Biomedical subjects
Publications and source records attributed to U M Klemen.
Report on 82 consecutive cases in which pars plana vitrectomy was performed because of intravitreal hemorrhage. Postoperative follow-up ranged from 3 to 4 1/2 years. Although an incipient improvement of the visual acuity was achieved in 54%, recurrent hemorrhages as well as progression of the proliferative diabetic retinopathy lead to visual deterioration of blindness in 64% of the eyes.
A follow-up study on 93 patients suffering from diabetic preretinopathy showed different courses of development. Predominantly occlusive types of microangiopathy were significantly more predisposed to a rapid progression of lesions than predominantly exudative types or occlusive exudative types. In addition, transition of one type into the other and reversibility of all symptoms were observed.
An electron microscopical study of vitreous structure in 14 eyes suffering from different types and durations of vitreous hemorrhages submitted to vitrectomy showed the typical stages of disintegration of erythrocytes. Neither the type (retrovitreal, intravitreal or combined retro- and intravitreal) nor the duration of the vitreous hemorrhages influenced the histological picture significantly. In cases of shrinkage of the vitreous body the collagen fibrillar meshwork showed normal periodicity of 640 A, partly split and irregular.
In 169 out of 409 diabetic patients without any ophthalmoscopically or biomicroscopically visible retinal changes, typical symptoms of diabetic pre-retinopathy were revealed by fluorescein angiography: capillary dilatation (89.3%), capillary occlusion (78.7%), leakage from small blood vessels (54.4%) and arteriovenous shunts (40.8%). No correlation was found between the duration of the diabetes mellitus and the onset of diabetic pre-retinopathy. Juvenile diabetics developed significantly more capillary occlusions, while in diabetics of advanced age capillary occlusions and leakage from small vessels were encountered with almost equal frequency.
Twenty-five patients suffering from incipient cataract and diabetic retinopathy were submitted to cataract extraction. The intention was not only to improve visual acuity but also to permit better follow-up by fluorescein angiography and useful treatment by xenon light or laser coagulation. Postoperative complications were no more common than in nondiabetic patients, and a comparison with nine cases who refused surgery showed that the diabetic retinopathy was managed better in the aphakic eyes in respect of visual acuity and diabetic fundus changes.
In 40.8% of 169 eyes affected with diabetic preretinopathy (verified by fluorescein angiography) arteriovenous shunt vessels were found. These vessels occur with significant prevalence in eyes with areas of retinal capillary occlusions, and in cases with diabetes of long duration. There is strong evidence that AV shunts are a consequence of the occurrence of areas lacking capillary perfusion in the retina.
Ninety-three patients with typical symptoms of diabetic preretinitis were kept under observation for three to five years (on average 3.9 years), and examined by fluorescein angiography at least once a year. The progress of the various individual symptoms, such as capillary occlusions, pigment extravasation from small vessels, microaneurysms and AV shunts was statistically significant in patients suffering from a predominantly occlusive form of diabetic preretinitis. Hence, more rapid progression of changes must be expected in such patients thn in those suffering from exudative forms.
Within the last five years 42 patients presenting with central serous retinopathy underwent argon laser photocoagulation. Both the plan of treatment and the evaluation of therapeutic success were based on the fluorescein angiogram.
Within the past 12 months, 64 intraocular lenses were implanted. Only eyes close to emmetropia and not exhibiting any pathological condition were considered for this type of surgery. The average age of our patients was 76 years. Preoperative medication and surgical procedure are described. Serious postoperative complications have not been observed so far. Striate keratopathy (in 22% of the cases), as well as secondary glaucoma (in 11% of the cases) were restricted to the initial 4-5 postoperative days. In 73% of the cases the postoperative visual acuity was 6/8-6/6. Maculopathy and opacification of the posterior lens capsule left behind were responsible for reduced visual acuity in the remaining cases.
Thirty-two patients suffering from branch vein occlusion were divided into three groups according to their fluorescein-angiographic lesions. In cases of venous stasis retinopathy with an intact perifoveal capillary arcade, spontaneous resolution may be expected. In eyes affected by hemorrhagic retinopathy the prognosis after laser coagulation was better than for untreated eyes.
By means of fluorescein-angiography diabetic microangiopathy can be earlier revealed than by means of ophthalmoscopy. 36 children with diabetes (aged 6,25-15,5 years, x 11,6 years) with a duration of the diabetes between 0 and 12,75 years (x 3,9) were submitted to fluorescein - angiography, in 20 cases a follow up study was performed. Pathological changes were found in 21 cases, in 10 of 15 children with normal angiograms the duration of the disease was less than 5 years. More than 50% of all patients followed up showed an increase of diabetic microangiopathy.
24 rabbit eyes were submitted to lamellar corneal keratoplasty, the grafts being fixed by highly concentrated fibrinogen. Adhesion of the graft seemed satisfactory after 5 min, and the postoperative oedema cleared within 2 weeks. However, biomicroscopy and histology revealed a limited axial cicatrization while in the majority of cases marginal wound adaptation was insufficient. In 5 of 8 eyes followed up more than one week clear grafts were obtained, surrounded by a low marginal step.
Episcleral plugs reduce the circumference of the globe and cause an egg-shaped deformation; immediately after the operation the deformation seems to be more important than the circumference reduction. Out of 46 eyes operated on with episcleral silastic sponges or submitted to encircling procedures 3 developed hypermetropisation, and 35 myopisation; in 8 cases the refraction did not change.
Following the operation about 75% of the treated eyes developed myopisation between 0,5 and 4,0 dptrs. During the first postoperative year this myopia initially decreased but beyond the sixth month after surgery no further changes could be observed.
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15 cases of congenital and juvenile cataract have been operated on utilizing the vitreophage of Klöti. In 3 instances posttraumatic cataracts have been removed, in two cases a cataracta complicata, in 9 cases after-cataractous membranes. Serious complications have not been encountered in any of our cases. One patients with congenital cataract and two probands with cataracta complicata developed postoperatively considerable flare in the anterior chamber and vitreous body, possibly the result of a phacolytic reaction. Excision of thick, inelastic after cataractous membranes proved to be difficult at times. The advantage of lensectomy lies in the possiblity of removal at the same sitting of opaque vitreous structures which had become visible during surgery.
A retrospective study of 19 patients, who suffered from diabetic retinopathy, were submitted to a xenon-light-coagulation 10 years ago and have been regularly checked, shows better results in the treated eyes than in the untreated fellow-eyes in regard to visual acuity and background morphology. In cases of poorly controlled metabolism, heavy smoking and simultaneous suffering from hypertension and nephropathy the prognosis of the treated eyes is unfavourably affected.
A 17-year-old apprentice affected with siderosis bulbi and lentis of his right eye, was examined by biomicroscopy, ultrasonography and x-rays without evidence of an i.o. foreign body. After extraction of the cataractous lens all signs of siderosis disappeared within six weeks. The histologic examination of the lens showed a small particle of subcapsular rust.