Stanley Chang 1992 recipient of the Hermann Wacker Prize of the Club Jules Gonin.
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Biomedical subjects
Publications and source records attributed to J Edmund.
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In the last century German medical sciences made up the chief inspiration to the medical profession in Europe. The influence of German ophthalmology spread to Denmark, and accordingly the first Danish professor, Edmund Hansen Grut was trained in the Graefe clinic. His successor, Jannik Bjerrum grew up in southern Jutland, a district later on lost to the German Empire. The hitherto prevailing Danish sympathies with the neighbour in the south vanished after this. Bjerrum thus wrote all his papers in Danish and made no efforts to achieve an international reputation. In contrast, Marius Tscherning, received widespread recognition as a scientist. He spent many years in France. His scientific insights at last brought him to the Danish chair of ophthalmology. The history of the first three professors of ophthalmology, so different in their attitudes, has narrative value, but exemplifies as well the rapid development of the profession in the years 1886-1925.
Of a pair of monozygotic twins who are both myopic, only twin B has an optic nerve pit in her left eye. At the age of 19 her visual acuity was reduced due to macular edema. Three years later, krypton laser coagulation treatment produced an appreciable improvement. Although both twins are myopic, the anisomyopia observed illustrates the influence of environment on ocular refraction.
In 116 diabetic eyes scheduled for vitreous surgery, the visual evoked potential (VEP) after flash stimulation was recorded prior to surgery. Latencies of the flash evoked potentials show a distribution suggestive of a Gaussian curve with an abnormal extension. Dividing the material into two groups based on a latency shorter or longer than 100 milliseconds revealed a highly significant difference in the visual improvement following surgery between patients with a short and patients with a long latency (P less than 0.001). With a latency longer than 100 millisec. most patients showed no visual change after operation, and among the few who did the change, consisted more often in visual reduction than improvement. Additional investigations in the study reveal that it is likely that the prolonged latency of the flash VEP is due to pathology of the retina or visual pathways.
To determine whether or not the electrophysiological status of the eye can give information as to the result of vitreous surgery, the visual evoked potential to flash stimulation was measured prior to vitreous surgery. Seventy-four eyes were submitted to surgery. Latencies of flash evoked potentials showed a distribution suggestive of a Gaussian curve with an abnormal extension. Dividing the material into 2 groups based on a latency longer or shorter than 100 millisec revealed a highly significant difference in visual improvement after surgery between patients with long latency and patients with short latency (P less than 0.001). With a latency longer than 100 millisec the patient has an almost equal chance of visual improvement or visual reduction by surgery. The frequency of operative complications was twice as high in patients with latency longer than 100 millisec compared to patients with a latency shorter than 100 millisec.
Based on a period of introduction with the vitrectomy technic the visual acuity results in 143 consecutive cases performed between 1976 and 1980 are related to the anamnestic information, the pre-, per- and post-operative findings. In this introductional period the patients referred had longstanding retinovitreal changes, and, because of lack of prognostic parameters, all patients were offered surgery regardless of the observed pathology. All vitrectomies were carried out with the Klöti macrostripper and diathermy unit, without any additional instrumentation. From the results of these early cases, we have changed our surgical method to a three-port entrance with a separate infusion canula, a separate fiberoptic illumination and an interchange between vitrector, automatic scissors, hook, stilleto, vacuo needle, forceps and intravitreous photocoagulation through a third port. Diabetics should be offered vitrectomy if vitreous haemorrhages last for more than 3 months. Vitrectomy is considered useless or contraindicated in diabetics with lack of light perception or light projection, neovascular glaucoma, extinguished visual evoked potential. Only an improvement in the peripheral vision can be expected in diabetics with macular detachment. In rhegmatogenous detachment cases with intravitreal traction, vitreous operations should be performed only where intraretinal or retroretinal changes do not prevent mobilization or unfolding of the retina. Traumatic vitreoretinal disorders should be operated upon early.
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The authors have developed a direct ophthalmoscope with simultaneous television transmission. The ophthalmoscope is used clinically for student as well as postgraduate teaching and for intercollegial discussion of retinal changes which give rise to differential diagnostic difficulties.
A method for dynamic angiography and quantitative measurement of fluorescence in ocular vessels in an in vitro experiment and in corneo-conjunctival angiography is described.
The picture of retinal detachment following cataractextraction is studied in 86 cases of aphakic detachment, and the hypothesis that two different forms of detachment exists is proposed. In order to study this hypothesis the time-interval, the refraction and the type of tear is analysed. The results seem to indicate that two forms are present. The first one, the so-called "non: aphakic" detachment, appears in the predisposed eye and will occur after a short time-interval. The other form, the "true" aphakic detachment appears at a later stage and though this form more often shows no clear-cut tear the prognosis seems to be somewhat better.
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