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Step-by-step instructions for the most common and difficult ophthalmologic procedures that are performed in an emergency department. Foreign body removal, including rust rings, is explained with an emphasis on limiting further injury to the corneal epithelium and stroma. Patching, irrigation, contact lens removal and corneal culture techniques are explained. Three methods of assessing intraocular pressure are described.
The authors analyze the results of one-year activity of a room for contact correction of vision at the Ophthalmology Course of the Kirov Branch of the Perm Medical Institute. They compare various types of soft contact lenses of different make by the following criteria: optical characteristics, variety of mathematical parameters, gas permeability, and tolerance of the lens by the eye. Recommendations on the choice of this or that lens type (simple soft contact or ultrathin lenses) are offered. Complications associated with wearing of soft contact lenses are described, which are subdivided into ischemic and allergic, their causes are discussed and measures to cope with them presented.
The paper presents a survey done in the Ophthalmological Clinic of Cluj on 140 children, 3 years old, for which the "Baby Vision" was applied. The examination consisted of strabismic angle determination, alternance estimation, visual acuity, stereoscopy, optokinetic nystagmus, refraction and eye fundus investigation. The results, particularities and difficulties in the examination and treatment of those little children are summarized.
The authors describe physical and biological properties of a CO2 laser operating in the infrared area (wave length 10,600 m). The authors discuss the use of this laser in ophthalmology and draw attention to its advantages as well as shortcomings. They describe the apparatus 20-C of Pfizer Laser Systems, incl. safety measures required for operation of the CO2 laser.
In developing countries, cataracts are a serious public health problem. There are a large number of patients, an estimated 3 millions in Africa alone, awaiting operations. However, the number of surgical interventions is small for a variety of reasons, including the cost. To try to reduce the cost of surgery, we analysed the various elements involved at the African Institute of Tropical Ophthalmology (AITO) in Bamako (Mali). The route followed by the patient, from contact with the health service through to post-operative health care was analysed in terms of individual jobs, supplies and equipment required. The unit cost of each of these elements was assessed using an adapted calculation method. The results show that the cost of the removal of the lens at the AITO is 15,200 FCFA (or $56). Installing an intra-ocular lens significantly improves the outcome for a similar cost (16,500 FCFA or $60). The relative costs of various elements were as follows: food, 32%, the suture, 12%; and equipment only 13%. Thus, to reduce the overall cost of surgery for cataracts, ambulatory surgery should be organised, with efforts to reduce the costs of suture. High quality equipment should be used, because its life-span is such that it can be amortised over a long period.
In 1876 A. Weber introduced chemically from P. jaborandi isolated Pilocarpium muriaticum into the ophthalmological therapy. One year later it was used as a local drug to lower the intraocular pressure in glaucoma and replaced in the following years the extract of Calabar bean (Eserine). Clinical and pharmacological data are discussed.
We reviewed and analyzed the visual acuities achieved and the complications after 949 cataract operations done by ophthalmology residents during the transitional period in which an intracapsular cataract extraction technique was replaced by an extracapsular one. The available records of all patients from 1982 through 1991 were reviewed. Eighteen intracapsular and 896 extracapsular cataract extractions were performed, followed by 906 primary and 43 secondary implants. Posterior capsular rupture occurred in 6.3% of the cases with vitreous loss in 3.4%. Cystoid-macular edema was the most common postoperative complication. The postoperative visual acuity was 20/40 or better in 91% of cases, and it was better than the preoperative visual acuity in 99.5% of cases. With appropriate training and supervision, a resident can achieve good results by doing extracapsular cataract extractions with lens implantations. These results were comparable to those reported by others.
The paper presents some of the trends of development in ophthalmological treatment and diagnosis with lasers: diode lasers, holmium-YAG and erbium-YAG lasers, excimer lasers, delivery systems through optical fibers and, in the same time, new applications. In the near future, the high rhythm of development of these new treatment and diagnosis technologies will change the attitude of ophthalmologists in the approach of the most difficult problems.
Surface anaesthesia is applied in ophthalmology for minor surgery, diagnostics tests and also in cases of corneal or conjunctival inflammation and injuries. The abuse of such anaesthetics may cause serious complications. The authors emphasize the necessity for their careful application.
Modern technology poses numerous and complex problems concerning the implications for health in the work/vision relationship. While many of the hypotheses made in the past about the possibility of serious eye alterations in non-industrial workers have not been confirmed by recent investigations, considerable attention is at present being addressed to the short- and long-term effects of office work, especially in the case of tasks requiring prolonged visual effort "at near point". The prevalence of asthenopia in such workers is rather high, between 40 and 80%. The considerable specificity of the symptoms and the shortcomings in assessment of exposure in most of the research done so far has meant that no clear and unequivocal causal relationship between work involving intense visual effort and onset of asthenopia has been established. Nevertheless, from an analysis of the literature three main guidelines for a correct ergophthalmologic assessment can be identified: a) ophthalmologic assessments that will detect any transitory inefficiencies of the accommodation and convergence system; b) specific analysis of the technical and illumination conditions with special attention to the distribution of the natural and artificial light sources; c) quantification of airborne pollutants that have a potential irritative effect on the "ocular surface". Other environmental parameters that could be considered are electric and magnetic fields in the vicinity of VDTs and PCs and the microclimate of the workplace.
