Biomedical subjects

J B Jonas

Publications and source records attributed to J B Jonas.

At least 109 records · Page 6Linked to original sources

PubMed2000

Influence of experimental chronic high-pressure glaucoma on age-related macular degeneration in rhesus monkeys.

PURPOSE: To assess prospectively whether development of age-related macular degeneration is influenced by experimentally induced chronic high-pressure glaucoma, and whether age-related macular degeneration influences the appearance of the optic nerve head in experimental chronic high-pressure glaucoma in older rhesus monkeys. METHODS: The longitudinal study included 102 eyes of 52 rhesus monkeys. The total study group was divided into a group with experimentally induced unilateral chronic high-pressure glaucoma (n = 40 eyes) and a normal control group (n = 62 eyes). Additionally, arterial hypertension and atherosclerosis were experimentally induced in both study groups in a similar percentage of monkeys. Mean monkey age at the end of the study was 19.6 +/- 3.1 years (range, 13-24 years). The macular region, optic disc, and retinal nerve fiber layer were morphometrically evaluated by color wide-angle fundus photographs taken at baseline and at the end of the study. RESULTS: The degree of age-related macular degeneration, measured as number and area of drusen in the foveal and extrafoveal region of the macula, did not differ significantly between the two study groups. In the glaucomatous group, the degree of macular degeneration was statistically independent of the development of parapapillary atrophy, loss of neuroretinal rim, and decrease in the visibility of the retinal nerve fiber layer. CONCLUSIONS: Development of age-related macular degeneration in rhesus monkeys is independent of concomitant chronic high-pressure glaucoma, including the development of glaucomatous parapapillary chorioretinal atrophy. Conversely, age-related macular degeneration does not markedly influence the course of experimental chronic high-pressure glaucoma or the development of parapapillary atrophy in monkeys.

Animals↗

PubMed2000

Ophthalmoscopic appearance of the normal optic nerve head in rhesus monkeys.

PURPOSE: To evaluate the ophthalmoscopic appearance of the normal optic disc, parapapillary region, and retinal nerve fiber layer in rhesus monkeys. METHODS: Color stereo fundus photographs of 17 normal eyes of 17 rhesus monkeys aged between 13 and 23 years were morphometrically evaluated. RESULTS: The neuroretinal rim was significantly (P: < 0.008) broadest in the inferior disc region followed by the superior disc region, the nasal region, and the temporal region. Retinal nerve fiber layer visibility was significantly highest in the inferior temporal fundus region followed by the superior temporal fundus region, the superior nasal fundus region, and the inferior nasal fundus region. It decreased significantly (P: < 0.001) with increasing age. The retinal arterioles were significantly (P: < 0.01) wider in the inferior temporal and superior temporal fundus regions than in the superior nasal and inferior nasal fundus regions. The alpha zone of parapapillary atrophy (14/17 or 82.4%) occurred significantly (P: < 0.001) more often than the beta zone (2/17 or 11.8%). In 15 eyes (88. 2%), the foveola was located inferior to a horizontal line drawn through the center of the optic disc. Neuroretinal rim shape and area and size of alpha and beta zones of parapapillary atrophy were independent of age. CONCLUSIONS: As in humans, in normal rhesus monkeys the neuroretinal rim has a typical physiologic configuration that spatially correlates with the retinal arteriole diameter, retinal nerve fiber layer visibility, and position of the foveola inferior to the center of the optic disc. Neuroretinal rim shape is independent of age. Retinal nerve fiber layer visibility decreases significantly with increasing age. These findings may be useful for the early detection and differentiation of experimental optic nerve damage in rhesus monkeys.

Animals↗

PubMed1999

Retinal nerve fiber layer thickness in human eyes.

