Biomedical subjects
Publications and source records attributed to W A Franks.
Peribulbar anaesthesia has been recommended as a safer alternative to retrobulbar anaesthesia. We report a case of perforation of the globe sustained during peribulbar anaesthesia which resulted in blindness. Orbital injections are potentially dangerous, be they peribulbar or retrobulbar. To minimise the risk, short, blunt needles are advocated for the peribulbar route.
Hypotony after fistulizing surgery is common, and most cases resolve without complications. Occasionally, a flat anterior chamber in phakic or pseudophakic eyes may lead to corneal decompensation or cataract formation. In aphakic eyes that have undergone previous vitreous surgery, flat anterior chambers will not develop, but large choroidal detachments and delayed suprachoroidal hemorrhage may occur while the eye is soft. To maintain intraocular pressure (IOP) in the early postoperative period, the authors used a technique to seal the drainage tube with a Vicryl tie, combined with injection of sodium hyaluronate, sulfur hexafluoride (SF6), or perfluoropropane (C3F8), perioperatively in 28 eyes undergoing glaucoma tube implant surgery. Eight eyes were treated with injection of sodium hyaluronate, 8 with SF6, and 12 eyes with C3F8. Hypotony was significantly less frequent in eyes treated with C3F8 compared with sodium hyaluronate (P less than 0.05). Mean IOP was significantly higher for eyes treated with C3F8 injection compared with sodium hyaluronate for the first 4 days after surgery (P less than 0.05).
Four women, from three families, are presented who developed severe bilateral optic nerve disease. A diagnosis of Leber's hereditary optic neuropathy (LHON) was made when male family members became affected. The disease ran a similar course in men and women with severe and permanent reduction in vision. Two women had been told that they suffered from multiple sclerosis. With recent advances in diagnostic techniques it should be possible to distinguish between these two conditions. Although LHON may be underdiagnosed in women, there does seem to be a male preponderance of the disease in most European pedigrees. Recent work supports the assumption that LHON is transmitted via cytoplasmic DNA; however, this does not explain why men are more likely to be affected, nor why only a minority of those carrying the defect develop the disease.
Two cases of pseudoexfoliation of the lens capsule are presented in which unilateral shallowing of the anterior chamber caused an acute rise in intraocular pressure. Both patients were elderly women. In one case anterior chamber shallowing was precipitated by administration of pilocarpine and the second followed central retinal vein occlusion. We suggest that pseudoexfoliation of the lens capsule weakened the zonule allowing forward shift to the lens and secondary angle closure.
The visual fields of 13 children aged 7 to 16 (mean 10.7 years) were assessed by oculokinetic perimetry (OKP), a technique where the field of vision is tested at reading distance using a simple chart, and the results compared with conventional Goldmann perimetry. Cooperation with testing was greater for OKP than Goldmann perimetry and in some cases OKP was better correlated with clinical findings. The advantages of visual field assessment by OKP for children are the close proximity of observer and child, the absence of the requirement for prolonged fixation, and the inexpensiveness and portability of the testing equipment. The disadvantages are movements of the head, with variability in the distance from the target, and the limitation to the central 25 degrees of the visual field.
Five eyes with large choroidal detachments and flat anterior chambers following fistulizing surgery were treated with injection of perfluoropropane into the anterior chamber. In all cases the choroidal detachments resolved within 4 days, without the need for drainage. Three phakic eyes developed anterior capsular opacification in the area of contact between the gas bubble and the anterior capsule. Injection of perfluoropropane is recommended as a simple and effective approach to the management of choroidal detachments with flat anterior chamber in pseudophakic eyes and in cataractous phakic eyes.
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