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Biomedical subjects

J Barraquer

Publications and source records attributed to J Barraquer.

At least 19 recordsLinked to original sources
PubMed1992

Cataract surgery and IOL implantation. More than 40 years of personal experience. My present criteria and considerations.

The author refers his personal experience with different types of IOL since 1950. After an initial period of enthusiasm (1950 to 1961) the author abandoned the techniques of Ridley, Strampelli and Dannheim, because of the considerable incidence of severe complications directly related to the IOL. Over many years he emphasized the serious postoperative complications which appeared in the course of the years, even with the different new types of IOL which acquired a certain prestige. With the new posterior chamber lenses placed in the capsular bag, the results became more encouraging and the author resumed IOL implantation with this type of lenses after an adequate period of observation and experimentation. The present criteria, technique and results of the author are discussed together with some considerations on future research work to develop new techniques for substitution of the opacified lens and also to attempt to restore accommodation.

Accommodation, Ocular↗
PubMed1989

Congenital idiopathic corneal endotheliopathy.

Two unrelated boys had a history of bilateral corneal clouding at birth following uncomplicated full-term gestations and spontaneous vaginal deliveries (without forceps). Clinical examinations disclosed bilateral corneal edema, no inflammation, and normal intraocular pressures. There was no history of similarly affected family members. The patients underwent penetrating keratoplasty at ages 4 months (patient 1) and 12 years (patient 2). Light and electron microscopic studies of the corneal buttons from both patients revealed areas of degeneration of the endothelium and separation of rounded endothelial cells. The morphologic features were strikingly similar to those in two acquired forms of corneal disorders--autoimmune endotheliopathy and "acute endotheliitis." Immunocytologic and in situ hybridization studies for herpes simplex virus were not consistent with either productive or latent corneal infection. Ultrastructural changes in Descemet's membrane reflect delayed or abnormal development of the postnatal nonbanded layer in patients 1 and 2, respectively. These suggest an intrauterine insult that resulted in endothelial dysfunction. The histologic and ultrastructural features of these two congenital cases are not typical of those seen in any of the recognized causes of congenital corneal clouding. We propose that these cases represent a unique congenital corneal endotheliopathy of undetermined origin.

Child↗
PubMed1988

Corneoscleral autotransplant.

We describe the clinicopathologic features of a corneoscleral autotransplant in place for 18 years, with excellent visual results. Donor and some recipient trabecular meshwork was present in some areas. Donor trabecular meshwork was hypocellular and partially covered by an overgrowth of uveal melanocytes. A cyclodialysis cleft was present and closed only by loose connective tissue. It is likely that aqueous outflow was, in part, to the supraciliary space.

Cataract Extraction↗
PubMed1987

Terrien's marginal degeneration: clinicopathologic case reports.

We report the clinicopathologic features of seven cases of Terrien's marginal degeneration. Three specimens studied were lamellar resections and four were full-thickness corneal segments. Of the four full-thickness specimens, three were semilunar and one was an annular ("doughnut-shaped") specimen. All cases had stromal thinning, vascularization, lipid keratopathy and local absence of Bowman's membrane. Descemet's membrane was markedly thickened and the endothelium was intact. Three of the four full-thickness corneal specimens showed healed ruptures of Descemet's membrane. One specimen had four healed successive ruptures in Descemet's membrane in the same area. The corneal endothelium in that area had produced a basement membrane that totalled 35 micron in thickness. The clinical and histopathologic features of pellucid and Terrien's marginal degeneration are similar. When idiopathic peripheral corneal thinning remains clear, it is regarded as pellucid degeneration; vascularization, scarring, and lipid keratopathy are regarded as Terrien's marginal degeneration. Breaks in Descemet's membrane contribute to these latter changes.

Basement Membrane↗
PubMed1985

Immunosuppressive agents in penetrating keratoplasty.