BACKGROUND: A study was carried out to measure the thickness of the retinal nerve fiber layer (RNFL) at the optic disc border. METHODS: RNFL thickness at the optic disc border was histomorphometrically measured on histological sections of 22 human eyes with normal optic nerves and 21 human eyes with absolute secondary angle-closure glaucoma. For three eyes with normal optic nerves, serial sections through the whole optic disc area were available. RESULTS: In the eyes with normal optic nerves, the RNFL at the optic disc border showed a double hump configuration with the highest mean thickness in the inferior quadrant (mean +/- S.D: 266+/-64 microm), followed by the superior quadrant (240+/-57 microm), the nasal quadrant (220+/-70 microm), and finally the temporal quadrant (170+/-58 microm). In the three globes with serial sections, RNFL was thickest at the inferior disc pole (397+/-58 microm), followed by the superior disc pole (313+/-38 microm), the nasal disc pole (165+/-19 microm), and finally the temporal disc pole (131+/-15 microm). In the eyes with absolute glaucoma, mean thickness of the remainder of the RNFL was 40+/-18 microm with no marked differences between the disc regions. CONCLUSIONS: In normal eyes, the RNFL shows a double hump configuration with its thinnest part at the temporal disc pole, followed by the nasal disc pole and the superior disc pole. RNFL is thickest at the inferior disc pole. In glaucomatous optic neuropathy, the inner limiting membrane moves backward about 60-100 microm at the temporal disc border, and more than 200 microm at the inferior and superior disc poles.

Age Factors↗

PubMed1999

Loosening of single versus double running sutures in penetrating keratoplasty for keratoconus.

PURPOSE: Purpose of the study was to evaluate single versus double running sutures in penetrating keratoplasty for keratoconus with respect to suture loosening. METHODS: Eighty-eight patients were consecutively operated for keratoconus by the same surgeon with the same surgical technique. For the first 45 patients, a single running 10-0 nylon suture was used. For the remaining 43 patients, double running 10-0 nylon sutures were taken. RESULTS: Suture loosening was observed significantly (P<0.001; Chi-Square test) more often in the patients with a single running suture (12/45=27%) than in the patients with double running sutures (0/43=0%). CONCLUSIONS: The results indicate that double running sutures in comparison to a single running suture may be helpful in preventing suture loosening in penetrating keratoplasty for keratoconus.

Corneal Transplantation↗

PubMed1999

Family history of glaucoma in the primary and secondary open-angle glaucomas.

BACKGROUND: A study was carried out to evaluate the frequency of a positive family history in the primary and secondary open-angle glaucomas. PATIENTS AND METHODS: The study included 1176 patients with chronic open-angle glaucoma who were differentiated into secondary open-angle glaucoma [pseudoexfoliative glaucoma (n=144) and pigmentary glaucoma (n=61)], and primary open-angle glaucoma (POAG; n=971). The POAG group was divided into non-highly-myopic patients without ("non-highly-myopic POAG"; n=662) or with circular parapapillary atrophy ("age-related atrophic POAG"; n=168), highly myopic POAG (n=35), and focal normal-pressure glaucoma (n=106). All patients were asked whether family members had glaucoma. RESULTS: In the POAG group, frequency of a positive family history of glaucoma (overall frequency 24.5%) decreased significantly with age from 35.8% in patients (n=240) younger than 50 years, to 25% in patients (n=501) aged between 51 and 70 years and to 11.7% in patients (n=230) older than 70 years. The overall frequencies of a positive family history of glaucoma did not vary significantly between age-related atrophic POAG, focal normal-pressure glaucoma, pseudoexfoliative glaucoma, and pigmentary glaucoma, compared with age-matched groups of non-highly-myopic POAG. Highly myopic POAG had a lower, but not significantly lower, frequency of a positive family history of glaucoma (17.1% vs 26.9%). CONCLUSIONS: In POAG, frequency of a known positive family history of glaucoma decreases with increasing age. Apart from juvenile-onset POAG with a relatively high, and highly myopic POAG with a relatively low frequency of known heredity, other primary and secondary open-angle glaucomas do not show pronounced differences in this variable when adjusted for age.

Age Factors↗

PubMed1999

Parapapillary atrophy in the chronic open-angle glaucomas.

