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PubMed1992

[Exfoliative syndrome and cataract surgery].

In the present prospective study, we compared the results of cataract surgery in two groups with or without exfoliation syndrome; 210 eyes were studied. The preoperative pupillary dilatation was smaller in the group with exfoliation syndrome (SE). We noticed a higher incidence of complications during planned extracapsular cataract extraction in patients with SE. A pupillary diameter smaller than 6 mm increases the incidence of capsulozonular rupture (22.5%) in these patients. After surgery, an inflammatory reaction and a transient increase in intraocular pressure were more frequent and the visual results were less favourable in the group with SE. The exfoliation syndrome is a major risk factor for cataract surgery. We recommend extracapsular extraction associated with a sector iridectomy when the pupillary diameter measures less than 6 mm.

Aged↗
PubMed2005

[The glaucoma theory of CF Heerfordt].

Based on numerous microscopical slides from two eyes from two patients suffering from "inflammatory" glaucoma Christian Frederik Heerfordt (1871-1953) put forward his very original theory in 1910-14: Some cases of intractable glaucoma are caused by occlusion of one (or two) vortex veins, sometimes with a flap, a sino- scleral plate into the sinus ( ampulla). Surgical treatment could be iridectomy in the sector with the occlusion, or perhaps better by blood- letting of the occluded vortex- vein. Heerfordts theory was damned by the Danish Ophthalmological Society as un-scientific and the messages in the danish newspapers un- etical. The consequences for science and for Heerfordt personally are discussed.

Denmark↗
PubMed1991

[The parasympathetic direct pathway from the midbrain to the ciliary muscle in cats and monkeys].

The visceral, namely the parasympathetic component of the oculomotor complex which directly innervates ciliary muscle was investigated using horseradish peroxidase (HRP) in three cats and three monkeys. A unilateral total iridectomy to abolish innervation to the iris was made in all animals. After 1 month to allow fiber degeneration in the iris, HRP was injected into the ciliary muscle of ipsilateral eye. Distribution of the labeled cells at the midbrain and at the ciliary ganglion was examined. Labeled cells were present in the ciliary ganglion and midbrain in all three cats and three monkeys. In the cat, labeled cells were distributed in the Edinger-Westphal (EW) nucleus and the Perlia nucleus. In the monkey, labeled cells were distributed in the anteromedian (AM) nucleus, the EW nucleus and the Perlia nucleus, respectively. Therefore, the existence of a direct parasympathetic pathway from the midbrain to the ciliary muscles was confirmed in these animals. Based on these observations, it is obvious that accommodation of the eye was innervated partly by a direct pathway from the midsagittal region of the parasympathetic neuron of the oculomotor nuclear complex.

Animals↗
PubMed1991

Cortex at the 12 o'clock position and the role of peripheral iris opening.

Performing a peripheral iridectomy is a safe and effective means of atraumatically removing cortex at the 12 o'clock position. It prevents pupillary block as well as adhesions between the iris and capsule. Also, it serves to position the anterior capsular flap and the superior edge of the intraocular lens.

Cataract Extraction↗
PubMed1991

Dedifferentiation potential of iris melanomas.

A histopathological study was conducted on four cases in which a diffuse iris melanoma presented with glaucoma. Drainage surgery was performed on three eyes for medically non-responsive raised intraocular pressure, and all cases eventually (within 2-7 years) required enucleation for secondary glaucoma. In the iridectomy specimens the tumour melanocytes were small, uniform in size and spindle shaped, while in the enucleation specimens the tumour cells were epitheliod and pleomorphic. The dedifferentiated tumour in the enucleated eyes spread extensively within the anterior chamber and anterior uvea. In three cases there was evidence of intrascleral spread. However, none of the patients has died from metastatic disease in the follow-up period of 2-6 years since enucleation.

Adult↗
PubMed1991

Transsclerally fixed posterior chamber lens in absence of posterior lens capsule support.

