Biomedical subjects
Publications and source records attributed to M Romem.
A 3-year prospective study revealed 39 hospitalized cases of ocular injuries from seashore racketball sports. Most were children and young adults and most had internal injuries of the globe. Over a third had retinal edema, 2 eyes were blinded, and at least 4 are subject to serious future complications.
A nationwide prospective collaborative study on ocular trauma was performed in Israel during a period of 3 years (1981 through 1983). Almost half of the traumas (1127 [47%] of 2416 eyes) were sustained by children younger than age 17 years, and mainly between the ages of 6 and 12 years. Most of the injuries happened at home (38.1%) or in the street (26.8%) and during play and sport (65.1%). The male-to-female ratio among the children was 4:1. Blunt injuries accounted for 59.2%; 30.5% were perforating injuries and the rest were chemical and radiation injuries. The visual acuity at the time of hospital discharge was better than 6/30 in the majority of the eyes but 122 patients (11%) had a visual acuity of less than 6/60, and no light perception was the result in 40 eyes (3%). The reasons for the severe outcome were as follows: 23 eyes (2%) owing to phthisis, 22 eyes (1.9%) were enucleated, and 16 eyes (1.4%) suffered from endophthalmitis.
Two cases, those of a man and a woman, developed retinal periphlebitis after hormonal treatment for infertility and contraceptives, respectively. Both had a unilateral severe decrease in visual acuity, and a central scotoma and defect in color vision were also present. The fundus had retinal edema, especially of the macula, a hyperemic disc with blurred margins, normal arteries, congested veins, and marked sheathing along the main veins, with retinal hemorrhages in the inferior half of the retina. Fluorescein angiography showed a delayed filling of the veins in the affected retina and late staining of these veins. Since there was severe visual impairment in each case, systemic adrenocorticosteroids were administered, and a rapid improvement in visual acuity occurred. In one patient, a trace Marcus-Gunn sign, a few small paracentral scotomas, and a defect in color vision were permanent sequelae.
A 9-year-old boy was admitted to the Pediatric Department with high fever, severe photophobia, and a rash on his face, eyelids, and neck. Two days before admission he received injections of penicillin. During the night his general condition worsened, and his fever rose to 40 degrees C. He began to hallucinate, and clear fluid-filled blisters appeared on his skin and mouth. Severe photophobic epiphora, conjunctival injection, and punctate keratitis were also observed. Several hours after local administration of corticosteroids and antibiotic eye drops, his eyelids swelled severely, the corneas became covered by pseudomembranes, and later, in attempting to open the eyelids, the skin peeled off and the eye lashes fell out. Treatment consisted of artificial tear eye drops, and intravenous antibiotics and steroids. His condition improved gradually, visual acuity became 6/15 in both eyes, and a superficial punctate staining of the cornea was observed. The Schirimer test showed lacrimal hyposecretion. A tarsal conjunctival biopsy showed a complete absence of goblet cells. Vitamin A was administered topically and systemically. After three months of treatment with Vitamin A, tear secretion was almost normal, and conjunctival biopsy indicated a regeneration of goblet cells.
A nationwide study of patients hospitalized for ocular injuries was conducted in Israel during the years 1981 through 1983, with the participation of 17 ophthalmic departments. The study comprised 2276 patients (2416 eyes), 47% of whom were children. The male-female ratio was 4.3:1. Bilateral injuries occurred in 140 patients, with children sustaining the most severe injuries. Ocular injuries occurred most frequently at home, and children at play were most vulnerable. Most patients retained good vision, 3.7% lost vision totally, and 2% of the eyes had to be enucleated.
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Intraocular ossification was investigated in a series of 20 eyes. Only 12 eyes were phthisical. The etiological factors were trauma, inflammation, glaucoma and massive intraocular gliosis. Bone tissue was of the compact and spongy type. A correlation was found between the intraocular ossification and retinal detachment, intraocular hemorrhage, intraocular neovascularization and uveitis.
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126 cases of retinal breaks treated in our department by photocoagulation during a period of 10 years (1963-1973) were selected for a close annual follow-up. Eliminated from the study were cases of macular holes, breaks which developed in an eye after retinal detachment surgery, and cases in which a close follow-up was impossible for various reasons. The study includes symptomatic retinal breaks in myopic, non-myopic, and aphakic eyes as well as asymptomatic holes which were found in the undetached fellow eye. Four eyes treated by photocoagulation (3.2%) developed a retinal detachment. The causes of failures and complications, such as retinal detachment, vitreous haemorrhage, and macular pucker, are discussed.