BACKGROUND: A study was carried out to evaluate whether parapapillary atrophy varies among different chronic open-angle glaucomas. METHODS: The study included 625 Caucasian patients with primary open-angle glaucoma (POAG), 123 patients with secondary open-angle glaucoma (pseudoexfoliative glaucoma n=86; pigmentary glaucoma n=37), and 481 normal subjects. POAG was differentiated into highly myopic POAG (n=32), juvenile POAG (n=33), focal normal-pressure glaucoma (n=46), "sclerotic POAG" with marked fundus tesselation (n=89), and "ordinary POAG" comprising the remaining POAG eyes (n=425). Color stereo optic disc photographs were morphometrically evaluated. RESULTS: The beta zone of parapapillary atrophy was significantly larger in sclerotic POAG (1.00+/-1.37 mm(2)) than in pseudoexfoliative glaucoma (0.65+/-0.93 mm(2)), pigmentary glaucoma (0.42+/-0.58 mm(2)), ordinary POAG (0.66+/-1.06 mm(2)), and focal normal-pressure glaucoma (0.34+/-0.36 mm(2)). In ordinary POAG, the beta zone was significantly larger than in juvenile POAG (0.33+/-0.72 mm(2)). Compared with all glaucoma groups, the beta zone was significantly the smallest in the normal eyes (0. 18+/-0.57 mm(2)). The alpha zone of parapapillary atrophy was significantly larger in the glaucoma groups than in the normal control group, with no significant difference between the glaucoma groups. The myopic crescent (4.11+/-3.42 mm(2)) present in the highly myopic eyes was significantly larger than the beta zone in any other group. CONCLUSION: The beta zone of parapapillary atrophy varies by a factor of more than 3 between the various types of chronic primary and secondary open-angle glaucomas. This may be important diagnostically and pathogenetically.

Adult↗

PubMed1999

Age-related macular degeneration and optic disk morphology.

PURPOSE: To assess the relationship between age-related macular degeneration and appearance of the optic disk. METHOD: By morphometric evaluation of wide-angle color fundus photographs, 143 patients with age-related macular degeneration were compared with 33 normal subjects and with 83 diabetic patients. RESULTS: Size and shape of the optic disk and size of parapapillary atrophy did not vary significantly (P > .12) between the study groups. CONCLUSIONS: Age-related macular degeneration is not associated with special features in the appearance of the optic disk. Parapapillary atrophy, large or small optic disk, and abnormal disk shape are neither risk factors nor protective factors of age-related macular degeneration.

Adult↗

PubMed1999

Optic disk morphology in experimental central retinal artery occlusion in rhesus monkeys.

PURPOSE: To evaluate longitudinally the optic disk morphology of nonglaucomatous optic nerve damage secondary to retinal nerve fiber damage, using experimental central retinal artery occlusion in rhesus monkey eyes as a model. METHODS: This prospective study included 24 eyes of 16 monkeys. In eight eyes of eight animals, central retinal artery occlusion was produced by clamping the central retinal artery in the retrobulbar space. Occlusion was verified by fluorescein fundus angiography. The same eyes at baseline as well as the eight contralateral healthy eyes and eight monkey eyes with experimental high-pressure glaucoma served as control groups. Serially taken optic disk photographs were morphometrically evaluated. RESULTS: The area and shape of the neuroretinal rim and alpha zone and beta zone of parapapillary chorioretinal atrophy of eyes after central retinal artery occlusion did not vary significantly (P > .30) from the same eyes before central retinal artery occlusion nor from the normal contralateral eyes. In the glaucomatous eyes, the neuroretinal rim was significantly (P < .001) smaller and parapapillary atrophy significantly (P = .01) larger than in the eyes after central retinal artery occlusion. CONCLUSIONS: Experimental central retinal artery occlusion, in contrast to glaucoma, does not markedly change the size and shape of parapapillary atrophy and neuroretinal rim; this confirms previous clinical studies. Thus, assessment of parapapillary atrophy and neuroretinal rim may be helpful to differentiate between glaucomatous optic neuropathy and nonglaucomatous optic neuropathy secondary to retinal nerve fiber damage. Parapapillary atrophy is independent of decreased retinal blood perfusion and development of nonglaucomatous optic nerve atrophy following experimental central retinal artery occlusion.

Animals↗

PubMed1999

Relationship between parapapillary atrophy and visual field abnormality in primary open-angle glaucoma.

