Biomicroscopy in intermediate uveitis.
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Biomedical subjects
Publications and source records attributed to H Slezak.
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The anterior axial vitreous body of aphakic eyes is often severely liquefied. In a vitrectomy case, it was removed easily and completely. The behavior of the prebasal vitreous cortex after the procedure was not predictable. The postoperative biomicroscopic examination resulted in two different findings, are reported on here.
The authors report on the transvitreal application of fibrin glue in retinal detachment surgery. Methods of application and the course of postoperative resorption are illustrated with reference to experimental studies on rabbit eyes. The prospects for this new method of creating chorioretinal adhesions are pointed out and discussed.
Retinal dialyses near the ora are large, crescent-shaped retinal defects immediately behind the ora serrata. It is assumed that they practically always occur without posterior vitreous detachment and spread within the vitreous base (intrabasal retinal dialysis). However, there are evidently exceptions to this rule: there may be posterior vitreous detachment with the posterior hyaloid membrane which encroach on the anterior margin of the retinal defect; the defect then spreads along the posterior margin of the vitreous base and is hence a juxtabasal retinal dialysis. While the ophthalmoscopic features of intrabasal and juxtabasal retinal dialysis near the ora serrata are always identical, there are distinct biomicroscopic differences between the two forms.
During gonioscopy the aqueous humor can be shifted by appropriate indentation with the goniolens (Forbes test). The iris root is affected in a variety of ways: it may sink in, troughlike, or be deformed to an S-shape, or remain unchanged. The different findings depend on the configuration of the ciliary processes and the position of the lens equator; they enable conclusions to be drawn concerning the risks of inverse reaction to miotics or of ciliary lens block (malignant) glaucoma.
In an experimental study the surface characteristics of two fundamentally different lamellar corneal dissection techniques were compared. Using porcine corneae, 9.5 mm lenticles were cut from the whole globe and evaluated by SEM. With an oscillating blade, a smooth cut surface was found in most cases with occasional irregularities. The rotating lamellar keratome had uniform cutting characteristics with a somewhat wavy surface structure, which has not so far been observed in human tissue. By increasing the speed of rotation and decreasing the rate of advance of the blade the surface structure was improved. The two cutting principles and their possible clinical applications are discussed.
Post-traumatic retinal detachment occurs frequently as a late consequence of progressive vitreous changes, especially following penetrating injuries. Occasionally, it develops soon after the trauma, without preceding proliferative vitreoretinopathy, is based on posterior vitreous detachment and morphologically resembles an idiopathic retinal detachment. It is possible that the posterior vitreous detachment in these cases is encouraged by the presence of intravitreal hemorrhage.
There are three forms of lens dislocation in the posterior segment: intravitreal, prebasal, and intrabasal. The location of the dislocated lens depends on gravity and the condition of the vitreous body. As a rule the dislocated lens lies at the bottom of the vitreous cavity; it may be completely embedded in the vitreous substance or completely outside the vitreous body, or partially within the vitreous base. The topographic relations between dislocated lenses and the vitreous body cannot be determined by ophthalmoscopic examination, but biomicroscopy generally permits an accurate assessment. Biomicroscopic findings are described.
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Three iridocorneal endothelial syndromes are distinguished: essential progressive iris atrophy, iris nevus (Cogan-Reese) syndrome, and Chandler's syndrome. Obviously, there are patients in whom findings do not correspond fully to any one of the three syndromes; signs and symptoms which justify being considered as a new iridocorneal endothelial syndrome are described.
Congenital, bilaterally symmetrical dislocation of the lens within the posterior chamber is referred to as lens ectopia. The behavior of the anterior hyaloid membrane in congenital lens ectopia has not been considered hitherto. The anterior hyaloid membrane in the aphakic area of the pupil is intact or ruptured and the ciliovitreal connex in the region of the lens dislocation may be normal or absent. If surgery is planned because of the dislocation, a knowledge of biomicroscopic details of the anterior hyaloid membrane might be useful.
Certain types of intermediary uveitis are accompanied by proliferative vitreoretinopathy and retinal detachment. As a rule both complications are confined to the fundus periphery; they often occur simultaneously but they are not always related to one another. Exudate plaques and/or neovascularizations at the base of the vitreous are the precursors of peripheral proliferative vitreoretinopathy. Clinical findings and their therapeutic consequences are discussed.
As a rule acute primary glaucoma can be diagnosed easily; however, if it is accompanied by pseudoprecipitates (precipitate-like changes of the posterios surface of the cornea), it can simulate a secondary, inflammatory increase in pressure. Pseudoprecipitates are thought to be caused by pressure-induced lesions of the corneal endothelium. They differ from true precipitates by their shape and distribution and appear to be a facultative sign of acute primary glaucoma. In cases with pseudoprecipitates examination of the corneal endothelium with the specular microscope does not reveal any specific findings, only an edema of the corneal endothelium (so-called cornea pseudoguttata).
As a rule, posterior detachment of the vitreous body (even the simple, flat, incomplete type) is irreversible, but in some cases of fresh, moderate, retrovitreal hemorrhage caused by untreated vasoproliferative retinopathy there is evidence of spontaneous reattachment of the vitreous body. Details of this finding are described.
The four methods of illumination in the use of slit-lamp biomicroscopy of the anterior segment, described first by Vogt, are equally useful in the posterior part of the eye. Examination of the ocular fundus is more difficult. In particular, photography of the central and peripheral parts of the fundus demands additional technical arrangements if all the appearances of biomicroscopy are to be recorded.
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