Biomedical subjects
Publications and source records attributed to W Doden.
Among 866 patients who had undergone extracapsular cataract extraction (ECCE) with implantation of a posterior chamber lens (Simcoe type), 4 cases of retinal detachment were found 1 to 3 years after an uneventful operation. This retinal detachment rate of 0.5% is significantly lower than the rate of 3.5% after intracapsular cataract extraction (ICCE).
Visual field defects already existing in 81 eyes prior to goniotrepanation (Elliot-Fronimopoulos) were followed up for up to 84 months postoperatively. In 11 eyes there were slight peripheral limitations due to cataract formation. In all of the other cases the visual fields were unchanged.
The present paper reports the authors' observations in a rare case of primary hereditary oxalosis (adult type). Four years after renal function loss, calcium oxylate deposits were found in the skin and in both retinae. In spite of hemodialysis and a special diet, the deposits increased considerably during an observation period of 19 months. The skin was indurated and the genucubital articulations were immobilized. In spite of incipient circumscribed edema the retinal changes did not cause any detectable restriction of function, as the fovea was not involved and the retinal border was only slightly affected.
A connection has been established between the normal photopic electroretinogram (ERG) during amaurosis caused by retrobulbar anesthesia and former analogous investigations of visual evoked, cortical potentials (VECP). It proves the assumption that retrobulbar anesthesia causes a sensoric blockade of the optic nerve while the retina continues to function normally.
Postoperative disturbances of the pupil are discussed on the basis of experience with more than 2500 intraocular lenses implanted after extracapsular cataract extraction (planned extracapsular or phacoemulsification). Apart from the changes to the pupil caused by an iris-fixed intraocular lens itself, the pupil may also be affected by blood, fibrinous inflammation, or remnants of cortex material or the anterior capsule after posterior chamber lens implantation. These conditions are frequently followed by synechiae between the pseudophakia and the iris. Mechanical damage to the iris or the sphincter muscle may also occur. Changes in the shape of the pupil often affect its function, and synechiae do so regularly. Secondary cataract necessitating treatment occurred in about 10% of our patients over a 7-year period. Today, YAG laser surgery represents the best means of restoring clarity to the pupil, though there are still a number of unresolved problems with the method. Neither primary nor secondary capsulotomy after pseudophakia implantation can be recommended. The methods of extracapsular cataract extraction with posterior chamber lens implantation are still at a stage of development which is not altogether satisfactory, since optic irregularities of the pseudophakia or the central posterior capsule may result in glare, disturbing the patient in spite of good visual acuity.
71 patients (average age 64 years) were examined for binocular vision after unilateral posterior chamber lens implantation. Average visual acuity in the pseudophacic as well as the phacic eyes was 0.8. Intact stereoscopic dose-up and long-distance vision was found in 85% of the cases. Patients with vertical phorias or moderately decreased visual acuity more often presented impaired binocular functions. Further investigations will be carried out.
In 1943 a 3 year-old-girl with hard star-like nuclear cataracts in both eyes underwent surgery. The white star-like nuclear remnants remained unchanged in the anterior chamber for more than 20 years. The son of this patient had the same rare cataract; surgery was performed on both eyes with practically the same results.
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Since 1977 intraocular lenses of 4 different types have been implanted in a total of 963 eyes at Frankfurt University Eye Clinic: the 4-loop lens (Binkhorst), the 2-loop lens (Binkhorst) and the posterior chamber lenses designed by Shearing and Simcoe. Implantation of a posterior chamber lens after extracapsular cataract extraction produced very good results with no severe complications.
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Investigations of lens particle which originate during phacoemulsification furnish information concerning their size, form and consistency. Their behavior in the eye and in the instructions is of significance with regard to postoperative results.
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In acute primary glaucoma tangential distortion of the iris in the pupillary zones are often seen. The reason for these iris changes has not yet been satisfactorily explained.