PURPOSE: To investigate the relationship of parapapillary atrophy measured by confocal scanning laser ophthalmoscopy to visual field sensitivity measured with standard automated perimetry and short-wavelength automated perimetry in patients with primary open-angle glaucoma. METHODS: Forty-seven eyes of 47 primary open-angle glaucoma patients with increased intraocular pressure (> or = 22 mm Hg) were enrolled. Optic nerve head topography and parapapillary atrophy (beta and alpha zones) were assessed by confocal scanning laser ophthalmoscopy. Mean deviation and corrected pattern SD were assessed with standard automated perimetry and short-wavelength automated perimetry. RESULTS: Beta and alpha zones were found in 23 (49%) and 47 (100%) eyes with primary open-angle glaucoma, respectively. The area of beta zone showed significant correlations with MD of standard automated perimetry, corrected pattern SD of standard automated perimetry, and corrected pattern SD of short-wavelength automated perimetry (Spearman r = -0.366, P = .012; r = 0.327, P = .025; and r = 0.436, P = .002, respectively). The area of alpha zone showed a significant correlation with mean deviation of standard automated perimetry (r = -0.378, P = .009). Mean MD of standard automated perimetry, mean corrected pattern SD of standard automated perimetry, and mean corrected pattern SD of short-wavelength automated perimetry were significantly worse in eyes with beta zone than in eyes without beta zone. CONCLUSIONS: Parapapillary atrophy measured by confocal scanning laser ophthalmoscopy, especially beta zone, is associated with glaucomatous visual field loss demonstrated by standard automated perimetry and short-wavelength automated perimetry.

Adult↗

PubMed1999

Timing of retinal redetachment after removal of intraocular silicone oil tamponade.

PURPOSE: To evaluate the interval between removal of intraocular silicone oil tamponade and retinal redetachment after pars plana vitrectomy, and to investigate factors influencing the length of the interval. PATIENTS AND METHODS: The retrospective study included 42 eyes of 42 consecutive patients who experienced a retinal redetachment after silicone oil had been removed 8.0+/-6.2 months after an initial pars plana vitrectomy including intraocular silicone oil (5,000 centistokes) tamponade. Pars plana vitrectomy had been performed for proliferative vitreoretinopathy caused by complicated rhegmatogenous retinal detachment. RESULTS: The retina redetached 2 days to 5.5 months after silicone oil removal (mean +/- SD, 1.3+/-1.4 months; median, 18 days). Thirteen (30%) of all 42 redetachments occurred in the first 9 days, 21 (50%) of all 42 retinal redetachments occurred in the first 18 days, and 32 (75%) of all 42 retinal redetachments occurred in the first 50 days. The interval between silicone oil removal and retinal redetachment was statistically (by analysis of variance) independent of the method of silicone removal (transpupillary drainage vs via pars plana sclerotomies), refractive error of the eye (P = .62), time between initial pars plana vitrectomy and silicone oil removal (P = .99), visual acuity before silicone oil removal (P = .26), type of anesthesia (P = .69), gender (P = .80), and age (P = .48) of the patients. CONCLUSION: The risk of retinal redetachment decreases steeply with increasing time after silicone oil removal. Three to 5 months after oil removal, retinal redetachment becomes unlikely. The time of retinal redetachment is statistically independent of the method of silicone oil removal, refractive error, time between the preceding pars plana vitrectomy and silicone oil removal, visual acuity before silicone oil removal, type of anesthesia, and gender and age of the patents. These data may be important for scheduling reexaminations and for counseling patients in their planned activities after removal of intraocular silicone oil tamponade.

Adolescent↗

PubMed1999

Rhegmatogenous retinal detachment after block excision of epithelial implantation cysts and tumors of the anterior uvea.

OBJECTIVE: To report on frequency, time of occurrence, treatment, and final outcome of rhegmatogenous retinal detachment after block excision, combined with corneoscleral tectonic grafts, of intraocular epithelial implantation cysts and tumors of the anterior uvea involving the anterior chamber angle. DESIGN: Noncomparative case series. PARTICIPANTS: The study included 144 patients who had consecutively undergone scleral full-thickness block excision of tumors of the anterior uvea (n = 87) or intraocular epithelial implantation cysts (n = 57). Diameter of the block excision ranged between 5.5 and 20 mm. In 39 patients, the tumor extended posterior to the ora serrata. INTERVENTIONS: Retinal detachment surgery. MAIN OUTCOME MEASURES: Retinal detachment rate, visual acuity, risk factors. RESULTS: Retinal detachment occurred in 10 (6.9%) of 144 patients (2 of 57, or 3.5% of patients with cysts; 8 of 87 or 9.2% of patients with tumors) 3 to 12 months after block excision. Six patients underwent primary pars plana vitrectomy with temporary endotamponade by silicone oil, which was removed 3 to 9 months later. In four patients, a scleral buckling procedure only was performed. After a mean follow-up of 31 months after silicone oil removal or the buckling procedure (median, 30 months; range, 13-42 months), the retina has remained attached in all patients operated on. Visual acuity increased from 2/20 (median; range, light perception-6/20) to 8/20 (median; range, 2/20-12/20). In the eyes with retinal detachment compared to the eyes without retinal detachment, the block excision was significantly larger (13.75+/-4.86 mm vs. 9.41+/-3.02; P = 0.01) and was located significantly more posteriorly (limbus distance of posterior excision margin: 6.75+/-2.87 vs. 4.35+/-3.24 mm; P = 0.01). CONCLUSIONS: Scleral buckling procedures and primary pars plana vitrectomy with temporary ocular endotamponade can give acceptable results in eyes with rhegmatogenous retinal detachment occurring after block excision of epithelial implantation cysts or tumors of the anterior uvea. Despite intraoperative vitreous prolapse or tumor extension posterior to the ciliary body, rhegmatogenous retinal detachment occurs in fewer than 10% of patients undergoing block excision of cysts or tumors of the anterior uvea. Size and posterior location of the block excision are the main risk factors for rhegmatogenous retinal detachment, which becomes unlikely later than 12 months after surgery.