If an anterior chamber lens is contra-indicated in case of a (secondary) lens implantation with absence of a posterior capsule support, a posterior chamber lens (PCL) can be implanted fixing the haptics by sutures. The fixation is best achieved by directly suturing the haptics transsclerally into the sulcus, or indirectly by means of an iris flap created from an iridectomy. Complications are rare and not severe and long-term stability is rather good, provided an appropriate technique is applied including small incision, anterior vitrectomy and the use of viscoelastics. Forty-eight cases are reported with a follow-up of more than 5 years.

Contraindications↗
PubMed1991

[Results of surgical treatment for anterior uveal malignant melanoma].

The authors observed for 5 to 18 years 41 patients (22 women and 19 men) with malignant iris melanoma and/or malignant melanoma of ciliary body. The age of the patients was 20 to 80 years. All patients underwent surgical treatment with preservation of the eye ball. In 21 cases iridectomy, in 18 cases iridocyclectomy, and in the remaining cases iridocyclectomy-choroidectomy was performed. In 25 eyes the tumour occupied less than 1/4, and in 16 eyes between 1/4 and 1/2 of the iris circumference. During the period of observation 7 eye balls were enucleated, and in 6 recidivation of the tumour was diagnosed. These patients belonged to the group of 18 people with the tumour occupying the iris and the ciliary body, or the ciliary body only. Mortality in this group was 28%. Among 5 patients who died, in 3 the tumour occupied more than 1/4 of the iris circumference. In 3 patients from this group recidivation was diagnosed, in 4 enucleation was necessary. In 4 eyes secondary glaucoma was diagnosed. Therefore, among risk factors one ought to list size of the tumour, recidivation, and secondary glaucoma. On the other hand infiltration of the sclera and of the optic nerve was found only in one deceased person. The authors have not been able to obtain current information about 2 patients. In the whole studied group mortality was 5 out of 39, that is 12.8%. The most common complication during the surgery was hemorrhages. Two other complications: complicated cataract, usually stationary, and secondary glaucoma occurred both before and after treatment. Despite of complications 68.3% of patients maintained good visual acuity.

Adult↗
PubMed1991

[Atypical postattack symptoms in closed-angle glaucoma].

The patient, a woman of 67 years old, has been diagnosed and treated about 19 years for glaucoma with open angle. After a leg fracture, she had great ocular aches at the left eye, perikeratic congestion and a great diminution of the eye-sight. After the application of the orthopaedic cure and of the general sedatives she went to the oculist who established the diminution of the eyesight at the left eye at 1/500 with synekies in semi-mydriasis and ocular pressure of 12 mm Hg at both eyes. She was hospitalised with diagnosis Uveitis at the left eye and the instillation with mydriatics improved the eye-sight. The patient presented glaucoma with closed angle after attack phase at both eyes for which the basal iridectomy is used. It is shown the importance of anamnesis in glaucoma with closed angle and the difficulties in diagnosis that can occur sometimes in glaucoma with closed angle.

Aged↗
PubMed1990

[Artificial iris diaphragm in silicone oil surgery].

An artificial PMMA iris diaphragm is described, which is similar to an inferior iridectomy after Ando. The diaphragm can be implanted in aniridic eyes requiring silicone oil surgery. It successfully inhibits contact between the silicone oil bubble and the corneal endothelium.

Aniridia↗
PubMed1990

The role of the iris in accommodation of rhesus monkeys.

After unilateral total iridectomy, maximum accommodation inducible by corneal iontophoresis of carbachol in rhesus monkeys was approximately 40% less in the iridectomized than in the contralateral untouched eyes, irrespective of age. Ultrasonographically measured anterior chamber shallowing and lens thickening were also less in the iridectomized eyes. Neither submaximal accommodation induced by intramuscular pilocarpine infusion nor maximum accommodation inducible by midbrain stimulation differed in iridectomized and intact eyes. The authors hypothesize that at maximum cholinomimetic drug-induced contraction, the iris sphincter muscle pulls the ciliary body farther forward and inward than does maximum ciliary muscle contraction alone, allowing additional rounding of the lens and, consequently, additional accommodative power.

