Biomedical subjects
Publications and source records attributed to I Schipper.
The present paper reports on the advice customarily given to patients and on methods of establishing the indication for radial keratotomy at the author's clinic. Examples are given to illustrate the problems involved. The unsatisfactory results in 2 cases following epikeratophakia are discussed.
The results of a study with Molteno-implants in eyes with intractable glaucoma, performed for the first time in Switzerland, are presented and discussed with regard to visual acuity, intraocular pressure, and painlessness.
In cases of visual impairment due to an accident it is the ophthalmologist's task to assess the functional loss. For the purposes of legal equality norms have been established for functional loss. Differences in the assessment of disability and loss of integrity in various countries are discussed.
On the basis of clinical findings and fluorescein angiography the authors diagnosed Harada's disease in a 30-year-old Caucasian woman. A drastic deterioration occurred under treatment with corticosteroids and immunosuppressive agents. Another cause of the uveitis was looked for and a reactive serology for lues was found in the blood and the cerebrospinal fluid. The severe inflammation was then treated successfully with high doses of penicillin, intravenously administered; visual acuity also improved as a result this treatment. The differential diagnosis of the two conditions is discussed.
After extracapsular cataract extraction, a Simcoe-style posterior chamber intraocular lens was implanted in the left eye of a 69-year-old patient. The visual acuity of the right eye was 20/25 with +3.0 diopter correction. Probably as a result of a biometric error, the left eye was rendered myopic (-1.75 -3.00 X 25 degrees). This anisometropia caused a disturbing diplopia, which could be explained by anisophoria rather than by aniseikonia. The problem of anisophoria is discussed, along with suggestions for correcting the problem.
A short time after a cataract operation without complications in which a 4-loop Binkhorst lens was implanted in a 66-year-old patient, recurrent hyphema with subsequent elevation of intraocular pressure occurred. Therapy with pilocarpine was found to be very effective.
We report the use of Healon to assist in the performance of penetrating keratoplasty. Filling the recipient's anterior chamber with Healon prior to trephination permits complete penetration of the cornea with less chance of damaging underlying structures.
A method for performing phacoemulsification and implantation of a foldable lens (Staar AA 4203) with an anterior chamber maintainer is described. The procedure eliminates the need for viscoelastics, preventing postoperative pressure elevation and reducing costs. The incision is kept sealed during the implantation with the injector, and the anterior chamber remains deep. Making a small incision under positive intraocular pressure pressure prevents the development of high astigmatism. I have implanted more than 500 lenses using this method, with very good results.
We studied a family with pattern dystrophy of the retina (PDR) in order to elucidate the clinical course of the disorder, relations between the different forms, and the mode of inheritance. Thirty-nine family members, representing three generations, underwent a thorough ophthalmological examination, with fluorescein angiography whenever a macular abnormality was suspected. Of family members over the age of 32 years, 46.7% showed signs of PDR. We classified the clinical forms of PDR in this family into four types: minimal lesion, pseudovitelliform type, butterfly-spider type, and late-stage lesion. These forms were predominant in the order cited in age groups 31-40 years, 41-50, 51-60, and > 60 years. Significant visual loss occurred only after the age of 50 years, when 8 of 14 eyes had visual acuity of less than 20/25. Inheritance was autosomal dominant. PDR presented different clinical forms in members of this family, and in successive age classes patterns of increasing severity prevailed. Thus, the different phenotypic forms apparently represent transient stages related to the age of the patient.
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Postoperative hypotony is not rare. When it occurs, effective treatment must be initiated to avoid secondary complications. We report two cases of postoperative hypotony that have been treated successfully with a single injection of balanced salt solution (BSS) into the anterior chamber. One patient developed hypotony three months after combined cataract surgery and trabeculectomy with the use of Mitomycin C (MMC). The cause of hypotony remained unknown. Leakage, hyperfiltration, cyclodialysis, and other possible causes had been excluded. With a single injection of BSS into the anterior chamber the long-standing hypotony was successfully managed. A second patient with hypotony after pars plana vitrectomy was also treated successfully with an injection of BSS into the anterior chamber. We conclude that an injection of BSS into the anterior chamber is an inexpensive and efficacious remedy for postoperative hypotony of unknown etiology.
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BACKGROUND AND OBJECTIVE: To evaluate the effectiveness and safety of combined surgery. PATIENTS AND METHODS: Combined surgery (CS) consisting of pars plana vitrectomy (PPV), phacoemulsification, and implantation of a posterior chamber intraocular lens (PC IOL) in the capsular bag was performed on 26 patients. Another 26 had phacoemulsification with PC IOL insertion one to 84 months (mean 17.3) after PPV (sequential surgery, SS). Mean follow-up was 21.9 months after CS and 19.5 months after the cataract surgery in the SS group. The data were analyzed in a prospective, nonrandomized fashion. RESULTS: Visual acuity and refraction, astigmatism, accuracy of biometry, intraocular pressure, intraoperative, postoperative and long-term complications, and medical treatment were comparable in the two groups. Among the four uveitis patients in each group, transient fibrin formation was more frequent with CS (100%) than with SS (25%). The advantages of CS are that only one operation is needed, intraoperative working conditions are good, macular recovery is not masked by postvitrectomy cataract formation, and ideal lens centration is achievable. Potential disadvantages of CS include a longer operative time and increased technical demand, shrinkage of the anterior capsular opening, which may interfere with fundus view, and increased inflammation may be seen in patients with preexisting uveitis. CONCLUSION: Combined surgery in selected patients is a safe and effective approach, and outcomes are comparable to sequential surgery.