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PubMed1977

[The consideration of topographic anatomy in ophthalmic surgery (author's transl)].

The fistulizing operations can be classified with regard to their topography to the Schlemm's canal into the precanalicular Elliot's trephining, the trephining in the region of the Schlemm's canal (intercanalicular) or of its next vicinity with scleral flap (goniotrephining with scleral flap), the sclerectomy in the region of the Schlemm's canal (intercanalicular) or of its next vicinity with scleral flap (trabeculectomy). If the trephining is performed retrocanalicularly, the scleral spur and the ciliary muscle are involved. Iridodialysis and haemorrhage from the circulus arteriosus iridis major may occur in the peripheral iridorhexis, which is recommended for the iridencleisis and for the iridectomy in acute glaucoma. The proof for the decompression of the intrascleral optical canal in central vein thrombosis by the surgical procedure reported by Vasco-Posada cannot be deduced when the topographic-anatomical circumstances are taken into consideration.

Eye↗

PubMed1980

Modified trabeculectomy: a new procedure for neovascular glaucoma.

A new surgical procedure has been described specifically for neovascular glaucoma with residual visual function. The procedure included excision of a large trabecular segment under a limbal-based scleral flap, partial non-penetrating cyclodiathermy, and partial ablation of abnormal iris vessels followed by a wide sector iridectomy. The preliminary results in five eyes with advanced neovascular glaucoma were encouraging.

Glaucoma↗

PubMed1981

Intraocular effects of substance P in the rabbit.

The intraocular effects of substance P (SP) were studied in rabbits by measuring the pupil diameter, intraocular pressure (IOP), and aqueous humor protein concentration. Most of the animals were pretreated with indomethacin to avoid any interaction with prostaglandins. Intracameral injection of 1 to 150 ng of SP caused strong and persistent miosis without appreciably affecting the aqueous humor protein concentration or IOP. Intracameral injection of 0.8 to 11 micrograms of SP also induced an increase in IOP (7 to 8 mm Hg) without any apparent concomitant disruption in the blood-aqueous barrier. Outflow facility of aqueous humor decreased by a mean value of 50% after intracameral injection of 0.8 to 1.5 microgram of SP. Since the increase in IOP could be prevented by iridectomy, it was probably caused by a pupillary block from the intense miosis induced by SP. No disruption in the blood-aqueous barrier could be detected after intra-arterial infusion of 10 micrograms of SP or intravitreal injection of 100 ng of SP, indicating that the ciliary epithelium was practically insensitive to exogenous SP. Topical as well as subconjunctival administration of up to 1 mg of SP did not cause any irritative response in the eye. The results show that with concentrations of SP causing intense miosis, the eye does not exhibit visible hyperemia and disruption of the blood-aqueous barrier. This finding is consistent with the hypothesis that after certain irritative stimuli, miosis is mediated by a pathway separate from the hyperemia and disruption of the blood-aqueous barrier.

Administration, Topical↗

PubMed1982

Substance P-immunoreactive nerves in the human cornea and iris.

Human corneas and irides obtained from corneal surgery or sector iridectomies were processed according to the indirect immunofluorescence technique for the demonstration of substance P (SP) immunofluorescence by means of a monoclonal SP antibody. SP immunofluorescence was observed in varicose fibers of the corneal epithelium and nerve trunks in the corneal stroma. SP-immunoreactive nerve fibers in the iris were detected mainly in the pupillary margin in both dilator and sphincter areas.

Cornea↗

PubMed1978

A minimum clearance molded scleral cosmetic-refractive contact lens.

The author describes the prescribing of a minimum clearance, molded fenestrated cosmetic scleral contact lens with a 2 mm lens in the iris section in front of an optical iridectomy. The lens was designed to improve cosmesis, and to restore a blind eye to 20/90.

Contact Lenses↗

PubMed1983

Iridoschisis and the corneal endothelium.

Iridoschisis has been known as a rare entity for the past 60 years, since its first description by Schmitt. It has been reported most frequently in eyes with a history of trauma or one of the glaucomas. While freely floating fibers of disrupted iris mesenchyma may be seen to brush against the corneal endothelium in many patients, there has never been a report of corneal compromise secondary to iridoschisis. A patient with bilateral glaucoma is described. Iridoschisis was present in one eye, and specular microscopy revealed a marked decrease in cell density (600 cells per square millimeter) directly over the split iris fibers. A high degree of polymegethism was also present over the involved sector of iris. Cell counts and morphological findings elsewhere in the cornea were normal for the patient's age. Iridoschisis may be a hitherto unrecognized cause of endothelial decompensation. In selected cases, prophylactic surgical iridectomy should be considered in order to remove the disrupted iris fibers that may play a role in corneal changes.

Aged↗

PubMed1984

Pars plana lensectomy by ultrasonic fragmentation: 1984--Part II: Operative and postoperative complications--avoidance or management.

