Practical aspects in the setting up of a vitreo-retinal unit.
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Biomedical subjects
Publications and source records attributed to L Gopal.
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Ocular trauma by "broomstick bows and arrows" is a unique penetrating injury among Indian children. Hitting the eye with a great velocity, these highly contaminated missiles may cause severe damage. The results of surgical treatment of 100 children who suffered such trauma are presented. Anatomic success, ie, successful reconstruction of the globe with attached retina, was attained in 85 (85%) of these eyes. Functional success, ie, improvement in visual acuity of two Snellen lines in eyes with measurable preoperative acuity, or improvement to at least 2/60 in the eyes with preoperative acuities of light perception or hand movements, was attained in 62 (62%) of the eyes. Of the functionally successful eyes, an acuity of 6/9 or better was achieved in 28 (45.2%). Factors predictive of poor anatomical success were: injuries involving both anterior and posterior segment (P < .02), endophthalmitis (P < .05), and presence of retinal detachment with or without proliferative vitreoretinopathy (P < .05). Mean follow up was 4.5 +/- 3.59 months (range, 2 to 24 months).
The Tono-Pen XL (Bio-Rad, Santa Ana, CA) was compared with manometer readings for intraoperative measurement of intraocular pressure (IOP) in 40 eyes of 40 consecutive patients after vitrectomy, lensectomy, and fluid-air exchange. Tono-Pen readings corresponding to manometer readings of 10, 20, 30, 40, and 50 mmHg were obtained in a masked fashion with a randomized sequence of manometer readings. A correlation was obtained between the manometer and Tono-Pen readings (r = 0.96 in emmetropic eyes and r = 0.93 in myopic eyes). The regression curve that represents the calibration curve of Tono-Pen in terms of the manometer readings for air-filled vitrectomized eyes was obtained. Any Tono-Pen reading can be easily translated into the corresponding manometer reading by referring to the curve. The Tono-Pen can therefore be effectively used to accurately determine intraoperative IOP in eyes undergoing vitrectomy, lensectomy, and fluid-air exchange.
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We prospectively studied the efficacy of peribulbar anesthesia in 76 consecutive patients who underwent vitreoretinal surgery. The mean duration of anesthesia was 124.74 +/- 50.17 minutes, and the mean duration of akinesia, 151.5 +/- 54.45 minutes. Adequate anesthesia and akinesia, independent of the duration of surgery, was obtained in 26 of 33 (78.8%) patients who underwent vitrectomy; 9 of 32 (28.1%) who underwent scleral buckling; and 2 of 11 (18.2%) who underwent vitrectomy combined with scleral buckling. In all, topical and systemic supplementation of drugs for inadequate anesthesia or akinesia allowed 32 of the 33 (97%) vitrectomies, 30 of the 32 (94%) scleral buckling procedures, and all 11 of the combined surgeries to be completed as planned. Three (4%) patients vomited, moved, or were restless, resulting in an operative complication or postponement of surgery. Fifty-eight (76%) said they would desire similar anesthesia if subsequent surgery was needed in the same or fellow eye. We conclude that peribulbar anesthesia should be considered primarily for patients requiring vitreous surgery alone, and as an alternative for patients requiring scleral buckling or combined surgery for whom general anesthesia is contraindicated.
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Seventeen eyes with retinal detachment secondary to retinal breaks in the colobomatous area were managed by vitrectomy procedures. Endodrainage was done through the break in the colobomatous area, with simultaneous fluid-air exchange. Endolaser photocoagulation was performed along the colobomatous margin posteriorly, while the anterior portion was treated by transscleral cryopexy. Silicone oil was then exchanged with air. In nine cases, the silicone oil had to be removed for complications such as emulsification, glaucoma, and keratopathy; in three of these eyes, oil removal resulted in recurrent retinal detachment. At the 2-month follow-up visit, there was 100% anatomic success, and 12 eyes (70.6%) recovered visual acuity of 10/200 or better. Of the 11 eyes with follow-up of more than 6 months, in 9 (81.8%) the retina remained reattached at last-follow up, and in 6 eyes (54.5%) a visual acuity of 10/200 or better was obtained.
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A retrospective study involving 40 eyes of 40 patients with giant retinal break is presented. A comparison is attempted between cases where silicone oil is used and in cases where it was not used. The final success rate was found to be same in the two groups on long term follow-up.
Leiomyoma of the ciliary body is a rare tumor that often causes a diagnostic dilemma. Sclerouvectomy has been found to be beneficial in the management of iris and ciliary body leiomyoma. We treated a case of leiomyoma of the ciliary body presenting as a fleshy mass in the anterior chamber, removed by partial lamellar sclerouvectomy. Ultrasound biomicroscopic and histopathologic features, including light microscopic, immunohistochemistry, and transmission electron microscopic features, were studied and the literature was reviewed.
The visual outcome in cases of congenital cataract, managed both surgically and conservatively, is outlined. Final vision was better in cases with partial cataract, about 40% of whom attained 6/24 or better vision. With total cataracts, none could achieve this level of vision, with the majority (84%) attaining only 6/60 or less acuity. Visual results were also better in patients without nystagmus, 34% of whom attained 6/24 or better vision, while in cases with nystagmus, only 15% could come up to this level. Cataracts necessitating early surgery had a worse prognosis than cataracts necessitating late surgery. Visual results were best in cases with bilateral cataracts, partial cataracts, absence of associated ocular anomalies, the absence of nystagmus and in patients requiring later surgery. The important causes of nonimprovement of vision were amblyopia and after-cataract. Retinal detachment, retinopathy, and degenerative myopia were some of the less frequent causes of poor vision, while mental retardation was another important factor. Full cooperation from the parents is absolutely essential in the proper visual rehabilitation of the handicapped child.
We describe using the technique of autoscleral flap grafting in 1 eye with scleral staphyloma, in 2 eyes with scleral ectasia, and in 1 eye with scleral deficiency following excision of a limbal tumor. In three cases, follow up was over 6 months; in the remaining case, 2 months. In one patient, the scleral ectasia recurred, since the scleral flap that could be dissected was thin. The recurrence was managed successfully by a periosteal autograft.