Biomedical subjects
Publications and source records attributed to C H Dohlman.
Intraocular lenses were implanted in combination with penetrating keratoplasty in a series of patients followed for up to 2 years. During this period of observation there was little or no evidence that the simultaneous implantation of an intraocular implant adversely affected the corneal graft. Technique and results are described.
The scanning electron microscope was used to follow morphologic events after alkali burn of rabbit corneas. Immediately after a burn there was extensive destruction and shrinkage of the epithelial cells. In subsequent healing, the regenerated superficial cells were morphologically abnormal and possed multiloculated cysts; three months later the normal polygonal packing of cells was not observed. Although the shape of these cells was irregular, microprojections were present on the cell surface. Basal cells were usually observed at the edge of an epithelial defect, an area where the epithelium was easily detached from the basement membrane. In long-standing epithelial defects, the basement membrane became eroded in a spot-like manner after about two weeks. Eventually, when a frank stromal ulcer had formed, bundles of collagen fibrils were visible in a meshwork-like fashion. These changes did not seem to be caused by the direct action of alkali but rather by latent secondary factors that took days or weeks to activate.
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The central corneal stromal thickness of patients with open angle glaucoma, secondary glaucoma (the majority aphakic), or a history of unilateral acute angle closure glaucoma were measured and compared with the stromal thickness of a group of normal patients. In open angle glaucoma, there was a small but significant increase in the average stromal thickness. This thickness increase was, in all likelihood, due to an abnormal function of the endothelium in this disease since the level of the intraocular pressure did not seem to be a factor. There was no correlation between stromal thickness and duration of the glaucoma or type of anti-glaucomatous medication. Most cases of secondary glaucome, controlled medically or not, had markedly increased corneal thickness, again, most likely, due to endothelial damage rather than to level of intraocular pressure. After an angle closure attack, permanent damage to the cornea was found to be rare.
A persistent, unilateral keratoconjunctivitis sicca developed immediately after palpebral dacryoadenectomy in a healthy 43-year-old woman with normal eyes and tear function before the operation. The unoperated on fellow eye remained normal during a ten-year period. Eight similar cases are collected from the literature. On the basis of the presented cases, we believe that the main lacrimal gland is an indispensable element of the tear system, and the accessory lacrimal glands are unable normally to prevent tear insufficiency.
While clinical experience has demonstrated that current storage techniques are adequate for the preservation of human endothelial cells, increased use of donor epithelium in cases of severe disturbance to epithelial and stromal integrity requires a reexamination of storage effects on the epithelial layer. Measurement of human and rabbit metabolite levels in stored corneas indicates that the epithelium is maintained in a normal state only if the eye is cooled promptly. If cold storage is delayed for as little as one hour after death, glucose levels in the stroma and aqueous fall below levels known to be required for preservation of epithelial integrity. The fundamental time of interest in preservation of donor corneal tissue is in the interval between death and cooling of the eye. If prompt enucleation is not possible, ice should be applied to maintain viability of the epithelium.
The continuous delivery in fluids to the ocular surfaces of 12 patients, for a collective total of 1,500 days, was achieved by means of a mobile perfusion pump. One patient used this device intermittently for a total of 21/2 years. Severe dry-eye symptoms were ameliorated in each patient by the constant perfusion. In various situations, the following perfusion fluids have been tried: commercial balanced salt solution, commercial artificial tear solutions, acetylcysteine, and autologous and homologous serum and plasma. In spite of disadvantages related to its size and weight, the pump seems to be of considerable value, especially following severe chemical burns and after keratoplasty or reconstruction of the lids and fornices in the severely dry eye.
The results of 48 consecutive penetrating keratoplasties for keratoconus were analyzed. The overall success rate was 93% clear grafts and there was no significant difference in the percentage of success, the amount of the spherical equivalent of the myopia, or the types of complications between the technique using 9-0 interrupted virgin silk sutures and 10-0 monofilament nylon running suture. The average astigmatic error was 25% less in the series employing the running suture.
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