One man and 2 women, aged 67, 63 and 68 years, observed for 8, 6, and 2 years, developed a classical postoperative malignant glaucoma. After a second operation, the use of atropine drops was continued for 2 years in one case, whereas in the other 2 cases miotics and later acetazolamide (Diamox) were necessary in order to maintain normal intraocular pressure. All 3 patients refused a preventive operation in the fellow eye and the use of miotics proved both necessary and effective in maintaining normal intraocular pressure, normal visual acuity, and normal visual fields.
A 73-year-old woman underwent an uneventful intracapsular lens extraction. Two years later, an iris abscess, hypopyon, strong flare, corneal edema, and elevated intraocular pressure developed. Visual acuity diminished from 6/6 (20/20) with aphakic correction to hand movements. Gram-positive cocci sensitive to erythromycin and chloramphenicol were cultured from the anterior chamber. The hypopyon and the iris abscess reabsorbed because we administrated erythromycin at the beginning of the illness. Final visual acuity was 6/6 (20/20) and only a small hole remained in the iris at the site of the abscess. She was in good health four years later.
A brief description is given of the main clinical, histological and epidemiological circumstances of retinal vein occlusion. In an assessment of the pathogeneis of the condition, primacy is given to the role of arteriolar flow insufficiency and stress is laid on the long-standing capillaropathy which precedes the heamorrhagic phase of the disease. Basic therapeutic considerations are mentioned but stress is laid on the diagnosis of the pre-occlusive stage and on measures of a preventive nature that may be taken. Retinal vein occlusion and haemorrhagic cerebral infarct are compared with regard to their pathogenesis and the advantages are discussed of a common ophthalmoscopic study of retinal vein occlusion with neurologists interested in cerebral vascular disease leading to an interchange of therapeutic experience in both conditions. Finally, there are detailed the studies in retinal vein occlusion being conducted by the Jerusalem Institute for the Prevention of Blindness. These are studies of incidence, natural history and of pathogenesis as observed in the experimental disease produced in rhesus monkey.
The value of preoperative cultures, sensitivity tests and prophylactic preoperative antibiotic treatment was evaluated in a group of senile, uncomplicated lens extractions. Sulfacetamide or a mixture of chloramphenicol and polymixin were applied preoperatively for 1 week and an injection of penicillin and streptomycin was given postoperatively. A control group of 140 cases without treatment was also studied. No postoperative infections developed in either group. The number of pathogenic cultures was significantly smaller in the treated group as compared with the untreated one; the mixture of chloramphenicol and polymixin B sulfate was found to be superior to sulfacetamide, different clinical data was compared in the two groups. No postoperative infections developed in either group.
A 42-year-old man was injured twice in his left eye. The first injury resulted in a lacerated skin wound on the forehead, eyebrows and lids, a broken orbital wall and rim, and a small rupture of the sclera at 12 o'clock. The second injury caused a rupture of his left globe. During the operation a large scleral rupture, 1 mm from the limbus, a prolapsed iris, vitreous, and the lens were found under the conjunctiva. The would had been cleaned, the prolapsed iris and vitreous were excised, and the scleral wound sutured. One year after the injury the visual acuity was 6/10 with an aphakic contact lens correction and binocular vision was established. Diagnostic features and indications for immediate repair are discussed.
Two and half years after a circling buckle operation in which two Supra-mid sutures and a solid silicone explant were employed, a Pseudomonas infection developed around the explant and progressed to the inner eye. Removal of all implanted foreign material and treatment with Rifamicin saved the eye. The relevant literature on infection following sclero-plastic procedures is reviewed, and the pathogenesis of the late infections is discussed.
Simultaneous, bilateral and symmetrical surgery was performed on 60 patients with V-esotropia. The results following one surgical procedure were evaluated. The patients were subdivided into three equal groups. A bilateral recession of the medial recti was performed in all three groups. In the first two groups a weakening of both inferior obliques, either by recession or by myectomy at insertion, was performed. In the third group only horizontal muscle surgery was done. Satisfactory results were achieved in 48 out of 60 patients following one surgical procedure. Consecutive esotropia was present in eight and exotropia in four patients. In cases of V-esotropia with marked overaction of both inferior obliques, a simultaneous 4-muscle surgery is recommended in order to minimize the number of surgical procedures.
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