scapular spine a potential free vascularised bone graft anatomical study

Since the use of free vascularised rib graft by-Buncke 1978 and free vascularised fibular graft by Taylor 1975, investigators were on the search for new bones to be used as free vascularised grafts. Several bones where investigated since then, the iliac crest based on the superficial circumflex illiac or the deep circumflex iliac [Taylor 1979], the lateral crest of the scapula [Teot 1981] based on the circumflex scapular, the second metatarsal based on the dorsalis pedis artery [Macleod et al 1979]. Recently we have been trying to investigate the possibility of using the scapular spine based on the suprascapular vessels as a free vascularised graft

Management of damaged sclera in re-operations of retinal detachment

Two hundred and sixty cases has been operated in the past ten years for recurrent retinal detachment which revealed relative damage off the sclera. These patients had either an encircling procedure segmental expolant or implants. Proper diagnosis of the degree off damage, was noticed before surgery and during re-operations. Management included either a trasvitreal or extrascleral approach, a delicate procedure with special exposure techniques. In 90%, the retina was re-attached, 75% off those had visual acuity ranging from 3/60 to 6/12, and 15% had ambulatory vision only

Stress induced retinopathies [a preliminary report]

One hundred and five patients with stress induced retinopathies were managed, 30 with central serous retinopathy, 35 with retinal vasculitis and 40 with uveitis. Patients had routine ophthalmological examination, visual acuity, intraocular pressure, fundus oxamination and fluorescein angiography. Medical and laboratory investigations has been done, including medical check up, blood chemistry immunological assays and hormonal profiles. Psychological analysis including regular settings and psychometry to those patients has been done. All of them showed clear ophthalmological improvement after starting psychic therapy with different onset and degree-15% of these patients did not continue the psychatric treatment, and refused the fact of psychic disturbance. All Patients had routine medical ophthalmological treatment and laser photocoagulation, when needed-Eighty five percent of patients- which continued the psychic therapy-showed improvement of the healing process and noticed to be able to cope better with their disease

Limitations of silicone oil in vitreous surgery

Thirty five cases of complicated retinal detachment, such as giant retinal tears, advanced proliferative vitreo-retinopathy, recurrent retinal detachment, posterior retinal breaks and diabetic tractional and rhegmatogenous retinal detachment, were operated upon; by modem vitreo-retinal surgery and liquid silicone injection. An anatomical reposition was attained in 95% of cases. Useful vision was reached in 55%, while ambulatory vision was reached in 40%. Complications were few over a period of one year. Advantages, disadvantages, limitations and rationale of the use of liquid silicone are discussed

Pathology of vitreous membranes

In order to acquire a better appreciation of the management of vitreous membranes, an animal model was devised by injecting small quantities of platelet-rich plasma [PRP] into the vitreous body of rabbit eyes.Membranes formed immediately on injection of PRP. Histologically, thesestructureswereamorphous,eosinophilic streamers of PRPabsorbed onto the vitreous collagen.These acellular [non-proliferative] membranes provoked an acute inflammatory response centered in the peripapillary and epipapillary regions. After fourweeks,thenon-proliferative membranes were transformedinto proliferative ones due to secondary fibroplasia that originated from the optic disc-medullary rayzone.The fibroblasts eventually grew upon the substrate of the abnormal vitreous membranes and supplied new collagen to their substance such proliferative membranes exerted tractiononthe medullary ray; additional traction was often contributed by alarge membrane originating at the pars plana injection site and the combined pull of these membranes caused localized retinaldetachment.Tertiary migrationofastrocytesinto the cortical vitreous was also demonstrated and was probably induced by the traction ofthe proliferative vitreous membranes

Pathology of vitreous membranes

In a series of 355 Pars Plana Vitrectomy procedures for proliferative vitreous diseases [Rhegmatogenous retinal detachment with proliferative vitreo-retinopathy proliferative diabetic retinopathy, trauma and vascular retinopathies., 27 cases had a complete pathological evaluation, including light microspy and transmission electron microscopy, which revealed five cellular types, retinal pigment epithelium, fibrocytes, fibrous astrocytes macrophages and myo-Iibroblasts. Collagen was seen intra-cellular and also extracellular in various dimensions derived from any of the above cells

comparative study of computerised automated versus manual perimetry

One thousand and foully manual and automated visual fields have been studied and analyzed. Eight hundred and ten manual kinetic visual fields were performed on the Goldmann projection perimeter and the B. and L. Tangent Autoplot perimeter; while two hundred and thirty tests were conducted using the Dicon 200 computerised autoperimeter. One hundred and eighty fields were conducted on patients using both manual and automated perimetry at the same sitting. It was found that reliable reproducable field could be obtained with computerised perimetry in an accurate way, highly comparable to the standared manual perimetry

Fundus fluorescein angioscopy in vaso-occlusive diseases of the retina

Four hundred eyes suffering from vaso-occlusive disease of the retina were evaluated by fundus fluorescein angioscopy. Utilising a strong light source, holding an exciting filter, connected to a binocular small pupil ophthalmoscopy by a fiberoptic cable. Yellow barrier filters are fitted on the ocular viewing lens. Utilizing a series of applanatic achromatic coated lens [28, 20 and 14 diopters] dynamic fundus and iris angioscopy could be evaluated. This method was especially useful in presence of media opacities and in viewing the fundus periphery which added information to the conventional photographic methods. The advantages and disadvantages is discussed in relation to developing countries