Lj Blanksma

Long-term patient satisfaction of external dacryocystorhinostomy

Purpose: To evaluate patient’s opinion on the long-term success of external dacryocystorhinostomy using the same quantitative parameter pre- and postoperatively. Methods: A postal questionnaire was sent to 139 patients who had undergone external dacryocystorhinostomy. The only parameter for success of the treatment was the improvement of patient’s subjective pre- and postoperative symptoms score. The duration of this follow-up ranged from 1 year up to 5 years postoperatively. Statistical analyses were performed using the Wilcoxon Signed-Ranks test and the χ2 test. Results: According to the patient’s own evaluation, external dacryocystorhinostomy is a successful operation. After 1 year the success percentage was 89%, after 2–3 years it was 79% and after 4–5 years it was 71%. Conclusion: External dacryocystorhinostomy is appreciated by the patients and considered a successful operation. The subjective evaluation of this operation should yield more creditability than objective methods.

Measurement of visual acuity with two different charts; a comparison of results and repeatability in patients with cataract

Purpose: To compare two different optotypes to measure visual acuity. Methods: Experiment 1: Fifty patients with moderate cataracts were asked to read a chart consisting of letters of the alphabet (Sloan letters) first and a chart comprising Landolts broken rings afterwards. Experiment 2: Half of patients were instructed to repeat the reading with a second letter chart, the other half was instructed to read the chart with the broken rings again. Results and conclusions: Experiment 1: It was found that with the letter chart more optotypes (two to four) were recognized than with the broken ring chart. The different result of visual acuity measurement with the two optotypes is irrespective of the visual acuity. Experiment 2: The re-read instruction revealed that the measurements were reproduced equally for both charts.

Concentration of timolol in aqueous humour

Two groups of twenty patients who were to undergo a routine e.c.c.e. applied eye-drops containing timolol 0.1% or 0.5% twice daily during the week preceding their operation. A third group of twenty patients, using placebo drops, served as control. During the cataract surgery a sample of aqueous was collected. The samples from the timolol 0.1% patient group contained a significantly lower concentration of timolol than those from the timolol 0.5% patient group, but there was considerable overlap.

CLINICAL AND PHYSICAL MEASUREMENTS OF THE CATARACTOUS LENS

In connection with the clinical trial of an anti-cataract drug (Bendazac lysine) a number of examination methods were used to assess the progress of the cataract: slitlamp examination, visual acuity determination, and the measurement of the contrast sensitivity, light scatter in the eye and the autofluorescence and transmission of the lens. In this article the measurements of 43 patients (43 eyes) are presented, taken at the time that medication was started. In this way we can get an impression of the value of these measurements for the study of cateractous lenses. The contrast sensitivity of the cataractous eye is lowered for all spatial frequencies as compared with the normal population. Light scatter is greatly increased. The autofluorescent profile of the lens with nuclear cateract differs markedly from that of the lens with cortical cataract.

TESTING OF LACRIMAL DRAINAGE WITH AID OF A GAMMA-RAY EMITTING RADIOPHARMACEUTICAL (TCO4(-)-TC-99M

Conclusions99mTc04−, is an excellent and harmless indicator in tests of the lacrimal drainage system. The detection instrument resolves the canaliculi, the valves in the lacrimal sac and the anatomical results of a dacryocystorhinostomy. The pictures are more easily read and are obtained under more physiological conditions than those obtained with the ordinary X-rays, where a radio opaque solution is injected into the lacrimal sac. The latter method also causes more annoyance to the patient.The velocity with which the radioactive substance passes into the sac and from there into the nose appears to be a usable criterion to discern functional deficiencies.Radio opaque substances disappear from the lacrimal sac within 20 minutes, but99mTc04− remains recordable even after 30 minutes. It remains to be established whether this is so because the radioisotope is more readily detectable or because it adheres better to the mucosa or even because it is absorbed by the mucous membranes.

Fluoro-photometry in myotonic dystrophy

We found pigment alterations in the anterior segments of the eyes of patients with myotonic dystrophy. We therefore performed fluoro-photometry in a group of ten myotonic patients and the results were compared with those of a group of normal persons. The fluorescence levels in the aqueous and vitreous of the myotonic eyes appeared to be two or three times higher than in the normal eyes. This brings us to the conclusion that myotonic eyes have a defect in the blood-ocular barriers.

Stereoscopic fluorescein angiography of the fundus

The fundus of the eye is a three-dimensional organ. The usual two-dimensional representation of the angiogram provides us with incomplete information. It is true that it is usually possible by indirect means to deduce at which level the pathological process is taking place, but a simple technique enables one to register and project the angiogram stereoscopically. This gives the observer a direct visual impression of the spatial proportions of the pathological process.

QUANTITATIVE-DETERMINATION OF FLUORESCEIN IN THE ANTERIOR-CHAMBER AND VITREOUS BODY

The blood-retinal barrier plays an important role in the physiology of the retina, the vitreous body and the aqueous humour. Many intra-ocular processes cause a breakdown of this barrier and this results in an increase in the concentration of fluorescein in the vitreous and the aqueous after it has been injected intravenously (Cunha-Vaz et al., 1975).In our clinic we have built an apparatus for the quantitative determination of the concentration of this fluorescein in both healthy and pathological eyes (Brubaker and Coakes, 1978).The goal of the present communication is to invite other workers with similar interests to compare their results with ours.

Lens reflectometry with a CCD video camera and computer image analysis.

Lens reflectometry is a useful method of determining the back scatter of light from the cataractous lens. Making use of normal programmes, the personal computer can be used for the quantitative determination of the lens reflex, as seen in the slit-lamp image. If three different images of the same eye are compared, it appears that the mean variation in the back-scatter readings made by our method is 8.3%.

Automutilation of the cornea II. Psychiatric aspects

In connection with a number of ophthalmological patients in whom automutilation was seen, the background to this behaviour is considered. It is usually seen in patients with a borderline personality. Automutilants differ from simulants.In practice, it is important to avoid confrontation and to look out for ‘splitting’. Psychiatric treatment is seldom successful.