One of the problems with corneal grafting is the occurrence of rejection. Immune reaction is considered to be an important cause of graft failure. Early recognition of such graft reaction can frequently be treated successfully with intensive topical administration of corticosteroids. Generally, I prefer to add systemic corticosteroids and immunosuppressive agents such as azathioprine. In the present study two cases are described to illustrate the use of azathioprine and demonstrate that even severe and recurrent graft reactions can be successfully treated with immunosuppressive agents.

Adrenal Cortex Hormones↗
PubMed1979

Keratoplasty in Fuchs' dystrophy and bullous keratopathy.

We studied the results in six cases of penetrating keratoplasty in Fuchs' dystrophy and bullous keratopathy. The prognosis has improved considerably in the last decade because of the advances and improvements in the fields of anesthesia, new drugs, better instrumentation, more refined surgical techniques performed under microscopic control, more meticulous selection of the graft, better knowledge of biologic mechanisms, and progress in the prevention, diagnosis, and management of complications.

Adult↗
PubMed1979

[Keratoplasty and reconstruction of the anterior segment of the eye after severe ocular trauma (author's transl)].

Severe ocular trauma is frequently not limited to the cornea, but affects the entire anterior segment of the eye. This requires "reconstruction" of the anterior segment. The procedure is long and complicated, but it is definitely justified to attempt to restore and save some vision, espeically in one-eyed patients or when both eyes have been affected by the accident.

Adolescent↗
PubMed1977

[Twenty-five years of experience with corneal grafts (author's transl)].

The progress in instrumentation and surgical techniques, as well as improvements in the knowledge of the biologic mechanisms have considerably enlarged the indications for keratoplasty. Even in unfavourable cases the prognosis has been notably improved by recent advances in medications and techniques to improve the conditions of the recipient and the operative technique, and also to limit the immunologic response. The use of impeccable instruments, meticulous selection of the graft and a refined surgical technique during the the operation are essential since neglect of any small detail may lead to failure of the operation. The graft and the recipient bed must be in perfect apposition. A very neat, smooth incision of the graft and the host window are imperative, as well as the application of a sufficient number of sutures. The sutures must be left in place for a sufficiently long period of time to ensure good cicatrization of the graft. Peripheral iridotomies or iridectomies facilitate the circulation of the aqueous humor avoiding the danger of postoperative pupillary block with all its consequences. The anterior chamber must be carefully restored, preferibly by air injection, to maintain the iris well away from the incision. It should be taken into account during the whole procedure that the endothelium is the most delicate and the most important structure of the graft as well as the host cornea. Contact with the instruments should be avoided and the sutures should provide good apposition of the endothelial edges. Early diagnosis and prompt adequate treatment of any accident or complication are essential. Undetected complications or incorrect management of the same may be responsible for failure of the operation and the final result may vary between a more or less opacified graft and the full-blown picture of phthisis bulbi. A number of illustrative cases are presented.

Adult↗
PubMed1977

[Keratoplasty in complicated cases (author's transl)].

Prognosis of corneal surgery has improved considerably owing to certain modern advances such as improved anesthesia, antibiotics, steroids, immunosuppressive drugs, better instruments, etc. Therefore it is now possible with the help of new techniques and medications to obtain very satisfactory results, even in cases which, in the past, were considered hopeless cases. Some examples from the author's personal experience are presented.

Conjunctiva↗
PubMed1977

[Considerations on surgery of the iris (author's transl)].

Surgery of the iris is of essential importance in anterior segment surgery. In angle closure glaucoma a peripheral iridectomy performed early enough, when the trabeculum is not yet altered, is curative. In simple glaucoma if a filtering operation is performed, the iridectomy is fundamental in order to have a good communication between the posterior chamber and the filtering bleb and to avoid iris incarceration into the filtering wound. In cataract surgery iridectomy is mandatory, especially in intracapsular extraction. In penetrating corneal grafts a patent iridotomy or iridectomy, or several, is a safety factor avoiding the consequences of pupillary block, anterior synechiae and irreducible mydriasis. Another important problem is the surgery of the iris for optical purposes. Other indications which are not discussed in this paper are trauma of the anterior segment of the eye, the removal of benign or malignant tumors, epithelial cysts etc.

Cataract Extraction↗