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Biomedical subjects

S Stenkula

Publications and source records attributed to S Stenkula.

At least 19 recordsLinked to original sources

The Swedish national survey of surgical excision for submacular choroidal neovascularization (CNV).

PURPOSE: To compare the visual outcome after surgical removal of subfoveal choroidal neovascularization (CNV) in patients younger and older than 50 years of age. METHODS: Patient records from all Swedish centers performing submacular CNV surgery were reviewed and 90 patients treated between 1992-1999 with a follow-up of 6 months or more were included. The results obtained in 49 patients aged 51-89 years (median=72 years) with neovascular disease caused by age-related macular degeneration (AMD) were compared with the outcome of 41 patients aged 6-49 years (median=36 years) with CNV secondary to non-AMD causes. The main outcome measure was the improvement or deterioration in visual acuity (standardized in logMAR units) at 6 months following surgery. Secondary endpoints were recurrent CNV and surgical complications. RESULTS: The level of preoperative visual acuity was not significantly different between younger patients with CNV associated with non-AMD and older patients with visual loss due to AMD (p=0.069). However, visual acuity at 6 months after surgery was better (p=0.0042) in younger patients (median improvement=0.19 logMAR) than in older patients (median improvement=0.0 log MAR). Marked visual improvement (>1 log MAR unit) was seen in 29% of non-AMD patients <50 years compared to 0% in the AMD group >50 years. CONCLUSION: Surgical removal of submacular CNV does not appear to improve visual acuity in patients > 50 years of age. However, it may be beneficial for younger patients where a substantial improvement of visual acuity is seen in a subset of these patients. Further studies are required to assess the long-term outcome.

Adolescent↗

Tackling the "dropped nucleus".

PURPOSE: To summarize and analyse the results of our experience in treating patients with a "dropped nucleus". METHODS: The case records of nineteen patients who underwent surgery for a "dropped nucleus" at the Ophthalmology Departments of Sahlgren's University Hospital, Gothenburg, and Orebro Medical Centre, Orebro, Sweden during 1994 were retrospectively reviewed to determine the mode of treatment used and the results of surgery. The frequency of this complication was also calculated for Sweden as a whole with the help of the National Cataract Register. RESULTS: The lens was successfully removed in all eyes. No retinal breaks or detachments were present at vitrectomy or follow-up. One eye was lost to panophthalmitis 11 days after the vitrectomy; the remaining 18 eyes showed a favourable outcome. CONCLUSION: The loss of a crystalline lens to the vitreous during cataract surgery is a severe complication. We recommend that an experienced vitreoretinal surgeon should be consulted at an early stage.

Aged↗

Long-term results of macular pucker surgery.

PURPOSE: Macular pucker patients were re-examined 16-90 months after surgery (mean 72 months) to evaluate visual acuity, metamorphopsia, and complications, with particular reference to cataract development. Surgery had been performed on 48 eyes in 46 patients, 31 eyes having a primary, and 17 eyes a secondary macular pucker. RESULTS: At the 6-month control 65% of the eyes with a primary macular pucker and 35% of the eyes with a secondary macular pucker exhibited an improved visual acuity defined as doubling or more of the visual angle. At the last control 57% of the primary group and 33% of the secondary group had a visual acuity which still exceeded the preoperative value. At the final examination a cataract progression was observed in 22/28 (79%) of the primary group and 8/14 (57%) of the secondary group. In the primary group 11% and in the secondary group 36% of the eyes suffered a retinal detachment. All cases were successfully treated and none were followed by visual deterioration. CONCLUSION: The improvement in visual quality after macular pucker surgery appears to be long-standing, if not permanent, especially in primary cases. In those eyes in which a decrease in visual acuity is observed, the most frequent cause is cataract development.

Cataract↗

Limbal sub-Tenon's administration of retrobulbar anesthesia using a blunt irrigating cannula.

