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Biomedical subjects

A H Chignell

Publications and source records attributed to A H Chignell.

At least 73 records · Page 4Linked to original sources
PubMed1979

Retinal detachment surgery without cryotherapy.

The authors have performed 43 retinal detachment operations omitting the use of cryotherapy or any other type of retinal adhesion. Only a full thickness buckling procedure has been performed with drainage of subretinal fluid in some cases. The cases were carefully selected and the follow-up period has been from 1 to 3 1/2 years. Redetachment has not occurred if the original hole was free of traction (round holes) but has so far occurred in 3 cases where traction was present.

Cryosurgery↗
PubMed1978

Absorption of subretinal fluid after nondrainage retinal detachment surgery.

A total of 134 cases of retinal detachment treated with a single successful nondrainage operation were studied to assess the rate of absorption of subretinal fluid in the postoperative period. It has been found that the relationship of the tear to the buckle at the end of the operation is an indicator of the rate of absorption of subretinal fluid that can be expected in the postoperative period. The age of the detachment or the age of the patient did not appear to be significant factors in influencing absorption. In 28 cases (21%), absorption of subretinal fluid took longer than one week. This delay in absorption shows that conservatism regarding early reoperation should be urged unless a definite cause of failure (such as a missed tear) can be found.

Absorption↗
PubMed1977

Retinal mobility and retinal detachment surgery.

A series of 200 consecutive retinal detachments was examined prospectively to consider the physical sign of mobility of the detached retina. Retinal mobility was found to be absent in 28 cases, and this immobility is caused by periretinal membrane formation. The importance of retinal mobility when considering the case for non-drainage retinal surgery has been examined with particular emphasis on the tear/buckle relationship at the end of the operation. It was found that there was an excellent prognosis (92% success rate) for cases in which the retina was found to be mobile in the vicinity of the retinal tear, and a high proportion of these cases (71%) can be successfully treated with a non-drainage operation.

Drainage↗
PubMed1977

Infection following retinal detachment surgery.

Since the introduction of gentamicin (given both as a soaked sponge and as an injection below Tenon's capsule at the end of surgery) no case of early infection either with or without intraocular signs after operation for retinal detachment has occurred in a series of 206 cases comprising 243 operations. However, late infection many months after operation has appeared in 3 cases (1-5%), though this rate appears to have been favourably influenced by the administration of gentamicin. Local or systemic side effects from the administration of gentamicin have not been seen, and therefore the sub-Tenon injection in the quadrant where the sponge has been placed is strongly advocated in all cases of surgery for retinal detachment when such sponges are used.

Gentamicins↗
PubMed1977

Retinal detachment surgery without cryotherapy.

The traditional role of the cryotherapy adhesion in retinal detachment surgery is challenged by the successful treatment of 26 out of a series of 29 cases. The omission of cryotherapy has not interfered with the absorption of subretinal fluid and re-detachment has not occurred.

Cryosurgery↗
PubMed1977

Treatment of rhegmatogenous detachment without apparent holes.

In a series of cases of retinal detachment without visible holes, failure was not associated with local procedures but, as in all cases of retinal detachment, with membrane formation and retinal fibrosis. In total detachments with no localizing signs we favoured the encirclement procedure. In this group of thirty cases of retinal detachment in which no hole could be found we achieved the surprisingly high success rate of 87 per cent, but in as many as seventeen of the thirty cases a local buckle was applied to the most likely site of the tear. We therefore feel that the principle of performing the least traumatic procedure, i.e. a local procedure, can still be followed in a considerable number of these challenging cases.

Adolescent↗
PubMed1977

Retinal detachment surgery. Buckling procedures and drainage of subretinal fluid.

The encircling procedure, while still an important part of succesful retinal detachment surgery, has been found to be unnecessary in a wide variety of retinal detachments which can be more simply treated by local buckles. A much more important aspect of the detachment procedure, however, is the avoidance where possible of drainage of subretinal fluid.

Drainage↗
PubMed1977

Current status of prophylaxis of retinal detachment.

Our indications for prophylaxis may be summarized as follows: (1) All symptomatic holes. (2) All holes in aphakic eye. (3) All holes in fellow eyes. (4) Lattice degeneration in fellow eyes, even when holes are not present. (5) Holes in snail-track degeneration. (6) The fellow eye of one with a giant tear. (7) Asymptomatic holes in myopic eyes except those within the vitreous base. (8) Some large asymptomatic holes in non-fellow or aphakic eyes.

Cataract↗
PubMed1975

Role of non-drainage of subretinal fluid in re-operation for retinal detachment.

In a study of 194 re-operations for retinal detachment in which one-third of the cases were managed without drainage of subretinal fluid, it was found that a number of failures occurred after non-drainage. Analysis of these failures shows that more than half could have been avoided if the correct choice of cases suitable for management without drainage of subretinal fluid had been made. It is felt that with careful attention to the criteria which are used to decide on the choice of surgical technique, the results obtained by the non-drainage method should be as good in the more complicated case as they have already been shown to be in the primary case. Because the drainage of subretinal fluid carries with it a risk of surgical complications and these complications may contribute to the development of massive preretinal retraction, management of the re-operation should be carried out without drainage of subretinal fluid whenever possible.

Drainage↗
PubMed1975

Immunoelectrophoretic analysis of subretinal fluid and its diagnostic significance.

(1) Immunochemical examination shows that subretinal fluid can be divided into two major categories. A 'barrier pattern' is found in the presence of an effective blood-retinal barrier, whereas a 'barrier-damage pattern' emerges when there is a progressive increase in the permeability of the choriocapillarispigment epithelium complex. (2) The immunoelectrophoretic appearance of the subretinal fluid from a recent simple detachment shows a 'barrier pattern' and consists of only low molecular-size plasma proteins, since the choriocapillaris-pigment epithelium complex allows the smaller proteins to escape into the subretinal space more readily than the larger. There is, therefore, a general relationship between the clearance of any plasma protein in the subretinal space and its molecular size.(3) It is only in long-standing detachment that the permeability of the blood-retinal barrier is sufficiently altered to allow the passage of higher-molecular-weight proteins such as IgG and IgA. Increase in permeability of the choriocapillaris-pigment epithelium complex, due possibly to structural modifications, is responsible for the 'barrier-damage' pattern of the subretinal fluid. (4) There may be variations in the degree of barrier breakdown. In those retaining a highly selective barrier, little or no high-molecular-weight proteins escape in the subretinal fluid even in cases of long-standing detachment, whereas, in those with low selectivity, the leakage of high-molecular-weight proteins parallels that of the smaller proteins. (5) The apperance of very large molecules in the subretinal fluid indicates a preceding choroidal inflammation or neoplastic invasion; and the detection of IgM is, therefore, of value in the differential diagnosis of retinal detachment.

Blood Proteins↗
PubMed1975

The role of non-drainage in reoperation.

In a study of 194 reoperation in which one third of the cases were managed without drainage of SRF, it was found that a number of failures occurred after non-drainage. Analysis of these failures shows that more than half could have been avoided if the choice of operation had been correct. It is felt that with careful attention to the criteria which was used to decide on the choice of surgical technique, the results obtained by the non-drainage method should be as good in the more complicated case as they have already been shown to be in the primary case. Because the drainage of SRF carries with it a high risk of surgical complications and these complications frequently result in the development of MPR, management of the reoperation should be carried out without drainage of SRF whenever possible.

Drainage↗