Variations of the functional results recorded after retinal detachment surgery.
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Biomedical subjects
Publications and source records attributed to J L Menezo.
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The authors have carried out a statistical study on two large groups of patients operated on for cataract and in whom the enzyme alph-chymotrypsin has been used, and the occurrence of ocular hypertension has been examined. One group, which contained 1,003 operations most of which were under the microscope using a firm closure technique, was compared with another group of 324 cases operated under the same conditions but without using the enzyme. In all cases the intraocular pressure was measured 24-48 hours after the operation. The rise in pressure, the rapidity of its development were studied together with its duration and the concentration of the enzyme. In addition these findings were compared with another group of 2,334 eyes operated on several years previously with standard techniques using a less hermetic wound suture, without a microscope, with alpha-chymotrypsin, but whose tensions were controlled from the third week. The results show conclusively that there is a greater frequency of the occurrence of raised intra-ocular pressure when the enzyme is used (40,3%) than when it is not used (25,3%). This ocular hypertension persists in all cases to the end of three weeks. The time of the appearance of the hypertension, the numbers affected and the duration of the intraocular pressure were not significantly meaningful in the statistical analysis.
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A patient with Urbach-Wiethe disease was studied, with special attention given to the analysis of the skin and mucosal lesions. An eosinophilia in the peripheral blood and a diabetic tendency were found. The skin papules and mucosal plaques contain abundant lipids, especially cholesterol (66 percent) and phospholipids (27 percent).
This study deals with the clinical observations of the different forms and shapes of retinal tears, their number and localizations in cases of relapses and recurrences in retinal detachement surgery. Two groups of patients were considered, the first belongs to our own centre and the second to referred patient operated in other hospitals. 45.1% of both groups account for relapses. We find 7.35% of undetected retinal breaks. The greater number of tears are mainly distributed in the temporal quandrants. The most common shapes of breaks are the punched-out hole, fingernail-tip-like tears, small and medium horseshoe tears, oval and 'pebbled'-like (cluster of microholes) holes. Approximately 25% of the breaks were seen in areas where thermotherapy had not been applied and 15% of them were found beside most probably overtreated areas.
For this experience report we have selected out of a total of 950 eyes with retinal detachment, 373 eyes and have sorted them out into three study groups: myopia over 8 d (197 eyes including 14 bilateral detachments), surgical aphakia (102 eyes) and traumatic detachment (74 eyes). With the help of tables and figures we tried to point out the form, number and localization of retinal tears in the eyes with retinal detachment in the above-mentioned groups. For fundus examinations we used routinely the binocular indirect ophthalmoscope without and with scleral depressor and the Goldmann three-mirror contact glass, also without and with scleral depressor. The striking features of the main types of retinal breaks in the three groups are commented, statistically analysed and compared.
A group of patients with retinal detachments was selected whose characteristics allowed the employment of much less traumatizing surgical techniques, such as localized plombs, cryotherapy or diathermy. Once the patient was operated and the retina flattened out itself completely, usually after 1 or 2 days, we proceeded to photocoagulate the degenerative areas of the retina which were usually present with argon laser. Also, a laser barrier was performed, generally at the equatorial level in order to avoid manipulative techniques in the operating room as much as possible. The study comprises the main clinical features of the detachment, the surgical technique employed, and the commented results. The follow-up time of the group in study ranged from 6 months to 2 years.
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An analysis is made of retinal detachments which occurred in patients operated upon for cataract with different surgical techniques, as well as the degree of operating experience of the surgeons. The main clinical features of the detachments are recorded such as number, shape, localization of retinal tears, type and extension. The different surgical techniques are explained and a statistical comparison of the incidence of detachments is set up.
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A group of 62 patients were examined for the adaptometry curve and the static central field in the early postoperative period following an operation for detached retina by various techniques. Comment is made of the data obtained with reference to extension of the detachment, reoperated cases, and results in general.
The authors describe some modifications of the surgical technique of external dacryocystorhinostomy. The preliminary exploration methods and their evaluation are considered. An arched skin incision is used for a more anatomical dissection to approach the lacrimal sac. The following bone trepanation is then made with burrs designed by Burch Barraquer. It should be rather large (15-20 mm), backwards and downwards in the nose bone. A running suture, with three external skin stiches as pexia, is used to tie the anterior muco-mucosal flaps together. This suture is them removed after approximately 12 days. Management and procedures in special cases as well as in reoperations are also discussed.?Author
In a series of 3,222 cataract operations where enzymatic zonulolysis with Alphachymotrypsin was employed, the authors describe two complications which are thought to be due to the effects of the enzyme. They are the persistent iridoplegia in 18 cases (0.05) and the filamentary keratitis in 34 patients (1.05%). The clinical picture of an acute enzymatic intraocular pressure increase and the appearance of a persistent iridoplegia are discussed. Furthermore, these complications are brought together in tables and associated with other which are also thought to be caused by Chymotrypsin.
The authors describe a case of primary corneal degeneration which is of calcareal nature and has annular shape. The patient has had a follow-up period of 15-16 years. A clinical study has been done and we have established a similitude with Axenfeld's primary calcareal degeneration, which was described by this author in 1917. Other corneal degenerations are also commented, which may induce into diagnostic error.
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