[Indications for keratoplasty in the treatment of corneal perforation].
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Biomedical subjects
Publications and source records attributed to R Weekers.
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1. Instillation of 2 drops of 4% solution of atenolol decreases the ocular pressure in open angle glaucoma. 2. In 12 glaucomatous patients treated as in-patients, 4 daily instillations of 4% solution lower the average tension of the group below 20-22 mm Hg day and night. 3. The tensionnal effects of 4 or 6 daily instillations on out-patients seems to be less effective. 4. The hypotensive effects of atenolol, on some of the patients at least, decreases during the second month of uninterrupted treatment. However, the response to a single dose remains constant even after a long term treatment. 5. Treatment with atenolol is remarkably well tolerated. It does not provoke either local or general side effect. 6. Although the combination of atenolol and myotics or carbonic anhydrase inhibitors produces an additive pressure lowering effect this results in a loss of the advantages of atenolol with regard to absence of undesirable pharmacological effects.
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The respective indications are briefly described for: a) trabeculectomy through a scleral flap, b) simple cataract extraction, c) combined operation of lens extraction and fistulation in open-angle glaucoma on the one hand and close-angle glaucoma on the other. The choice of operation is dictated by many considerations. The main considerations are as follows. A Lens extraction alone has no lasting effect on the pressure in open-angle glaucoma, but is a good operation against early closed-angle glaucoma. B. Any fistulising operation predisposes to cataract when performed on old patients whose lenses suffer from senile changes already before the operation. A fistulising operation predisposes more to cataract in close-angle as in open-angle glaucoma. C. Lens extraction removes the risk of post-operative "athalamia" and hence of post-operative malignant glaucoma. D. The combined operation avoids a second surgical intervention and reduces the risks of oedematous dystrophy of the cornea in elderly patients who already have before the operation definite signs of endothelial dystrophy. E. Combining the glaucoma and cataract operations although, having certain peculiar risks, gives in a high percentages of cases efficient and long-lasting fistulation and a satisfactory intracapsular lens extraction.
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Sixteen keratoplasties (15 perforating, 1 lamellar) were performed on 12 perforated corneas and on 2 eyes threatened by imminent corneal perforation. The causal disease was metaherpetic kératitis (6 cases), chronic and recurrent ulcers (4 cases), acute keratoconus (1 case) and corneal traumas (3 cases). Enucleation has been avoided and the anterior chamber was restored in all the cases, with or without anterior synechiae. One case only developed ocular hypertension which was cured by fistulisation. Architectonic results are satisfying in all the cases. Recuperation of visual functions is possible only in the most favourable cases. It is indicated to perform keratoplasty before the perforation when this one seems unavoidable and to consider this surgical procedrue as an emergency when the cornea is perforated.