Adolescent↗

PubMed1999

Determinants of optic disc characteristics in a general population: The Rotterdam Study.

OBJECTIVE: To determine whether age, gender, height, and refractive error are associated with optic disc morphology in a general elderly population. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: A total of 5114 subjects 55 years of age or older participated in this study, representing 76% of a population-based sample of 6777 ophthalmologically examined white patients from a geographically well-defined suburb in Rotterdam, The Netherlands. MAIN OUTCOME MEASURES: Disc area, neural rim area, cup area, vertical and horizontal cup-to-disc ratios, and parapapillary atrophy. METHODS: Disc characteristics were measured on stereoscopic simultaneous optic disc transparencies using an image analyzer. The presence and location of parapapillary atrophy, differentiated into zones alpha and beta, were assessed from disc transparencies of both eyes in a random sample of 894 persons. Subjects with open-angle glaucoma were excluded. RESULTS: The mean disc area was 2.42 mm2 (standard deviation [SD], 0.47), mean neural rim area was 1.85 mm2 (SD, 0.39), mean cup area was 0.57 mm2 (SD, 0.34), mean vertical cup-to-disc ratio was 0.49 (SD, 0.14), and mean horizontal cup-to-disc ratio was 0.40 (SD, 0.14). Age was not a determinant of any disc characteristic. Disc and rim areas were 3.2% (P < 0.0005; 95% confidence interval [CI], 2.7%-3.7%) and 4.3% (P < 0.0005; 95% CI, 3.5%-4.6%) larger in men than in women. For each diopter increase toward myopia, the disc area increased by 0.033 mm2 (P < 0.0005; 95% CI, 0.027-0.038) and neural rim area by 0.029 mm2 (P < 0.0005; 95% CI, 0.025-0.034). The disc area increased by 0.02 mm2 (P = 0.02; 95% CI, 0.005,0.05) for each 10-cm increase in height. The prevalence of zone alpha slightly decreased by 0.4% per 10 years of age (P = 0.035; 95% CI, 0.03%-0.8%), whereas the prevalence of zone beta increased by 1.3% (P = 0.0003; 95% CI, 0.57%-1.9%) for each diopter increase toward myopia. CONCLUSIONS: In a general population, statistically normal discs may vary twofold in disc area and threefold in rim area. Age is not associated with any disc characteristic, whereas disc area and neural rim area are slightly larger in men than in women. Refractive error is weakly related to disc area and neural rim area. Height is weakly related to disc area in persons of medium height. The prevalence of zone beta is higher in myopic eyes.

Age Factors↗

PubMed1999

[Morphology of the optic papilla in glaucoma. I. Primary open-angle glaucoma].

