Biomedical subjects
Publications and source records attributed to W E Benson.
We used a modification of lens removal by phacofragmentation in conjunction with posterior vitrectomy without any serious complications in over 200 procedures. This modification allowed removal of hardened nuclear sclerotic lenses and reduced the time required for lens removal.
Two young patients developed bilateral posterior subcapsular cataracts while receiving oral sodium cyanate for treatment of sickle cell hemoglobinopathy. In one of the patients, lens opacities regressed spontaneously after cyanate therapy was discontinued.
Forty-one patients underwent vitrectomy through the pars plana for sequelae of severe penetrating injuries. Almost all were inoperable by conventional techniques. After a minimum follow-up time of six months, 13 eyes (32%) had visual improvement and six (15%) were technical successes. The main cause for failure was intravitreal proliferation of fibrous tissue.
One hundred eighty-five patients with unilateral aphakic retinal detachment were studied to determine the frequency of retinal detachment in the fellow eyes undergoing cataract surgery. It was found to be four times higher than the frequency in those eyes that remained phakic (26% vs 7%). Despite the high incidence of detachment, 94% of the aphakic group had a final visual acuity of 20/60 or better in the second eye. At the time of surgery, the macula was still attached in only 17% of the 185 first eyes as compared to 57% of the 21 second eyes that developed an aphakic retinal detachment.
A patient with Best's vitelliform macular dystrophy in his right eye had an intact vitelliform disk and drusen of the optic papilla. Although the foveola elevated by a few tenths of a millimeter, resolution was only slightly affected and the retinal receptors remained remarkably well-aligned, suggesting that mechanisms subserving receptor alignment still functioned. Hue discrimination and visual acuity were only slightly affected and the electroretinogram and visually evoked response showed essentially normal values. The vitelliform disk in the left eye ruptured by direct, blunt trauma. This same eye later developed subretinal macular neovascularization, as its visual acuity reduced, retinal sensitivity decreased, receptor orientation showed abnormalities, and hue discrimination became less efficient; the electroretinogram and visually evoked response remained normal.
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Prophylaxis of selected retinal breaks is effective in preventing detachment. Most retinal breaks, however, will not cause detachment and can be safely followed without treatment. This paper reviews the evidence for and against prophylactic treatment of commonly encountered retinal breaks in an effort to arrive at typological guidelines for treatment. Education of patients with high risk of detachment is probably of equal value to cryotherapy or photocoagulation in preserving visual acuity.
Idiopathic central serous chorioretinopathy (ICSC) is a localized detachment of the sensory retina in the macula which is commonly seen by the general ophthalmologist. However, ICSC with bullous retinal detachment is a rare disease characterized by extensive sensory retinal detachment of the posterior pole and elsewhere. Thus far it has been reported in only nine Caucasian patients in the American literature. Two case reports are presented, one typifying ICSC, the other typifying ICSC with bullous retinal detachment. Although both entities probably share the same pathophysiologic mechanism, they are distinct in terms of diagnostic features and treatment. While ICSC is usually self-limiting and frequently diagnosed by history alone, ICSC with bullous retinal detachment is frequently misdiagnosed and subsequently treated improperly.
Posterior scleritis must be considered in the differential diagnosis of many ocular conditions, including angle closure glaucoma, choroidal folds, optic disk edema, circumscribed fundus mass, choroidal detachment, and exudative retinal detachment. Because it is rare, a high index of suspicion is necessary. Anterior scleritis, pain, or a history of collagen-vascular disease, when present, help to alert the clinician to the correct diagnosis. Posterior scleritis affects women more often than men, but annular ciliochoroidal effusion and choroidal folds are more common in men. Exudative macular detachment and a circumscribed fundus mass are more common in women. This paper reviews the world literature on posterior scleritis and describes findings in a series of 43 patients seen at Wills Eye Hospital. It stresses the clinical features and ancillary diagnostic tests that help to establish the diagnosis.
A live, subretinal fly larva was observed in a 16-year-old Caucasian female. Argon-laser photocoagulation killed the larva without a destructive inflammatory response. The patient's vision improved from 20/200 to 20/20 as the eye recovered. Clinical photographs demonstrate the larva and the acute and later healed pathopneumonic subretinal tracks. The laser photocoagulation technique is described.
A series of 24 consecutive patients presenting with a fundus picture characterized by a predominance of cotton-wool spots, or a single cotton-wool spot, is reported. Excluded were patients with known diabetes mellitus. Etiologic conditions found included previously undiagnosed diabetes mellitus in five patients, systemic hypertension in five patients, cardiac valvular disease in two patients, radiation retinopathy in two patients, and severe carotid artery obstruction in two patients. Dermatomyositis, systemic lupus erythematosus, polyarteritis nodosa, leukemia, AIDS, Purtscher's retinopathy, metastatic carcinoma, intravenous drug abuse, partial central retinal artery obstruction, and giant cell arteritis were each found in one patient. In only one patient did a systemic workup fail to reveal an underlying cause. The presence of even one cotton-wool spot in an otherwise normal fundus necessitates an investigation to ascertain systemic etiologic factors.