BACKGROUND AND OBJECTIVE: To eliminate sharp needles when administering local anesthesia to the eye in order to reduce serious complications caused by needle perforation. PATIENTS AND METHODS: After topical anesthesia, limbal conjunctival incision, and sub-Tenon's dissection, a retrobulbar irrigation of an equal mixture of bupivacaine (5 mg/ml) and lidocaine (20 mg/ml) was given using a blunt cannula. RESULTS: The technique was used in both vitreoretinal surgery (n = 70) and anterior segment surgery (n = 235) with good analgesic and akinetic effects. No serious adverse were noted. CONCLUSION: This proved to be a safe and efficient technique that abandoned the use of sharp needles.

Adult↗

The use of perfluorocarbon liquids in vitreoretinal surgery.

Two perfluorocarbon liquids (perfluoro-n-octane and perfluorodecaline) were evaluated as technical aids in vitreoretinal surgery in 42 patients. Perfluorocarbon liquids were found to stabilize the retina and simplify removal of repiretinal membranes, which in many cases permitted the subsequent use of an expanding gas instead of silicone oil at the conclusion of the operation. The infusion of a perfluorocarbon liquids allowed the drainage of subretinal fluid through peripheral retinal breaks obviating the need for a retinotomy in most cases. No difference could be observed between the two types of perfluorocarbon liquids, and there were no adverse effects associated with their use. The retina was centrally attached in 32 eyes (76%) at 3-10 months follow-up.

Adolescent↗

Healon GV in posterior segment surgery.

Healon, a viscoelastic preparation of Sodium hyaluronate, has been reported effective in posterior segment surgery for dissection of epiretinal membranes, i.e. proliferative diabetic retinopathy and macular pucker. A more viscous substance might be more effective for this kind of surgery. Therefore, a new Sodium hyaluronate preparation Healon GV with a ten times greater viscosity at rest than Healon, was tested in an open clinical study. Twenty-four patients of both sexes and not younger than 18 years were enrolled. The follow-up time was three months. The main indications for using Healon GV were: to separate membranes from the retina, to stop bleeding and to reposition a detached retina. 0.2-0.5 ml of Healon GV was injected through a 27 gauge bent cannula and at close of surgery irrigated out of the eye. Postoperatively the patients were monitored concerning intraocular pressure, vitreous clarity, anterior chamber flare and visual acuity. Healon GV was found to make the surgical procedure simpler and safer. No inflammatory reaction and no increase of IOP was observed.

Adult↗

Hypertensive retinal vascular changes: relationship to left ventricular hypertrophy and arteriolar changes before and after treatment.

Eye-ground-photos were taken in twenty-eight previously untreated men with mild to moderate essential hypertension. The same eye was evaluated before and after 26 weeks of double-blind treatment with Enalapril or Hydrochlorothiazide. The vascular changes were assessed by using a more elaborate and refined grading than the Keith-Wagener-Barker scale. All photos were examined by the same observer without knowledge of blood pressure, type of treatment or the order in which the photos had been taken. There were significant positive correlations between the vascular alterations in the retina in the untreated state and left ventricular wall thickness (echocardiography), minimal vascular resistance in the calf (plethysmography) and blood pressure respectively. Treatment with Enalapril decreased the reflection of the retinal arterial wall significantly and reduced the narrowing of arteries and arterio-venous crossing phenomena non-significantly. Hydrochlorothiazide did not affect any of the retinal vascular changes. It can be concluded that this relatively simple technique of evaluating eye-ground-photos with a new grading scale, when used in non-malignant hypertension, gives a useful assessment of the degree of hypertensive target organ damage in the retina as well as in other important target organs, i.e. the heart and vascular beds. In addition, Enalapril positively affects hypertensive retinopathy in contrast to Hydrochlorothiazide, reflecting what happens to structural cardiovascular changes in the rest of the body.

Adult↗

Healon Yellow as a surgical tool in maneuvering intraocular tissues.

