Hungarian Ophthalmological Society January 22, 1965
1
MEETINGS, CONFERENCES, SYMPOSIA EDITED BY THOMAS CHALKLEY, M.D. HUNGARIAN OPHTHALMOLOGICAL SOCIETY January 22, 1965 PAL WEINSTEIN, M.D., presiding CEREBRAL EMBOLISM AFTER HEART SURGERY DR. S. ERΦSS: At the Department of Sur- gery No. 4 (Budapest), cerebral embolisms producing ophthalmologic symptoms occur- red in six cases of 730 of mitral commisurot- omy performed in six years. In one case, the picture was that of retinal embolism, the clot occluding the inferior temporal artery. In one case, there was paralysis of the ocu- lomotor nerve, in two convergence was weakened. In two cases, bilateral blindness resulted. One patient was 21 years of age. On the day following the operation, the ce- rebral embolism led to total blindness without light sensation. The patient was cured in six weeks, after 18 blockades of the stellate ganglion and cautious anticoagulant therapy. Six years later there was only a slight con- centrical narrowing of the field of vision. The other patient, a man aged 39 years, also lost sight on the first postoperative day. The eyegrounds were normal, the columns of blood were smaller in diameter in the blood vessels. Procaine blockades of the stellate ganglion and anticoagulant therapy resulted in full recovery of sight after six weeks. The right field of vision was complete, the left was narrowed concentrically. LESIONS CAUSED BY LIME DR. S. ERΦSS: AS a result of an analysis of the conservative treatment of 112 eyes damaged by lime (subconjunctival vasodila- tors, procaine injections, etc.), it may be stated that, except for the three cases of poor and two of impaired vision, the other patients recovered with about 5/10 vision. Secondary glaucoma, so common previously, developed in one of the 112 cases, but even that was cured by conservative treatment. SURGICAL TREATMENT OF LIME LESIONS DR. B. ALBERTH: After 65 serious le- sions, in which the sight was never better than movement of fingers, a total of 100 keratoplasties were performed. In slightly more than 50% of the cases (33) vision im- proved, in six to over 0.1. In such severe cases, the first operation must never be one causing partial perforation, but it should be reparative total lamellar transplantation, which may be repeated if necessary. As the last measure, subtotal or total perforation with removal of the lens may be carried out in apparently hopeless cases. Denig's opera- tion must never be performed in cases of fresh injury, because it makes any other op- eration impossible to carry out. In cases of total symblepharon and an- kyloblepharon the sockets and the motility of the eyelids should be restored before car- rying out an optical keratoplasty. In more or less partial symblepharons the method of Bacskulin gives satisfactory re- sults. It consists of sharp mobilization of the lids with repeated episcleral circular au- tohemo-injections. The method originates from the well-known treatment of Nowosi- birsk for lime burn. In cases of total adhesion, a new proceed- ing has been inaugurated—extracorneal ker- atoplasty. After immobilizing the eyelids all scarred tissue is removed from the sciera. On the bare circumcorneal scierai surface, very thin lamellar human grafts are placed next to each other and sutured with fine episcleral biosutures. As a rule it is possible to perform corneal lamellar keratoplasty at the same time. If it seems necessary, the tarsal surface may be covered similarly. The procedure requires five or six human corneas, a number sometimes difficult to ob- tain, therefore silicone-desiccated corneas of cattle were also tried. Experience showed, however, that human material is better. Gyula Lugossy, Recorder. 178
Transcript of Hungarian Ophthalmological Society January 22, 1965
MEETINGS, CONFERENCES, SYMPOSIA EDITED BY T H O M A S C H A L K L E Y , M.D.
H U N G A R I A N O P H T H A L M O L O G I C A L
S O C I E T Y
January 22, 1965
P A L W E I N S T E I N , M.D., presiding
CEREBRAL EMBOLISM AFTER HEART SURGERY
D R . S. E R Φ S S : At the Department of Surgery No. 4 (Budapest) , cerebral embolisms producing ophthalmologic symptoms occurred in six cases of 730 of mitral commisurot-omy performed in six years. In one case, the picture was that of retinal embolism, the clot occluding the inferior temporal artery. In one case, there was paralysis of the oculomotor nerve, in two convergence was weakened. In two cases, bilateral blindness resulted. One patient was 21 years of age. On the day following the operation, the cerebral embolism led to total blindness without light sensation. The patient was cured in six weeks, after 18 blockades of the stellate ganglion and cautious anticoagulant therapy. Six years later there was only a slight con-centrical narrowing of the field of vision. The other patient, a man aged 39 years, also lost sight on the first postoperative day. The eyegrounds were normal, the columns of blood were smaller in diameter in the blood vessels. Procaine blockades of the stellate ganglion and anticoagulant therapy resulted in full recovery of sight after six weeks. The right field of vision was complete, the left was narrowed concentrically.
LESIONS CAUSED BY L I M E
DR. S. E R Φ S S : A S a result of an analysis of the conservative treatment of 112 eyes damaged by lime (subconjunctival vasodilators, procaine injections, etc.) , it may be stated that, except for the three cases of poor and two of impaired vision, the other patients recovered with about 5/10 vision. Secondary glaucoma, so common previously, developed in one of the 112 cases, but even that was cured by conservative treatment.
SURGICAL TREATMENT OF L I M E LESIONS
D R . B. A L B E R T H : After 65 serious lesions, in which the sight was never better than movement of fingers, a total of 100 keratoplasties were performed. In slightly more than 50% of the cases (33) vision improved, in six to over 0.1. In such severe cases, the first operation must never be one causing partial perforation, but it should be reparative total lamellar transplantation, which may be repeated if necessary. As the last measure, subtotal or total perforation with removal of the lens may be carried out in apparently hopeless cases. Denig's operation must never be performed in cases of fresh injury, because it makes any other operation impossible to carry out.
In cases of total symblepharon and an-kyloblepharon the sockets and the motility of the eyelids should be restored before carrying out an optical keratoplasty.
In more or less partial symblepharons the method of Bacskulin gives satisfactory results. It consists of sharp mobilization of the lids with repeated episcleral circular au-tohemo-injections. The method originates from the well-known treatment of Nowosibirsk for lime burn.
In cases of total adhesion, a new proceeding has been inaugurated—extracorneal keratoplasty. After immobilizing the eyelids all scarred tissue is removed from the sciera. On the bare circumcorneal scierai surface, very thin lamellar human grafts are placed next to each other and sutured with fine episcleral biosutures.
As a rule it is possible to perform corneal lamellar keratoplasty at the same time. If it seems necessary, the tarsal surface may be covered similarly.
The procedure requires five or six human corneas, a number sometimes difficult to obtain, therefore silicone-desiccated corneas of cattle were also tried. Experience showed, however, that human material is better.
Gyula Lugossy, Recorder.
178
