Per Syrdalen

Ultrasonographic study on changes in axial eye dimensions after encircling procedure in retinal detachment surgery.

The pre‐ and postoperative results of ultrasonographic measurements on the axial ocular components in 10 phakic eyes with retinal detachment treated with encircling silicone rubber band are presented. A significant increase (P < 0.001) in axial eye length from 0.62 to 1.24 mm (average: 0.98 mm) was found. The elongation of the eye was caused by a corresponding increase in the length of the vitreous cavity. No significant changes were found in the anterior segment of the eyes. These data demonstrate that the postoperative refractive change in a myopic direction, which an encircling procedure with moderate indentation often produces, is caused by an axial elongation of the eye.

Vitrectomy in double perforating eye injuries

Abstract. The results of 41 consecutive cases of double perforating eye injuries, operated with vitrectomy between December 1975 and December 1982, are reported. Fourteen eyes (34%) obtained a visual acuity of 5/10 or better, and 23 eyes (56%) obtained 5/200 or better. Twenty‐eight (68%) developed retinal detachment, and 12 of these were attached by surgery. In this series the pre‐operative visual function and the type of injury had a significant effect on the final result. No beneficial effect from early (within 14 days) vitrectomy could be shown.

Haemorrhagic maculopathy in young adults.

The results from a retrospective clinical study of a group of patients with a specific macular disease are presented. The group includes young adults, otherwise healthy, with no hereditary diseases. The macular disease is as a rule monolateral. The lesion consists of a small central nodule surrounded by subretinal haemorrhages, retinal oedema and degenerative changes in the adjacent pigment epithelium. Fluorescein angiography demonstrates subretinal neovascularization in the central part of the lesion. The disease is selflimiting and the lesion develops into a fibrotic scar. In some cases, small, atrophic spots are seen scattered in the eyeground. There is no vitreous reaction and no signs of anterior uveitis. The clinical picture is identical with the macular lesion reported in the presumed ocular histoplasmosis syndrome.

Intraocular metastasis from cutaneous malignant melanoma

Abstract. Metastatic melanoma to the eye can show a number of unusual features. Two cases with intraocular metastases from primary cutaneous malignant melanoma, with a latency of 5 and 16 years, respectively, from excision to debut of ocular symptoms are reported. In the first case, tumour cell invasion of the chamber angle caused an advanced secondary glaucoma. This eye was enucleated some months later when the tumour extended through the sclera despite palliative external radiation therapy. In the other seeing eye, small melanoma metastases were treated with laser. The patient died of systemic involvement. In the second case, a probable melanoma metastasis was revealed by a vitrectomy of a thickened posterior vitreous membrane. Ophthalmoscopy and B‐scan ultrasonography 8 months later showed growths projecting 2 mm into the vitreous cavity. Metastases from a malignant melanoma with infiltration of the retina forming nodules, but also affecting adjacent choroid and optic nerve, was disclosed by histology. The patient died of metastasis to the brain.

Retinal detachment after YAG‐laser capsulotomy

Abstract Preoperative findings and postoperative results in 8 patients with retinal detachment after YAG‐laser capsulotomy are described. In this period the overall incidence of clinical retinal detachment in pseudophakic eyes after YAG capsulotomy in our hospital was 1.0% (2 of 193). Possible relationships between YAG‐laser capsulotomy and retinal detachment are discussed. Two risk factors for developing retinal detachment were found in 6 of 8 patients. After surgical repair 7 retinas were re‐attached. The final visual acuity was better than 0.5 in 5 patients.

Retinal detachment after intraocular lens implantation

Abstract Between August 1982 and July 1985, 19 eyes were operated for pseudophakic retinal detachment (PRD) (Anterior chamber lens in 13 eyes, posterior chamber lens in 3 eyes and iris supported lens in 3 eyes). The characteristics of these pseudophakic retinal detachments were very similar to those following intracapsular cataract extractions. Retina was re‐attached in 18 eyes (95%), in 14 eyes, after one buckling procedure. In 4 eyes, altogether 12 surgical procedures were needed to re‐attach the retina. Problems to visualize the peripheral retina, made it necessary to remove the IOL in 3 eyes (2 iris fixated and one in the anterior chamber).

