[Spontaneous retinal detachment in the light of clinical studies and determination of mineral components and free fatty acids in the subretinal fluid].
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Biomedical subjects
Publications and source records attributed to M Starzycka.
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65 infants with gestational age 25-36 weeks and birth weight 800-2650 g were observed. Retinopathy of prematurity was found in 27 infants; in 9 eyes of 7 infants cryotherapy was applied. Examination at the age of 12 months evaluated: position and movements of the eye, refraction, visual acuity with preferential looking method, as well as anterior segment and fundus of the eye. Disturbances in eye position and movements were observed in 26 infants. Emmetropia was found in 16 eyes, 77 were hypermetropic and 27 myopic. The length of the eyeballs ranged from 14.6 to 22.5 mm. Visual acuity was determined in 39 infants, in 9 of them only binocular. It was 0.2 (normal) in 22 eyes, > in 2 and < in 36 eyes.
Lincoff's development of silicone sponge and substitution cryosurgery for diathermy in the mid-1960s, was the beginning of the minimized surgery for retinal detachment, limited to the surgery of the breaks. The aim of this paper is to present our experiences with these kinds of operations, with special attention to the complications causing the necessity of removing the sponge. Our studies concerned the patients who underwent retinal detachment surgery, in the Ophthalmological Clinic in Cracow in the years 1983-1992, using scleral buckling procedures with silicone sponge. In 152 cases circumferential and in 36 radial local scleral buckling procedures were performed; in 30 cases local buckling was added to encirclement with silicone band. The complications, attributed to the sponge, were observed in 9.7% of cases. Anterior segment inflammatory reactions, often sterile were found in 15 eyes, in 7 of them it was necessary to remove the sponge. In 13 eyes the sponge was removed on account of its extrusion. In none of the cases removal of the sponge influenced the retinal attachment. Our studies confirmed, that silicone sponge is a very good material for scleral buckling procedures.
The studies comprised 531 patients (544 eyes) who underwent retinal detachment surgery in the Ophthalmological Clinic in Cracow, in the years 1983-1992. Drainage of subretinal fluid was performed in 54.6% of the eyes and in this group attachment of the retina was achieved in 72.4% of cases; in the group of patients with nondrainage operations it was 74.5%. Intraocular haemorrhages, the only complications, which may be attributed to the drainage of subretinal fluid were found in 18.9% of eyes with drainage and in 8.1% without; this difference was statistically significant (p < 0.01). Statistically significant relationship (p < 0.01) was also found between subretinal fluid drainage and severity of the retinal detachment. The results showed that there were no significant relationships between drainage of subretinal fluid and the results of surgery and that it is indicated first of all in severe cases of retinal detachment in which method of choice is an encirclement procedure.
Basing on the clinical material of the years 1984-1991 the authors have compared the results of retinal detachment surgery in two groups of patients, depending on the method of adhesion. Diathermy was used in 182 eyes (group I) and cryosurgery in 274 (group II). Retinal attachment was achieved in 69% of the eyes in group I and in 74% in group II. Inadequate closing of the breaks was the cause of failure in 22.8% of the cases in group I and in 30.6% in group II. Various changes of the macula were observed in 31% of the eyes in group I and in 24.5% in group II. Statistically significant relationships were found between method of adhesion and: development of PVR (p < 0.05), appearance of pigmentary changes in the eye ground (p < 0.01) and cicatrization of the breaks (p < 0.01). Stronger cicatrization was observed after cryosurgery as well as the pigmentary changes in the fundus which have not influenced the results. The studies revealed that no significant differences depending on the method of adhesion were found in results of retinal detachment surgery.
The authors presented a case of Stickler's syndrome diagnosed in 56-year-old woman referred to the clinic because of cataract in both eyes. After surgery typical vitreo-retinal changes mainly extensive lattice degenerations, pigmentary lesions and preretinal membranes in vitreous were found. Orofacial and musculoskeletal abnormalities confirmed diagnosis.