Staffan Stenkula

Retinal detachment. A study of a population-based patient material in Sweden 1971-1981. I. Epidemiology.

Abstract A population‐based series of retinal detachments (RD) collected during a 10‐year period (538 patients, 590 ‘cases’, i.e. diseased eyes including new RD after 6 months in the same eye) is reported. The annual incidence was 10.6 per 100 000 population. Bilaterality was observed in 11.2%. In this material preponderance of the right eye was found. In non‐traumatic RD there was a small sex difference, with a higher incidence among females. Older persons were at high risk of sustaining RD, as were myopes. In myopic males the risk increased with the degree of myopia and with increasing age. In myopic females the greatest risk was found in the age group 30–59 years. Myopic eyes are probably also more vulnerable to traumatic RD. Lattice degeneration was more common in middle‐aged than in older patients and was also more common in myopic eyes than in eyes with other phakic RD. High myopia (> –5D) was more frequent in patients with lattice degeneration than in those without. Aphakia was found to be an important predisposing factor for RD. A classification taking into account the above‐mentioned factors is proposed.

Limbal sub-Tenon's administration of retrobulbar anesthesia using a blunt irrigating cannula.

BACKGROUND AND OBJECTIVE To eliminate sharp needles when administering local anesthesia to the eye in order to reduce serious complications caused by needle perforation. PATIENTS AND METHODS After topical anesthesia, limbal conjunctival incision, and sub-Tenons dissection, a retrobulbar irrigation of an equal mixture of bupivacaine (5 mg/ml) and lidocaine (20 mg/ml) was given using a blunt cannula. RESULTS The technique was used in both vitreoretinal surgery (n = 70) and anterior segment surgery (n = 235) with good analgesic and akinetic effects. No serious adverse were noted. CONCLUSION This proved to be a safe and efficient technique that abandoned the use of sharp needles.

Ocular Perforation During Retrobulbar and Peribulbar Injections

BACKGROUND AND OBJECTIVE To determine the ocular perforations during retrobulbar and peribulbar injections. PATIENTS AND METHODS Twenty-five ocular perforations between 1976 and 1993 occurred after 13 retrobulbar and 12 peribulbar injections. Eighteen patients (72%) were women. Eighteen eyes were myopic (72%). Risk factors included high myopia in 11 cases (44%), use of Atkinson gaze in 21 cases (84%) and a sharp injection needle. RESULTS Deep position of the posterior pole was common. Perforation signs comprised vitreous hemorrhage in 25 eyes (100%), subretinal hemorrhage in 19 eyes (76%), retinal breaks along the inferior vascular arcade in 19 eyes (76%), and retinal detachment in 14 eyes (56%). Proliferative vitreoretinopathy developed in 11 eyes (44%). CONCLUSION Retinal detachment strongly correlated to poor visual outcome.

CAVERNOUS HAEMANGIOMA OF THE RETINA

Seven cases of retinal cavernous haemangioma are presented. Three cases have been followed for more than 6 years, and three cases between 1 and 2 years. Six cases had no eye symptoms related to the vascular tumour, while in one case vitreous haemorrhage occurred on two occasions. On both these occasions full vision was regained. None of the vascular tumours were treated. Two patients had grand mal seizures. They also had convulsive disease in the family history. In three cases family members of two generations were found to have normal eyes on examination.

Healon® GV in posterior segment surgery

Abstract. Healon®, a viscoelastic preparation of Sodium hyaluronate, has been reported effective in posterior segment surgery for dissection of epiretinal membranes, i.e. proliferative diabetic retinopathy and macular pucker. A more viscous substance might be more effective for this kind of surgery. Therefore, a new Sodium hyaluronate preparation Healon® GV with a ten times greater viscosity at rest than Healon®, was tested in and open clinical study. Twenty‐four patients of both sexes and not younger than 18 years were enrolled. The follow‐up time was three months. The main indications for using Healon® GV were: to separate membranes from the retina, to stop bleeding and to reposition a detached retina. 0.2–0.5 ml of Healon® GV was injected through a 27 gauge bent cannula and at close of surgery irrigated out of the eye. Postoperatively the patients were monitored concerning intraocular pressure, vitreous clarity, anterior chamber flare and visual acuity. Healon® GV was found to make the surgical procedure simpler and safer. No inflammatory reaction and no increase of IOP was observed.

Liquid silicone in the treatment of retinal detachment

Abstract. Liquid silicone was used in the surgical treatment of 46 eyes with complex retinal detachment. Forty‐six eyes have been followed up for at least 6 months. In 27 of these eves (58.7%) the retina was totally or partially attached at the 6‐month follow‐up. Visual improvement was found in 20 of the 46 eyes (43.5%). These results are encouraging considering the poor prognosis of the operated eyes. There were few severe complications during an observation time of 6 months. Liquid silicone was found to be a valuable help in the surgical treatment of severe forms of retinal detachment.

Retinal detachment: A study of a population-based patient material in Sweden 1971-1981. II. Pre-operative findings

Abstract In a population‐based material of patients with retinal detachment (RD), the pre‐operative findings in different subgroups were studied. In traumatic cases flap tears and round holes were found in at least as high a frequency as oral dialysis, or even higher. In aphakic cases subtotal or total RD was often observed on admission for surgery. A high proportion of aphakic eyes without lattice degeneration exhibited no breaks. RD in myopic eyes was usually large, and round holes were frequently found. Full‐thickness fixed retinal folds were more seldom seen pre‐operatively en myopic than in non‐myopic eyes. Lattice degeneration was usually observed in myopic RD patients of ages less than 30 years, but mainly in hyperopic or emmetropic eyes in patients over 60. In RD with lattice, multiple breaks were frequently found. A comparatively large group of RD cases without lattice were non‐traumatic, phakic and non‐myopic (40%). Most of these patients were 60 years and older. Flap tears were often seen, and the detachment was seldom large in this group.

Healon® Yellow as a Surgical Tool in Maneuvering Intraocular Tissues

Tinted sodium hyaluronate (Healon Yellow) was used during posterior segment surgery mainly for the dissection of epiretinal membranes in cases of proliferative diabetic retinopathy and macular pucker. The yellow color facilitated injecting the viscoelastic substance under the membranes and simplified its removal at the end of surgery.

Retinal detachment in aphakia.

In a prospective study five hundred consecutive cases of cataract operations were followed during ten years. Nine cases of retinal detachment were observed.

Sealing of retinal breaks with metal tacks: Evaluation of a new procedure in retinal re-attachment surgery

Abstract Metal retinal tacks were used in 18 patients with complicated retinal detachments, such as giant tears (3 cases), severe proliferative vitreoretinopathy (PVR) (7 eyes) and diabetic traction and rhegmatogenous detachment (8 cases). All eyes had undergone vitreous microsurgery, including excision or segmentation of epiretinal membranes, fluid‐air (SF6) or silicone oil exchange. Retinal breaks and the cut edges of retinotomies and retinectomies were successfully sealed by metal tacks. Retinal re‐attachment was achieved in 9 cases and partial re‐attachment in another 5 eyes (follow‐up 3–6 months). Retinal tears in diabetic macular detachment associated with extensive epiretinal fibro‐vascular membranes were also successfully sealed despite persisting traction. Our first experience indicates that the closing of retinal breaks with metal tacks is a major step forward in retinal re‐attachment surgery.