Operative complications of pars plana lensectomy included mechanical failure, blocked fragmenting needle, air bubbles in the irrigating tubing, miosis, inadvertent iridectomy, hemorrhage, lens remnants in the posterior pole, metal fragments from the fragmenting needle, retinal hole, and retinal detachment. Postoperative complications included hypotony, hypertension, hemorrhage, lens remnants, cystoid maculopathy, retinal hole, retinal detachment, and sterile endophthalmitis.

Cataract↗

PubMed1978

[Fluorescencangiographical and histopathological findings in cases of non-pigmentes iris cysts (author's transl)].

The clinical, fluorescencangiographical and histopathological findings in 3 cases of non-pigmented iris cysts are described. The first case was a posttraumatic cyst after cataractextraction, the second in all probability, also a posttraumatic cyst and the third case was a spontaneous intrastromal nonpigmented iris cyst. Although the clinical and histopathological findings are not always helpful in the differential diagnosis between non-pigmented posttraumatic and non-pigmented spontaneous iris cysts, we believe, that fluorescencangiography may provide valuable additional information. The preoperative differentiation is important, because radical excision including the affected cornea or sclera is necessary in the posttraumatic cases, whereas only a simple iridectomy is required for the spontaneous cysts.

Adult↗

PubMed1982

Epithelial invasion of the anterior chamber following repeated keratoplasty.

A 17-year-old man underwent five perforating keratoplasties. The first operation was due to keratoconus and the first two grafts were rejected. Five months after the second operation, the patient complained of severe ocular pains and retrocorneal and iris membranes were noted. Because of acute glaucoma, a peripheral iridectomy was performed, followed by by trabeculectomy due to persistent high pressure. After the third keratoplasty, a diagnosis of epithelial downgrowth was histopathologically established. Fourth and fifth keratoplasties were done because of corneal abscesses, this time combined with membrane peeling from the vitreous cavity. Epithelial cells were diagnosed again in histopathological examination of material removed from the vitreous. The rarity of epithelial downgrowth after surgically uncomplicated keratoplasty and the importance of the symptom of severe disabling pain are stressed.

Abscess↗

PubMed1982

Secondary surgical procedures after epikeratophakia.

Five patients required secondary surgical procedures after receiving epikeratophakia grafts. A neonate underwent epikeratophakia in combination with extracapsular cataract extraction, followed one week later by peripheral iridectomy and nine months later by strabismus surgery. A 53-year-old male had surgery to correct retinal detachment 4-1/2 months after epikeratophakia surgery for the correction of aphakia. A five-year-old male had epikeratophakia after removal of a traumatic cataract; five weeks later, retinal detachment necessitated vitrectomy, 360 degrees buckle, and cyclocryotherapy. A 4-1/2-year-old female had epikeratophakia for aphakia, followed nine months later by strabismus surgery. A 38-year-old female with keratoconus received a plano epikeratophakia graft, in combination with an extracapsular cataract extraction and anterior vitrectomy, followed two weeks later by an Ocutome vitrectomy. In all cases, the epikeratophakia grafts and interfaces remained clear, and in four of the five patients in whom secondary procedures were successful, vision continued to improve with time.

Adult↗

PubMed1982

The use of FEIBA (factor eight inhibitor bypassing activity) in cataract extraction in hemophilia A patient with inhibitor.

A 34-year-old patient, with severe factor VIII deficiency (anti-hemophilic factor deficiency) and inhibitor against factor VIII, underwent a phacoemulsification with posterior capsulatomy and thermal iridectomy under general anesthesia. FEIBA (Factor Eight Inhibitor Bypassing Activity) was used to achieve hemostasis. The surgical procedure was successful and no complication was ensued. A brief management of hemophilia A patient requiring surgery is discussed.

Adult↗

PubMed1983

Anterior pars plana vitrectomy for phakic malignant glaucoma.

Phakic malignant glaucoma was seen in five eyes of four patients: it occurred in four eyes after trabeculectomy and in one eye after peripheral iridectomy. They were treated by anterior pars plana vitrectomy combined with intracapsular lens extraction through a corneal incision. In all eyes the anterior chamber regained its normal depth, and the intraocular pressure could be controlled by medical treatment in three eyes. The remaining two eyes required further filtering procedure and subsequently the intraocular pressure was controlled by medical treatment. No serious complications were encountered throughout the postoperative follow-up period of 7-26 months.

Aged↗

PubMed1983

Surgical therapy of traumatic hyphema.

The usual management of traumatic hyphemas in our institution has been to avoid or delay surgery until absolutely demanded by the clinical course. Despite this, most (73%) of our in-patients with total hyphema underwent surgery before leaving the hospital. In those who required surgery, 43% developed corneal staining. Optic nerve damage occurred in half of the patients whose surgery was performed eight or more days after the hyphema occurred, but was absent in those undergoing earlier surgery. The usual procedure used in this series was a trabeculectomy with iridectomy and gentle irrigation of the anterior chamber, and no surgical complications occurred. We believe that surgery, being relatively safe, should be performed early in cases of total hyphema unless the elevated intraocular pressure is controlled medically and spontaneous resolution is clearly imminent. For cases in which surgery is nearly inevitable, we suggest that earlier surgery might reduce the incidence of optic nerve damage and corneal staining.