TRAUMA AND RETINAL DETACHMENT: The anterior chamber angle, with special reference to width, pigmentation and traumatic ruptures

Traumatic ruptures in the anterior chamber angle are frequently seen as a result of ocular contusion (Ti injum 1966). When these changes are seen in eyes with retinal detachment, they may be taken as proof of previous ocular contusion (WoZff &Zimmernian 1962, Cox et al. 1966). A history of trauma is very often reported by retinal detachment patients and it would be of interest to know the incidence of chamber angle ruptures due to contusion in these eyes. Gonioscopic findings in eyes with retinal detachment have been reported by Sebestyen et al. (1962), but chamber angle lesions due to contusion were not dealt with by these authors, and the incidence of these changes in eyes with retinal detachment, has not yet been evaluated. Pigmentation of the anterior chamber angle occurs more frequently with advancing age both in normal and in glaucomatous eyes (Zuege et al. 1967), and more frequently in glaucoma capsulare than in eyes with primary open angle glaucoma (Hiirven 1966). As retinal detachment is a disease of age and also a disease seen in connection with trauma, eye surgery, uveitis and other eye diseases, angle pigmentation is not expected to be less in detachment eyes than what seen in a normal population. In order to get more information about width, pigmentation and traumatic

CORNEAL INDENTATION PULSE AND GENERAL ANESTHESIA

Most of the experimental work previously done in animals in order to study the ocular blood supply and hydrodynamics has been performed during general anesthesia. I t is quite possible, however, that the general anesthesia itself to some extent may influence the various factors responsible for the ocular blood supply, such as blood pressure, intraocular pressure and the peripheral vascular resistence. In order to investigate this possibility, dynamic tonometry (Hurrven 1968) was performed during Nembutal (pentobarbital sodium) anesthesia on two rabbits by one of us (I. H.) with a corneal pulse amplitude recorded close to zero as a result. This preliminary finding initiated the present study which offers the results obtained by dynamic tonometry performed before, following premedication and during general anesthesia in human beings.

The use of sodium hyaluronate (Healon) in the treatment of complicated cases of retinal detachment

Abstract Thirty ‐six eyes with retinal detachment and various degrees of proliferative vitreoretinopathy were operated with conventional buckling techniques and the additional use of intravitreal injected sodium hyaluronate (Healon). Eightteen eyes (50%) had re‐attached retina 6 months post‐operatively. The re‐attachment rate depended upon the severity of the proliferative vitreoretinopathy. Three of 4 eyes with grade B, 4 of 5 with grade C‐1, 8 of 13 with grade C‐2, 2 of 11 with grade C‐3 and 1 of 3 eyes with grade D‐1 were reattached. Major complication occurred in 3 aphakic eyes where persistent intraocular pressure rise to 60–70 mmHg necessitated removal of Healon to normalize the intraocular pressure. In one eye Healon passed through a retinal rupture to the subretinal space.

Corneal indentation pulse and retinal detachment pre- and postoperative study.

Hydrodynamically, the vascular bed of the eye may be divided into a nonpulsatile and a pulsatile part. The blood flows through the non-pulsatile part a t a constant volume per time unit in diastole and in systole, while the pulsatile part receives blood in systole. This excess of blood entering the eye in systole will, according to its volume (.AV) and the intraocular pressure level, initiate a corresponding increase in intraocular pressure ( 11’). Pulsesynchronous variations in intraocular pressure was first recognized by Wr~bcr in 1850, and may be studied in detail by various methods (Suzziki 1962, Dnucuigrr 1963, CastrPrz SLnzlikniiieia 1963, Bynkc X KT-uknu 1964, Broil ct nl. 1967) of which dynamic tonometry (Hi i rum 1968) is used in the present study. Clinically, the corneal pulse amplitudes will vary with the size of AV. Decrease in amplitudes is seen by occlusion of the common or internal carotid artery (Yt lcborg 19G0, Cash& SC Lnui/:ciinen 1963. Brori (it 01. 19(i7), during general anesthesia (HOrum X Syrdnlcn 1970): during retrobulbar anesthesia (Syrdolcn ,VH i i r u m 1970), during tachycardia (HOruen k Syrdulcn 1970), in giant cell arteritis (HOrueii 19iOc) and in choroidal dcgencrations (By?i/w S. SchPle 19fi7, Horuen 1970b). Increase in corneal pulse amplitudes has been seen in Sturge Weber’s syndrome (Flugc k HOrucn 1970), during bradycardia (Hiirucn ‘ VSyrrlulrn 1970), during pain attacks of cluster headache (Broch ct al. 1970), by arteriovenous shunts (HOruen 197Ob), by choroidal melanomas (Hor-