Biomedical subjects
Publications and source records attributed to J Hakenová.
The damage of the visual functions represents a very rare complication of acute necrotic pancreatitis. We have seen it in two cases. The first one in form of toxic damage of the optic nerve, the second one in form of abscess of the vitreous humour and the retina. Both patients were in relative stabilized state, not in the first peracute phase of the disease.
The authors investigate in a retrospective study complications of cataract operations which were performed in their department during the last 2.5 years by vitreoretinal surgery. They divided the operations into three basic groups: retinal detachment, luxation of the lens into the vitreous body and endophthalmitis. The largest group was formed by pseudophakic detachments--0.29% of operated cataracts. Luxation of the lens into the vitreous body and endophthalmitis treated by vitrectomy accounted for 0.06% each of operated cataracts. In the first part of the paper the authors analyze peroperative complications of cataract surgery, risk factors enhancing the risk of retinal detachment and evaluate anatomical and functional results of operations of pseudophakic retinal detachments. Peroperative rupture of the posterior capsule before cataract surgery was found in 63.6% of pseudophakic detachments, anterior vitrectomy was performed in 40%, YAG capsulotomy preceded the development of detachments in 13.3% of patients. The retina was applied in 76.4% of the eyes. Functional improvement was recorded in 65.8%, deterioration in 15.6% and an unaltered function after surgery was recorded in 18.6% eyes.
The second evaluated group of vitreoretinal complications after cataract surgery were patients with lens luxation into the vitreous body. During the investigation period the authors treated two cases of luxation of the patient's own lens into the vitreous body and three cases of luxation of intraocular lenses, a total of five eyes, i.e. 0.06% of all operated cataracts. The third group was formed by five patients with postoperative endophthalmitis which was treated by pars plana vitrectomy and intraocular ATB administration in a permanent infusion (Vancomycin 20 mg/500 ml). The frequency of postoperative endophthalmitis treated by PPV was 0.06%. The final mean visus was 0.21.
The authors submit a report on investigation of progressing myopia in children and adults meeting the criteria for indication of scleroplastic surgery. However, the operation was not performed. In children with myopia gravis (5 eyes) the progression of myopia in the course of six years was 1.1 +/- 1.02 D, in children with myopia progressiva (14 eyes) 2.9 +/- 1.4 D/6 years. In adults with myopia gravis (96 eyes) the progression in 6 years was 1.5 +/- 1.9 D, in adults with myopia progressiva (7 eyes) the progression in 6 years was 1.1 +/- 1.2 D. The difference in the two groups was statistically significant at the 1% level. It is necessary to seek procedures to prevent progression of myopia to higher values.
The authors give an account of the development of implantology and extracapsular extraction in their department. In 1987 they performed 342 operations of cataract, an intraocular lens was implanted in 13.2%, extracapsular extraction was performed in 12.9%. In the first half of 1991 354 operations of cataract were performed, an intraocular lens was implanted in 82.5%, and extracapsular extraction was performed in 96.9%. The most frequent peroperative complication was rupture of the posterior capsule--from 14.0% to 20.1%. The most frequent postoperative complication (306 implantations in the first half of 1991)--keratopathia striata 179, fibrinous exudate--79, elevated intraocular pressure--50. The time spent in hospital in the first half of 1991 was on average 2 days in 156 operated patients who did not develop any or only one postoperative complication. The most frequent postoperative complication was posterior capsule opacification--11%. The most serious late complication during the entire follow-up period was endo-ophthalmitis in 8 eyes which in 5 patients after an interval up to 12 months following operation ended by evisceration of the bulbus--in all instances Russian lenses which were sterilized by ourselves were involved. The visual acuity on admission was below 6/60 in 72.3%, on discharge 6/12 or better in 32.8% and 6 months after operation 6/12 or better in 73.9%, incl. 651 eyes (88%) without supplementary correction. Despite the difficult conditions extracapsular extraction with implantation of an intraocular lens has become a routine method in our department, with a short period of hospitalization and minimal contraindications.
The authors are presenting the results of the traumatic cataract surgery in 52 patients (45 male, 7 female). The cataract was caused in 7 cases by blunt trauma, in 43 cases by penetrating trauma (in 16 cases with intraocular foreign body). The mean age of patients was 29 years, ranging from 4 to 73 years. In 2 cases was indicated the intracapsular extraction for the subluxation of the lens, in 2 eyes the discision was done and in 2 eyes the primary evacuation. In all other cases the extracapsular extraction was performed (19 with IOL implantation). Before the operation the visual acuity was 0.1 and worse in 90.4%, 0.16-0.33 in 7.7% and 0.5 and better in 1.9% of the patients. The visual acuity at the time of the last follow-up visit (3 months to 3.5 years after the operation-average 15.6 months) was 0.1 and worse in 16.7% of cases, 0.16-0.33 in 19% and 0.5 and better in 64.3%. The visual acuity 0.5 and better was in 85.7% of patients with IOL implantation. The most serious complication was the hypotony of the eye (in 3 cases) followed by the atrophy of the eye (1 eye was enucleated). Although we could expect more complications of the surgery of traumatic cataract it is possible to gain good visual acuity results. The IOL implantation is indicated in cases where it is not excluded by the condition of the eye.
In a group of 104 patients operated at the Ophthalmological Clinic in Ustí nad Labem on account of retinal detachment in 1987-1989 the authors investigated the anatomical and functional results of the operation during an average period of 15 months. Anatomical attachment of the retina was achieved in 82%; 52% of the patients improved from the functional aspect. In addition to vision on admission, discharge and during the last check-up the authors evaluated the extent of retinal detachment, the site of fissures, the number of myopes and aphakic subjects in the group and the period of retinal detachment before operation. There were 37.5% myopes and 27.9% aphakic patients and artephakia was recorded in 4.8%. The duration of detachment of the retina before operation was 7.4 weeks (3 days to 2 years). An association between the development of retinal detachment and injury was proved in six patients (5.8%).
The authors investigated in a group of 100 eyes the incidence of micro-organisms in the conjunctival sac and on the borders of the eyelids and their sensitivity to antibiotics before planned operations of the eyes. In all instances cultivation at three time intervals was used--on admission, on the morning before operation after administration of antibiotic drops for at least one day, and in the operation theater after careful disinfection of the surgical field. The assembled results indicate the small effectiveness of short-term preoperative administration of disinfectant and antibiotic drops and confirm the high effectiveness of antiseptic preparation of the surgical field.
The authors present an account of their initial experience with balloon probe according to Lincoff-Kreissig. The surgical procedure was that described by the authors without modifications. The balloon probe was used in five patients, twice because of fatigue of material an episcleral implant had to be used. The retina was put in position in all patients. Temporary buckling by means of a balloon probe is a simple and safe therapeutic method in suitable types of detachment of the retina--fissures to the extent of 1 hour of the circumference of the retina, without traction of the vitreous body. After training at a department with sufficient experience with this method, it can be used even in departments where the number of operations of detachment of the retina is not high.
In the course of three years from the total number of 124 CT examinations indicated by the Ophthalmological Department of the Regional Hospital in Ustí nad Labem ten examinations of the orbit with an intraocular foreign body were made. Based on a group of 10 eyes the authors present a report of their hitherto assembled experience with the use of computed tomography in the diagnosis of intraocular foreign bodies. They draw attention to the advantages but also certain limitations of the location of foreign bodies by CT. In two of 10 cases the foreign body was located incorrectly by CT in the bulbar wall--although it was retrobulbar. In the remaining eight cases the CT examination was a great asset and contributed greatly to successful operation. 50% of the patients have after operation a vision of 6/6.