Adolescent↗

PubMed1980

Unintentional lens injury in glaucoma surgery.

In 1891, Priestly Smith wrote that in glaucoma surgery, "the lens is occasionally wounded, unsuspected by the operator," and described serious consequences. In 1953 Christensen and McLean found histologic evidence of perforation of the lens capsule in many eyes which had been enucleated after unsuccessful glaucoma surgery. Twelve additional enucleated eyes with lens perforations plus clinical consultations indicate that unintentional surgical injuries to the lens still are occurring during iridectomies, filtrations, and trabeculectomies and usually are unsuspected by the surgeon. This injury should be considered when a lens opacity becomes manifest within a few days or weeks after surgery. In addition to failure of the operation, the consequences vary from limited cataract formation to complete opacification and subluxation of the lens. The lens injury also may cause a severe phacogenic uveitis which requires early lens extraction to avoid extensive intraocular fibroplasia. Clinical features and histopathology are presented with illustrative cases. The prevention and management of unintentional lens injury are discussed.

Cataract↗

PubMed1980

[Iris suture in cataract surgery (author's transl)].

Cataract extraction can cause a diffuse traumatic dilatation of a narrow pupil in patients with long-standing application of miotics or after iridocyclitis. In order to avoid a total iridectomy a technique for performing an iridotomy with a single iris suture is described. We present the long-term observation of twenty cases: a pear-shaped pupil in a fairly centric position was obtained in all cases and an iris diaphragm was present. The nylon suture was tight in all cases and a bridge of cicatricial iris tissue present.

Aged↗

PubMed1980

A prospective, controlled study to compare the Scheie procedure with Watson's trabeculectomy.

Decisions regarding patient care are made difficult because of lack of adequate knowledge. Surgeons try to decide upon choice of procedure and surgical technique based on the results of their experience and their understanding of published reports. Yet there are virtually no prospective controlled studies comparing different procedures for open-angle glaucoma. The present study compares peripheral iridectomy with a thermal sclerostomy, as described by Scheie, with trabeculectomy, as described by Watson. In 15 patients with primary open-angle glaucoma a Scheie procedure was performed in one eye and a trabeculectomy in the other, the choice of procedure being determined randomly. Surgical technique was standardized. Shallow or flat anterior chambers were more common in patients treated with a Scheie procedure, but in the 15 cases studied no patients required alteration of their postoperative care because of any complication. When reevaluated five years later, central visual acuity was approximately the same in both groups, control of glaucomatous disease was considered to be slightly easier in patients receiving a Scheie procedure, and intraocular pressure was 16 mm Hg in patients treated with the Scheie procedure in contrast to 22 mm Hg in those in whom a trabeculectomy had been performed. The Scheie procedure resulted in a thin cystic conjunctival bleb. In only two cases was a detectable bleb present following trabeculectomy.

Cataract↗

PubMed1982

Fluid permeability of monkey ciliary epithelium in vivo.

Four months after total iridectomy, the aqueous humor of each of six cynomolgus monkeys was perfused at the spontaneous intraocular pressure under urethane anesthesia. The perfusate solution consisted of mock aqueous humor containing trace amounts of 14C-dextran (70,000 mol. wt.). The aqueous was stirred to bathe the ciliary epithelium. Aqueous flow was calculated from the tracer dilution. The aqueous humor was then perfused with bovine serum albumin (35 mg/ml) added to the perfusate. A new aqueous flow value was determined. Aqueous flow during mock aqueous perfusion was 1.28 +/- 0.12 microliters/min and 1.64 +/- 0.12 microliters/min during mock aqueous plus albumin perfusion. From the increase in aqueous flow due to the osmotic effect of the albumin solution (13.2 mm Hg), the osmotic fluid permeability of the ciliary epithelium was calculated to be 0.027 +/- 0.007 microliters/min/mm Hg. This permeability value places the ciliary epithelium in the category of membranes with "leaky" tight junctions. However, the low fluid permeability of the ciliary epithelium suggests a minor role for ultrafiltration in aqueous humor formation in the monkey.

Animals↗

PubMed1982

Pressure profile of ophthalmic surgical procedures: an experimental study on the rabbit eye.

A balloon sensor was implanted in the posterior wall of the rabbit eye, and pressure fluctuation during several surgical procedures was monitored. Temporary IOP increase during digital massage sometimes reached near 100 mm Hg. Pressure increase during incision on the cornea was quite high, while corneal suturing, lens extraction, iridectomy, and open-sky vitrectomy induced minor fluctuating pressure on the posterior wall. Diathermy coagulation and scleral incision during simulated retinal detachment surgery increased IOP, exceeding 50 mm Hg and sometimes reaching 100 mm Hg.

Animals↗