Tinted sodium hyaluronate (Healon Yellow) was used during posterior segment surgery mainly for the dissection of epiretinal membranes in cases of proliferative diabetic retinopathy and macular pucker. The yellow color facilitated injecting the viscoelastic substance under the membranes and simplified its removal at the end of surgery.

Diabetic Retinopathy↗

Scleral reinforcement by a teflon graft and a tissue adhesive.

Expanded patches of polytetrafluoroetylen, teflon (Impra) together with a tissue adhesive (cyanoacrylate) have been used to reinforce the scleral wall. The material has been used in 3 different trials on animals in periods up to 8 months. The histological analysis showed that the material was well accepted. The study indicates that scleral reinforcement with teflon and cyanoacrylate is a safe procedure.

Animals↗

Ophthalmomyiasis interna posterior.

Ophthalmomyiasis interna posterior (OIP) means infection of the posterior part of the eye with the larvae of flies. Few cases have been reported in which the larvae have been removed from the eye and the visual acuity preserved. We report four cases of OIP with living larva in the vitreous cavity. The larvae produced severe uveitis and were removed alive with vitrectomy and a procedure for removing foreign bodies. They were identified as first-stage reindeer warble fly larvae (Oedemagena tarandi). We also observed dead larva in the vitreous cavity of a patient who suffered severe uveitis in 1943, and this eye survived with normal visual acuity. Another patient had a blind eye enucleated and the remnants of a larva were found inside the eye. All patients live in Scandinavia.

Adolescent↗

Retinal detachment. A study of a population-based patient material in Sweden 1971-1981. I. Epidemiology.

A population-based series of retinal detachments (RD) collected during a 10-year period (538 patients, 590 'cases', i.e. diseased eyes including new RD after 6 months in the same eye) is reported. The annual incidence was 10.6 per 100,000 population. Bilaterality was observed in 11.2%. In this material preponderance of the right eye was found. In non-traumatic RD there was a small sex difference, with a higher incidence among females. Older persons were at high risk of sustaining RD, as were myopes. In myopic males the risk increased with the degree of myopia and with increasing age. In myopic females the greatest risk was found in the age group 30-59 years. Myopic eyes are probably also more vulnerable to traumatic RD. Lattice degeneration was more common in middle-aged than in older patients and was also more common in myopic eyes than in eyes with other phakic RD. High myopia (greater than -5D) was more frequent in patients with lattice degeneration than in those without. Aphakia was found to be an important predisposing factor for RD. A classification taking into account the above-mentioned factors is proposed.

Adolescent↗

Retinal detachment. A study of a population-based patient material in Sweden 1971-1981. II. Pre-operative findings.

In a population-based material of patients with retinal detachment (RD), the pre-operative findings in different subgroups were studied. In traumatic cases flap tears and round holes were found in at least as high a frequency as oral dialysis, or even higher. In aphakic cases subtotal or total RD was often observed on admission for surgery. A high proportion of aphakic eyes without lattice degeneration exhibited no breaks. RD in myopic eyes was usually large, and round holes were frequently found. Full-thickness fixed retinal folds were more seldom seen pre-operatively en myopic than in non-myopic eyes. Lattice degeneration was usually observed in myopic RD patients of ages less than 30 years, but mainly in hyperopic or emmetropic eyes in patients over 60. In RD with lattice, multiple breaks were frequently found. A comparatively large group of RD cases without lattice were non-traumatic, phakic and non-myopic (40%). Most of these patients were 60 years and older. Flap tears were often seen, and the detachment was seldom large in this group.

Adolescent↗

A new technique of treating rhegmatogenous retinal detachment using the Q-switched Nd:YAG laser.

In eyes with retinal detachment and a horseshoe break, vitreous traction on the retina has been relieved by severing the flap of the break with the aid of the Q-switched Nd:YAG laser. The retina often flattens in eyes with shallow retinal detachment after this treatment; the breaks then can be sealed off with argon laser. In cases of retinal detachment treated with expanding gas, fewer recurrences were observed when vitreous traction had been relieved by Nd:YAG laser treatment.

Argon↗