To minimize the learning problems, related to the present teaching method, we developed the Educational Program on Ophthalmology, that offers an interactive and self-controlled way of learning, through the multimedia and hypertext (hypermedia) resources to the students. The software has 200 images (pictures and photos), 40 minutes of digitized voice (.WAV), 50 minutes of video animation (.AVI) and more than 200 links. The first evaluation demonstrated a great interest from the medical graduated students, who feel motivated with the utilization of the software.
Automated perimetry is one product of the computer revolution that has had a dramatic impact on the practice of ophthalmology, affecting the quality of both the perimetric test (perimetric technique) and the interpretation of the test results. Before automation, the quality of visual field technique in many practices was poor, partly because perimetrists lacked the volume of patients requiring the test to provide training sufficient to maintain a high level of experience and expertise. At first, automated perimetry was developed simply to make available to all practitioners visual field testing that was nearly as good as the most skilled manual perimetry. The data provided by first-generation automated perimeters lacked the accuracy, sensitivity, and reproducibility obtainable from a highly skilled manual perimetrist. As automated perimeters evolved, perimetric techniques and the software that analyzes data for clinical significance were improved. The use of automated perimetry to evaluate routinely various visual disorders that require testing of the visual field has increased significantly. Statistical analysis of the test results aids interpretation, both to determine if the field is abnormal and if there is change in the field from one occasion to another, especially in the context of glaucoma. The test is excellent; it is now standardized, with better test algorithms, and in many cases it achieves better results than the best manual perimetrist. However, attention to detail and skill in administering the automated test are still essential. The future will hold further improvements. Nevertheless, as each manufacturer enhances computerized perimetry, it may become more difficult to compare the test results among instruments or even between two test algorithms on the same instrument. In addition, clinical knowledge and experience will still be necessary to reach accurate diagnostic conclusions.
Medical audit is now a well-established part of the routine of ophthalmology departments. Accomplishing a complete audit is a complex task and its effectiveness depends on how it is performed. In order to evaluate the procedure in our department a retrospective analysis of 18 audits was carried out with particular reference to the level, objectives, beneficial effects, and effects on current practice. Our practice was critically analysed using these factors. One audit fulfilled the criteria for a full audit. Eleven (60%) were partial or potential and six (30%) were an attempt in planning an audit. The majority omitted plans for implementing change or targets for future assessment. Seven had educational benefit. There was little effect on patient care, cost-effectiveness or communication. Medical audit can be clinically effective, educational and stimulating. Failure to complete all stages affects the outcome. This study identifies the difficulties involved in performing complete audits and suggests improving the procedure by auditing audits on a regular basis.
717 anaesthetics, consisting of a combination of droperidol and ketamine, were given to children aged between 2 months and 17 years for surgical and diagnostic procedures in ophthalmology. The administration of droperidol prior to ketamine resulted in (1) reduced doses of ketamine of 3.59 mg/kg body weight for a mean surgical duration of 18.11 min and (2) an absence of controversial psychomimetic side effects of ketamine. This procedure--called Dualanaesthesia--is simple and of low risk. Investigations were made concerning the cardiovascular and respiratory system, as well as the oculocardiac reflex, analgesic and antiemetic effects. Based on these positive experiences, this method is recommended for paediatric anesthesia.
1. An RVU system can forecast staffing needs for a busy ambulatory ophthalmology clinic. 2. The average amount of time needed for basic ophthalmic screening is 15 minutes. 3. Further studies should be conducted of infrequent tasks and for indirect care before an RVU system can be accurately used.
Reviews ophthalmologic equipment designed in Russia and the former USSR countries in recent years. Groups the equipment by its purpose: diagnostic equipment, devices for investigating and training the visual functions, therapeutic and surgical equipment. The review is highly informative and describes in detail the devices presented.
First experiences with a new Colour-TV-System in the University Eye-Clinic Munich are reported. The system is described in detail and special problems of fitting the TV-cameras to the ophthalmological instruments such as operation microscopes, slit lamps and fundus cameras are described.
Results of the technical development in laser technology created new possibilities in ophthalmic surgery, too. The easy access to various lasers offers an extraordinary opportunity for eye surgeons. At the Department of Ophthalmology of the University Medical School of Debrecen we performed 1400 laser treatments in 1996. Out of that 1100 were retinal Argon laser coagulations because of diabetic retinopathy, 200 YAG laser capsulotomies because of secondary cataract, and 30 laser iridotomies because of glaucoma. Additional 70 laser treatments were performed for special indications. During the laser treatment of the retina and the choroid we use Argon gas lasers, whereas the Nd:YAG laser used in the anterior segment of the eye is a solid-state laser. Our pulse mode modus synchronized Nd:YAG apparatus can produce megawatts of energy in nanoseconds. Authors give an account of the Nd:YAG lasers' possibilities in therapy (capsulotomy, iridotomy), present the most frequent indications of treatments in 1996, and compare it with international literature data. Authors demonstrate the newest principles of the Nd:YAG laser treatment of secondary membranes that are occasionally formed in the anterior chamber especially in the area of the pupil following cataract surgery.