Accommodation, Ocular↗
PubMed1990

Subconjunctival THC: YAG laser limbal sclerostomy Ab externo in the rabbit.

A chromium-sensitized, and thulium and holmium-doped YAG laser (THC:YAG laser) was used to create bilateral limbal sclerostomies in six Dutch pigmented rabbits. The laser is a long-pulsed (300 microseconds) [corrected], compact, self-contained, solid-state laser operating in the near infrared (2.1 microns). A 1-mm conjunctival stab incision was made 12 mm away from the sclerostomy site to allow entry of a specially designed 26-gauge (480 microns) optic probe that delivers energy at right angles to the long axis of the fiber. Probe insertion minimally disturbed the conjunctiva. Pulse energies of 60 to 150 mJ were used with a repetition rate of 5 pulses/s. Energy levels ranging from 1.35 to 6.6 J produced full-thickness sclerostomies. Histopathology showed a sharply defined perforating limbal wound at all energy levels. The overlying conjunctiva was intact, with swelling of the adjacent cornea. A peripheral iridectomy was intentionally created with the laser through the peripheral limbus, resulting in a sharply defined perforating tract through the iris/ciliary body. This technique may simplify filtering sclerostomy surgery, without anterior chamber instrumentation and with minimal conjunctival trauma.

Animals↗
PubMed1990

[Surgery of post-traumatic cysts in the iris of children].

The authors describe 7 cases of implanted iris cysts which appeared after perforating corneal injuries in children aged 3 to 14 years. All the cysts have been excised by sector iridectomy performed in the healthy iris. Described is the technique of the intervention. Attention is called to the possibility of preservation of a round pupil by leaving intact the pupillary border or by a simultaneous plastic operation of the iris.

Adolescent↗
PubMed1990

[The surgical treatment of uveal glaucoma].

The paper describes results after surgical treatment of 17 eyes with uveal glaucoma. Since conservative treatment could not achieve normalization of intraocular pressure, the following surgical interventions were made; peripheral intralamellar iridencleisis (7 eyes), sinusotrabeculectomy with basal iridectomy (4 eyes), iridocycloretraction (2 eyes), diathermocoagulation of the ciliary body (2 eyes), drainage by a silicon tube (2 eyes). Surgical complications were hyphema in 2 eyes, injury of the lens capsule in 1 eye; in 4 eyes a slight aggravation of the uveal process after the surgery was arrested by antiinflammatory therapy. Intraocular pressure normalized in 15 eyes. Visual functions increased in patients with early diagnosed and operated glaucoma; in far-advanced cases the operation removed pains, but no functional effect was achieved.

Adolescent↗
PubMed1990

[Torpid endophthalmitis in pseudophakia: diagnostic and therapeutic difficulties. Apropos of 4 cases].

The authors report four cases of chronic endophthalmitis following extracapsular cataract extraction with intraocular lens implantation in the posterior chamber. The first attack of intraocular inflammation occurred in the form of recurrent iridocyclitis two to six months after surgery. The first attack usually responded well to local corticosteroids. After many relapses of inflammation, increasingly resistant to medical treatment, a severe attack occurred leading to the decision to treat such endophthalmitis surgically: endocular fluid aspiration, vitrectomy, intraocular injection of antibiotics combined with systemic antibiotics and corticosteroids. It may be very difficult to prove the infectious origin of torpid endophthalmitis. Growing bacteria from endocular fluid aspirates is much more difficult than in acute endophthalmitis. No organisms were found in this series by this method, despite the fact that fluid aspiration was often performed many times in these 4 cases. A bacterium was identified in 3 cases, twice on the implant itself and once after culture of an iridectomy specimen. Intraocular antibiotic injections resulted in the complete recovery of one patient. Following failure of standard treatment, intraocular lens explantation resulted in the disappearance of infectious inflammatory signs in 3 cases. The treatment of chronic endophthalmitis is governed by the same rules as acute endophthalmitis but is not always as successful. Intraocular lens removal is often the only solution and confirms the pathogenic hypothesis that slime production by organisms, their adherence to the intraocular lens and their quiescent state make them less vulnerable to antibiotics and host defences.

