New instrument: a wet-field cordless coagulator.
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Biomedical subjects
Publications and source records attributed to R C Drews.
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A total of 776 specimens yielded significant data on quality control and manufacturing defects in lens implants and on the biodegradation of lens implant and suture materials. Improved quality and an understanding of durability of materials in vivo has permitted wider safe use of intraocular lenses.
Intermittent touch of a pseudophakos to the corneal endothelium is heralded by three signs: ciliary flush, (local) corneal dystrophy, and cystoid macular edema. This syndrome is often missed, and should be ruled out whenever any one of these three signs is detected. Once diagnosed, elimination of the touch should be accomplished promptly. If discovered early, the syndrome may be reversed.
Perimetry performed on a Fieldmaster Model 200 on a consecutive series of 167 patients in a clinical practice setting demonstrated that Fieldmaster testing elicited 95% of defects found on Goldmann kinetic perimetry with very few false-positive or false-negative results; relatively unskilled personnel were able to conduct Fieldmaster testing well; and as our personnel and patients became familiar with the test, the rate of incomplete examinations declined to less than 2%.
The Barraquer Clinic experience in lens implantation is briefly reviewed. About 500 lenses were implanted in a seven-year period, with excellent early results. Late disasters, particularly corneal dystrophy, required the removal of over 300 of these lenses. Recently an extensive analysis has been completed of 162 of the lenses removed. These included Ridley, Strampelli, Dannheim, Boberg-Ans, and Barraquer lenses. The examination of the lenses themselves, coupled with current knowledge of design requisites for intraocular lenses, permits a scientific analysis of these early implants and the problems associated with their use.
Experience gained from over one million intraocular lens implants has emphasized the importance of quality control, correct design and knowledgeable use of materials. Biodegradation of nylon is well known; polypropylene also degrades, but much more slowly; polymethylmethacrylate does not show evidence of biodegradation even, in one specimen for which I have a control, after 23 years.
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A retrospective review of 90 cases of Medallion lens implantation, all with at least a five-year follow-up, revealed a variety of late complications, very few of which were directly related to the implantation or presence of an intraocular lens. Long-term progressive deterioration of nylon iris-lens sutures occurred, but late lens dislocations were not a problem, although two cases developed worrisome erosion through the sphincter into the iris stroma. Some of the earlier patients were those with a guarded prognosis; overall visual results would have improved had these cases been deleted.
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One hundred and thirty-eight eyes were examined at an average of 11.5 months after extracapsular cataract extraction and implantation of a Pearce-style posterior chamber lens. Although centration of the Pearce tripod lens may be of some concern, the overall clinical results in this series were most impressiv. This lens is certainly capable of yielding excellent results in expert hands. Considerations of its use by those skilled in extracapsular techniques can be recommended.
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