the pre-retinopathic stage and in cases of commencing non-proliferative retinopathy. Medical treatment is based on the achievement of a decrease in vascular permeability and a lowering of the blood lipid level; a diet enriched with phosphates may influence retinal hypoxia by increasing the 2,3 diphosphoglycerate level in the erythrocytes, thereby leading to an improved free oxygen supply to the tissue. Complete medical and dietetic compensation of hyper-permeability of the retinal capillaries, of the intraretinal exudation of lipoproteins, and of retinal hypoxia belong still today to utopia; hence, conservative treatment is only of auxiliary character. Hypophysectomy has largely been abandoned in view of the mutilation involved and the poor results of this procedure. The most effective active treatment is photocoagulation. The best results are obtained by a combination of generalized unselective coagulation of the peripheral retina by means of a xenon coagulator and the selective elimination of progressive vascular changes seen in the fluorescein angiogram with argon laser.
Capillary Permeability↗
Echography and histological studies in various eye conditions.
A correlation between A-scan echograms recorded clinically in vivo and histological studies of corresponding sections has been made in 42 eyes with intraocular pathological conditions. This study yielded both new and little known acoustic differential criteria for the diagnosis of retinoschisis, funnel-shaped vitreous detachments, serous as well as hemorrhagic retinal and choroidal detachments, intravitreal hemorrhages, and intraocular tumors.
Choroid Neoplasms↗