Biomedical subjects
Publications and source records attributed to U M Klemen.
A new method of small incision cataract surgery is presented which allows sutureless wound closure with a fistulating aperature for regulating IOP. After in-the-bag pcIOL implantation, a triangular opening is made into the posterior scleral valve and combined with a peripheral iridectomy. Sufficient regularization of the IOP and good visual results could be observed in the majority of all 61 eyes operated on using this method.
A technique designed to reduce zonular stress and ensure safe intercapsular phacoemulsification is described. This one-handed method is especially effective in eyes with strong adhesions between nucleus and cortical layers where hydrodissection is not possible. Early experiences in 150 eyes yielded a reduction in emulsification time and such intraoperative complications as posterior capsule rupture and zonulysis.
In 27 eyes, secondary implantation of posterior chamber lenses was performed. The precondition was the existence of a part of the posterior lens capsule with zonular fibers. After cleaning of the capsule surface by means of irrigation/aspiration as well as lysis of posterior synechiae and if necessary, anterior vitrectomy, the lens was fixated in the ciliary sulcus using air and healon. Postoperatively, the visual acuities were found to be the same or better in comparison with the preoperative readings. The two main complications were decentralization of the intraocular lens and further opacification of the posterior lens capsule.
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Within the last 18 months the authors have measured, in cases of juvenile cataract seen by them, the axial length of the eye and other parameters. As a control group, children from the authors' squint clinic, with various refractive errors, were examined. With the data thus gathered, correlation and regression analyses were performed, postoperative refraction values were calculated, and eye growth in phakic eyes was compared with that in aphakic eyes. Regression formulas were established which enabled the authors to calculate eye length at a given age, to determine the postoperative refraction of their juvenile cataract patients with great accuracy, and, so far, to prove that there is no significant difference between phakic and aphakic eyes as regards growth.
In a group of 14 children who underwent extracapsular cataract extraction for cataract of the posterior pole, a reopacification of the posterior capsule was observed in all 18 eyes treated. Only in four eyes, in which rupture of the posterior capsule had occurred intraoperatively, was a reoperation unnecessary. In ten eyes satisfactory removal of the opacifications was accomplished using McIntyre's aspiration cannula; in four cases lensectomy was performed because of severe fibrosis. During a follow-up period of two to eight months after the posterior capsule had been rendered clear, transparency was found to be good in eight out of ten eyes.
The records of 500 eye injuries were analyzed according to age, causes, type of injury and place and time of accident. Children accounted for 16% of the cases, almost half of them between 11 and 15 years old. Forty percent of the injuries were the result of accidents while playing. An increase in the number of injuries in April, July, and on Saturdays was observed. On the basis of this investigation the authors have attempted to recommend a number of sensible preventive measures.
Sixty-four infant diabetics were kept under observation for an average of 6.1 years to obtain ophthalmologic and endocrinologic data (biomicroscopic fundus examination, fundus photography, fluorescein angiography; blood sugar level, HbA1c determination, ketoacidosis, microalbuminuria, HLA-DR typing). In 28 patients (44%, Group B) retinal vascular changes corresponding to the picture of diabetic preretinopathy were detected by fluorescein angiography. In 36 children (56%, Group A), the retinal vascular system was normal. In 16 patients vascular anomalies increased during the observation period, while in 12 patients no further changes were seen. On comparing the endocrinologic findings in the two groups, the only statistically significant difference was in the ketoacidosis values. A tendency to hypoglycemic attacks, as well as elevated HbA1c and microalbuminuria levels, was likewise more frequent in Group B. Aside from the typical distribution, HLA-DR typing revealed a considerable percentage of children with 1/4 localization in Group B only. It was not seen in any patient in Group A. These results give rise to the hope that HLA-DR typing will enable prognostic conclusions to be drawn concerning the time of onset and progression of diabetic retinal alterations in the future.
As opposed to florid diabetic retinopathy, pseudothrombosis in type I diabetics has a favorable prognosis and responds well to panretinal photocoagulation therapy. In the past decade eight cases of retinal pseudothrombosis were evaluated, treated and kept under observation at the department for diabetic eye complications of the 1st University Eye Clinic, Vienna. Photocoagulation therapy repeated at brief intervals halted progression in all cases and improved visual acuity. In the follow-up period (2-10 years) no further episodes of progression were seen.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
71 out of 4803 diabetics attending the special outpatient clinic for diabetic eye complications at the 1st Eye Department of the University of Vienna were found to be suffering from glaucoma. Ocular hypertension was observed in 717 cases. Neither the course of diabetic retinopathy nor the correlation between duration of diabetes mellitus and the manifestation of retinal changes differed from the findings in diabetics with normal ocular pressure. The hypothesis that increased ocular pressure in response to the topical application of steroids might be of beneficial influence on the course of diabetic retinopathy was not confirmed by these observations.
Although photocoagulation is no cure for diabetic retinopathy, it slows down or, in favourable cases, prevents further progression. In order to achieve the desired therapeutic effect, photocoagulation has to include the ischaemic mid-periphery of the retina. Following a latency period of varying duration during which no further progression is evident either on ophthalmoscopic examination or fluorescein angiography, recurrence of neovascularization is observed in some cases. The therapeutic management entails additional panretinal photocoagulation, in particular at the periphery. The authors report on 75 patients who, following panretinal photocoagulation, were treated by additional argon-laser coagulation.
Report on 11 patients who underwent penetrating keratoplasty and were treated with Cyclosporin A for an average of 6 months because of excessive superficial and deep vascularization of the recipient cornea. In none of the patients was a permanent Cyclosporin A-induced side-effect observed. After an average follow-up period of 11 months 9 grafts remained completely clear; however, an allograft-reaction occurred in 2 cases in spite of the immunosuppressive therapy.
In 78 eyes treated by different fistulizing procedures (57 by goniotrepanation or trabeculectomy, 13 by Elliot trepanation and 8 by iridencleisis) extracapsular cataract extraction with implantation of posterior chamber lenses was performed. A sector iridectomy had to be performed in about 40% of the eyes because of difficulties in dilatation of the pupils and posterior synechiae. Postoperatively the IOP was regulated in 83% of all eyes without additional topical medication; a second fistulizing procedure was only necessary in one eye. Complications such as keratopathies, posterior capsule fibrosis, and dislocations of the posterior chamber lenses were not found to be more frequent compared with nonglaucomatous eyes treated by extracapsular cataract extraction with implantation of posterior chamber lenses.
About 2% of the Austrian population suffer from diabetes mellitus, the incidence being higher in the 5th and 6th decades of life. As a consequence the number of diabetics requiring cataract surgery is relatively large. In recent years extracapsular cataract extraction with implantation of a posterior chamber lens has become the method of choice. The question under what circumstances implantation is indicated in diabetics and in which cases it is contraindicated is still under discussion. During the past 2 years extracapsular cataract surgery with implantation of a posterior chamber lens has been performed on 36 patients (42 eyes). The average period of observation ws 8.5 months. The patient material was analyzed in a retrospective study and the results of surgery are reported in this paper.
One eye of each of 27 patients suffering from preproliferative diabetic changes in the periphery of the retina was treated by panretinal photocoagulation; in the fellow eye photocoagulation was only performed in the peripheral zones of the fundus. Follow-up observations over an average period of 1.5 years showed a centripetal progression of capillary obliterations in only 5 eyes after peripheral photocoagulation and a less pronounced tendency to development of a diabetic maculopathy as compared to eyes treated by panretinal photocoagulation.