BACKGROUND: Previous studies have shown that the chronic open-angle glaucomas form a heterogeneous spectrum of diseases which have in common an open anterior chamber angle and glaucomatous optic nerve damage. Purpose of this study was to evaluate whether the appearance of the optic disc differs among the various types of primary open-angle glaucoma. METHODS: Color stereo optic disc photographs of 683 patients with primary open-angle glaucoma (POAG), and 481 normal eyes were morphometrically evaluated. RESULTS: Morphologic characteristics of the glaucoma types were as follows: Highly myopic POAG: secondary macrodiscs with abnormal shape; shallow, flat, concentric disc cupping; low frequency of disc hemorrhages; large parapapillary atrophy or myopic crescent; medium to low intraocular pressure. Juvenile-onset POAG: Optic disc of normal size and shape; deep and steep disc cupping; low frequency of broad rim notches or large disc hemorrhages; small parapapillary atrophy; high minimal and maximal intraocular pressure measurements. Age-related atrophic POAG: Optic disc of normal size and shape; shallow, flat and concentric disc cupping; medium to low frequency of disc hemorrhages; large parapapillary atrophy; medium to low intraocular pressure. Eyes with normal-pressure glaucoma: Optic disc of normal size and shape; deep and steep cupping; relatively small parapapillary atrophy; high frequency of disc hemorrhages and rim notches. CONCLUSIONS: These characteristics in the appearance of the optic disc may be helpful for clinical diagnosis and therapy and may give pathogenetic hints.

Adult↗

PubMed1999

[Morphology of the optic papilla in glaucoma. II. Secondary chronic open angle glaucoma].

UNLABELLED: Previous studies have shown that the chronic open-angle glaucomas form a heterogeneous spectrum of diseases which have in common an open anterior chamber angle and glaucomatous optic nerve damage. Purpose of this study was to evaluate whether the appearance of the optic disc shows specific features among various types of secondary chronic open-angle glaucoma. METHODS: Clinical data and color-stereo optic disc photographs of 126 patients with pseudoexfoliative glaucoma and 47 patients with pigmentary glaucoma were compared with those of 501 patients with primary open-angle glaucoma (POAG) and of 481 normal subjects. The glaucoma groups did not differ in neuroretinal rim nor in perimetric mean defect. RESULTS: Mean optic disc area was significantly smaller in the pseudoexfoliative glaucoma eyes (2.54 +/- 0.51 mm2 vs. 2.71 +/- 0.63 mm2, p = 0.03) than in the primary open-angle glaucoma eyes. The pigmentary glaucoma group did not vary significantly from the primary open-angle glaucoma group in size of the optic disc. No significant differences were found for neuroretinal rim area, configuration of neuroretinal rim, depth of optic cup and diameters of the retinal arterioles and venules at the disc border between the secondary glaucoma groups and the POAG group respectively. Size of zone beta of the parapapillary atrophy was slightly, but not significantly smaller in the secondary glaucoma groups than in POAG. In the secondary glaucoma groups, the maximal intraocular pressure measurements were significantly (p < 0.001) higher than in the group with POAG. All glaucoma groups had a significantly smaller neuroretinal rim, significantly smaller retinal arterioles, and significantly larger parapapillary atrophy compared to the normal group. CONCLUSIONS: Except of a slightly smaller optic disc in eyes with pseudoexfoliative glaucoma, eyes with secondary glaucoma due to pseudoexfoliation or due to pigmentary dispersion do not vary significantly in their optic disc morphology compared to POAG and do not show pathognomonic features of the optic disc despite marked changes in the anterior segment of the eye.

Adult↗

PubMed1999

[Complications after rupture of the lens capsule with vitreous body prolapse during routine cataract operations].

PURPOSE: To evaluate the rate of complications and visual outcome after vitreous loss due to an unintended rupture of the posterior lens capsule during routine cataract surgery. PATIENTS AND METHODS: The study included 32 consecutive patients who underwent planned cataract surgery by extra-capsular extraction or phacoemulsification during which the posterior lens capsule ruptured and vitreous prolaps occurred. In all patients, the same surgeon was called to continue with the operation. After substantial transpapillary vitrectomy, a posterior chamber lens was implanted in all patients. The pseudophakos was transsclerally fixed in 12 patients. Mean follow-up time was 20.9 months (range, 1.5 to 71.6 months). RESULTS: The list of complications included cystoid macula edema in 2 patients (2/32 or 6.2%), persisting corneal endothelial decompensation in 1 patient (1/32 or 3.1%), and dislocation of the pseudophakos in one patient (1/32 or 3.1%). Rhegmatogenous retinal detachment did not occur. Compared with the preoperative status, visual acuity increased in 26 patients (26/32 or 81%). Visual acuity of equal or better than 20/30 was achieved in 15 eyes (15/32 or 47%). In 5 eyes (5/32 or 16%), visual acuity was equal to or better than 20/25. CONCLUSIONS: In eyes with a ruptured posterior lens capsule during routine cataract surgery eventually requiring vitrectomy, frequencies of complications are relatively low, if all vitreous adherent to the edges of the lens capsule rupture is removed by substantial transpapillary vitrectomy, and if in doubt of a sufficient lens capsule support for the posterior chamber lens, the pseudophakos is fixed by transscleral sutures.

