Biomedical subjects
Publications and source records attributed to H D Gnad.
Thirty-two patients suffering from branch vein occlusion were divided into three groups according to their fluorescein-angiographic lesions. In cases of venous stasis retinopathy with an intact perifoveal capillary arcade, spontaneous resolution may be expected. In eyes affected by hemorrhagic retinopathy the prognosis after laser coagulation was better than for untreated eyes.
420 mongoloid children aged between one month and 14 years were examined in a special ophthalmology department for disabled children employing biomicroscopy, retinoscopy under atropine and, if possible, visual acuity testing. Epicanthal folds were present in 46%, mongoloid slanting of the lids in 72% of cases. A decrease in binocular vision was present in 40% of the children. Brushfield's spots were encountered in 86% of the patients in a circular arrangement, whilst in 7% only the temporal half of the iris was involved. Lens changes of a variable degree were present in altogether 55% of cases and an increase in the number of retinal vessels, as well as their radial arrangement, as described by Williams, were documented in 46% of the cases. A comparison of the incidence and degree of refractive anomalies in mongoloid and normal children was undertaken. The present findings are discussed and compared with the results of other investigators.
Following the operation about 75% of the treated eyes developed myopisation between 0,5 and 4,0 dptrs. During the first postoperative year this myopia initially decreased but beyond the sixth month after surgery no further changes could be observed.
15 cases of congenital and juvenile cataract have been operated on utilizing the vitreophage of Klöti. In 3 instances posttraumatic cataracts have been removed, in two cases a cataracta complicata, in 9 cases after-cataractous membranes. Serious complications have not been encountered in any of our cases. One patients with congenital cataract and two probands with cataracta complicata developed postoperatively considerable flare in the anterior chamber and vitreous body, possibly the result of a phacolytic reaction. Excision of thick, inelastic after cataractous membranes proved to be difficult at times. The advantage of lensectomy lies in the possiblity of removal at the same sitting of opaque vitreous structures which had become visible during surgery.
Report on a 42 year old patient from the Mediterranean area suffering from recurrent iridocyclitis for 2 years, accompanied by aphthous changes of the buccal mucosa and genitalia. Behcet's disease was suspected, and the patient was treated for ten days with i.v.-infusions of 200 mg Endoxan and 50 mg Prednisolon. After appearance of a leutic maculo-papulous rash systemic application of Penicillin lead to a quick cessation of the cutaneous efflorescences as well as of the uveitis. This case shows that luetic etiology of ocular inflammations is by no means beyond actuality.
A report is presented of 46 diabetics submitted to pars plana vitrectomy on account of severe intravitreal haemorrhage. The follow-up period lasted up to 15 months. The visual acuity alone is not an adequate parameter for the evaluation of postoperative success in view of the central retinal lesions resulting from severe diabetic retinopathy. The vitreous cavity was found to be clear in 33 cases and in 27 cases visual acuity reached at least 6/60. In 11 cases new haemorrhages occurred postoperatively, 6 of which cleared spontaneously within 2 weeks. In the remaining cases irrigation of the vitreous chamber by means of the vitrectomy instrument was necessary. Retinal injury due to the tip of the instrument was avoided in every case. The patients were out of bed on the first postoperative day and discharged between the 8th and 10th postoperative day provided that no relapse haemorrhage occurred.
Keratopathy following intraocular surgery is usually a neglegible transitory lesion which does not require special treatment. An intractible bullous keratopathy frequently develops in cases of endothelial dystrophy. Other causative factors leading to postoperative keratopathy are excessive operative traumatisation of the cornea, vitreocorneal adhesions, athalamia, detachment of Descemet's membrane or epithelial down-growth. For conservative treatment of postoperative keratopathies topical application of corticosteroids, acetylcholine, vitamine-A-ointments, hyperosmotic agents, soft contact lenses, and systemic application of carboanhydrase inhibitors can be used. According to our experience even in cases of severe keratopathy a significant improvement of visual acuity and discomfort may be achieved by long lasting and intensive conservative treatment. Only in rare cases one has to resort to glueing a contact lens on the cornea (Dohlman) or to perform a keratoplasty using Stocker's technique.
Report on a case of advanced siderosis bulbi. Besides the typical alterations in the anterior segment of the globe, siderotic changes of the retina could be revealed. The ERG showed a reduction of the b-wave. After removal of the foreign body, a partial regression of the siderotic changes took place. In addition, the ERG became normal within 8 weeks postoperatively. The indication for removal of metallic intraocular foreign bodies despite specific alterations of the ERG is emphasized.
A review is given on systemically applied drugs, which may cause vascular disturbances of the retina with possible irreversible involvment of the ocular function. Based upon personal observations and reports in the literature a series of drugs with such side effects is reported. In particular, besides retrolental fibroplasia and complications which can be induced by oestrogens, drugs are described, which on the basis of an allergic reaction may produce retinal haemorrhages or occlusions of retinal blood vessels.
Besides vitreous suction, vitrectomy gains an increasing method in vitreous surgery. Regarding the access to the vitreous cavity, the open sky vitrectomy and the vitrectomy via pars plana have been introduced. The principles of the various instruments for simultaneous cutting and suction of the vitreous body are discussed. From the published results some conclusions can be made concerning the actual indications of vitrectomy. Finally the prospects and limitations of the operation are ventilated as far as it can be done in the present state of development.
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