Aged↗
PubMed1990

[Iris nevus (Cogan-Reese) syndrome--clinicopathological correlations].

Clinicopathological correlations of iris nevus (Cogan-Reese) syndrome were studied by light and electron microscopy, using tissues obtained surgically by trabeculectomy and peripheral iridectomy. The patient was a 52-year-old female, who had a typical appearance of the disease with nodular iris nevi, distorted pupil, ectropion uveae, peripheral anterior synechia, and intractable glaucoma. The histopathological studies of the specimen revealed abnormal corneal endothelialization and basal lamina formation continuously covering the peripheral cornea, trabecular meshwork, and anterior iris surface. Lymphocyte infiltration was found in the layer of the endothelialization and in the anterior iris stroma. The nodular iris nevi were found to consist of mainly integration of degenerated iris melanocytes and clump cells of Koganei. Neovascularization associated with infiltration of lymphocytes and macrophages was also observed in the trabecular meshwork. The present study suggests that the disease might occur by chronic inflammation primarily as corneal endothelitis and iritis.

Endothelium, Corneal↗
PubMed1990

Intraocular lens implantation following extracapsular cataract extraction in uveitis.

We reviewed the results of intraocular lens (IOL) implantation in the posterior chamber following extracapsular cataract extraction (ECCE) in 70 cataractous eyes with various types of endogenous uveitis, predominantly acute anterior uveitis, Fuchs' heterochromic cyclitis, Harada's disease, and Behçet's disease. During an average of 23.1 months' follow-up (range, 13 to 48 months) there was no exacerbation of the preexisting uveitis in any of the eyes. Postoperative visual acuity in all eyes was better than it was preoperatively, although further procedures were required in some eyes: a pars plana vitrectomy in one, a surgical peripheral iridectomy in one, and Nd:YAG laser capsulotomy in 10. Our results suggest that selected uveitis patients can tolerate and benefit from an ECCE and IOL implantation.

Adolescent↗
PubMed1990

Pupillary block glaucoma following pediatric cataract extraction.

We present a case of pupillary block glaucoma that developed after cataract extraction in a pediatric patient. To prevent pupillary block and secondary glaucoma after cataract surgery we recommend that all pediatric cataract patients be given a prophylactic peripheral iridectomy.

Cataract Extraction↗
PubMed1987

Microsurgical treatment of lens capsule perforations--Part II: Clinical applications and results.

A microsurgical technique using human fibrinogen concentrate for the closure of anterior lens capsule wounds and through-and-through perforations was developed, experimentally tested and clinically applied. I consider here the first consecutive 31 patients treated. All these patients had perforating injuries of the lens and still localized lens damage; they showed no spontaneous healing tendencies. Successful treatment of lens capsule wounds, where an otherwise clear lens is locally scarred, has been rare. The technique described here was effective in more than 50% of the patients with anterior lens capsule lesions. Removal of degenerated lens cortex matter before fibrinogen application further improved the healing rate. The healing rate was low, however, in through-and-through perforations of the lens when the posterior lesion was not treated at all (of 11 cases, 1 success, 10 traumatic cataracts). It was not much better when the posterior lesion was approached via a basal iridectomy and around the lens equator (of 4 cases, 1 success). But translental fibrinogen application, following the foreign body pathway, together with removal of degenerated cortex matter from the anterior and posterior capsule lesion area, resulted in the prevention of traumatic cataract in all 4 patients treated so far. There were no undesirable local or systemic side-reactions. (Intraocular complications could be avoided by not exceeding the recommended amount of fibrinogen concentrate, 0.01-0.02 ml). The case histories of 3 patients are shown in three photographs.

Aprotinin↗