Aged↗

PubMed1999

[Cataract extraction combined with trans-pupillary silicone oil drainage by planned posterior capsulorhexis].

BACKGROUND: A cataract is frequently observed after pars plana vitrectomy with silicone oil endotamponade. PATIENTS AND METHODS: Forty-three consecutive patients underwent cataract surgery combined with transpupillary removal of silicone oil. After phacoemulsification of the lens material through a sclerocorneal tunnel incision, a planned posterior capsulorhexis with a diameter of 3-4 mm was performed. By injecting saline through the capsulorhexis into the vitreous cavity, the silicone oil was rinsed out. Widening of the sclerocorneal tunnel facilitated the drainage of the silicone oil through the pupil and tunnel. After ophthalmoscopic evaluation of the fundus, a plano-convex PMMA posterior chamber lens was implanted into the capsular bag or ciliary sulcus, and the corneoscleral tunnel was closed by a 10-0 nylon suture. RESULTS: Depending on the underlying retinal disease the visual acuity improved in some eyes. Silicone oil bubbles left behind in the vitreous cavity were smaller than 0.5 mm in diameter. Persisting corneal decompensation or a clinically detectable cystoid macular edema related to cataract surgery did not occur. Due to the posterior capsulorhexis, secondary cataract did not develop postoperatively. Small postoperative vitreous hemorrhages resolved during the first three post-operative days. Retinal detachment recurred in 11 eyes (11/42 or 26.2%). In one eye, dislocation of the pseudophacos occurred which had to be corrected surgically. Since the pars plana region remained untouched, direct retinal lesions in the periphery of the fundus or marked vitreous hemorrhages were not encountered. CONCLUSIONS: Silicone oil removal can be combined with cataract surgery with transpupillary drainage of the silicone oil.

Adult↗

PubMed1999

[Titration of intraoperative anesthesia and postoperative analgesia].

PURPOSE: To evaluate a temporary retrobulbar catheter for local anesthesia in intraocular surgery and for postoperative analgesia after intraocular surgery. PATIENTS AND METHODS: The study included 40 patients undergoing pars-plana vitrectomy (n = 24) or cyclocryocoagulation (n = 16). After a retrobulbar injection through a 23 G needle, a commercially available 28 G flexible catheter was inserted through the needle. As soon as the patients complained about pain during or up to 24 hours after surgery, local anesthetics were injected through the catheter. RESULTS: Repetitive injections of anesthetics were necessary in 13 patients during pars plana vitrectomy. Starting about 2 hours after surgery, 13 patients after pars-plana vitrectomy and all patients who had undergone cyclocryocoagulation received up to 6 re-injections (every 1.5-5 hours). After all re-injections, the patients became pain-free within two minutes. The catheter was removed after 24 hours. CONCLUSIONS: The results suggest that a temporary insertion of a catheter into the retrobulbar space allows repetitive application of local anesthetics thus leading to a titrable local anesthesia and postoperative analgesia in intraocular surgery.

Anesthesia, Local↗

PubMed1999

[Exit of the retinal central vascular trunk and extent of para-papillary atrophy].

PURPOSE: To evaluate whether the position of the central retinal vessel trunk exit on the lamina cribrosa spatially correlates with the location of parapapillary atrophy in glaucoma. METHODS: Color stereo optic disc photographs of 79 patients with primary or secondary open-angle glaucoma and 53 normal subjects were morphometrically evaluated. We determined the position of the central retinal vessel trunk exit on the lamina cribrosa surface and measured the area of parapapillary atrophy in four 90 degrees quadrants. RESULTS: After correction for normal values, the beta zone area of parapapillary atrophy in the glaucoma eyes was significantly larger, when measured in the disc quadrant most distant to the central retinal vessel trunk exit than as if measured in the quadrant containing the vessel trunk exit. CONCLUSIONS: Position of the central retinal vessel trunk exit on the lamina cribrosa influences the location of parapapillary atrophy in glaucoma. The longer the distance to the central retinal vessel trunk exit, the more enlarged is parapapillary atrophy.

Adult↗