Circumferential Buckling on Equator: III. Retinal Dialysis up to 180 Degrees

The purpose of this paper is to describe the most appropriate surgical techniques in the repair of retinal dialyses up to 180 degrees. In this sesies, silicon bands were used as an encircling element with conserved sclera implant. Perhaps a circling buckle will decrease a traction of vitreoretinal pathology located in equatorial area and reduce the rate of recurrence in patients who are exposed to an active life with repeated minor traumata. Retinal dialyses up to 90 degrees have been treated with a shorter and higher implant because the ends stretch the retina circumferentially by the sloping ends of the buckle. All of the 37 eyes with a dialysis up to 90 degrees and a clinical retinal detachment maintained successful reattachment of the retina. In retinal dialyses between 90-180 degrees a long, broad and lower implant was applied. The sclera was lamellarly dissected into two flaps extending approximately one hour of the clock beyond each end of the tear. In five of ten eyes with giant break, the posterior edge of tear could be settled on the underlying pigment epithelium during slight compression on sclera with Eisner's contact lens ane in five eyes the flap was everted and immobile. The retina was intentionally incarce rated on the buckle when the flap was everted and immobile. By this technique a giant dialysis could be transformed into two neighbouring dialyses up to 90 degrees. Of those eyes without everted three out of five were successfully reattached and of those eyes with an everted immobile flap four out of five eyes. 93.6% of the consecutive 47 cases of dialyses with a clinical retinal detachment were successfully reattached. If the patient with a postequatorial large horseshoe-shaped tear and a case with chorioretinohyalopathy and neovascularization of the chamber angle were excluded, the success rate rose to 97.9%. Three cases of the successful reattachment required a second operation. This report reviewed the results of the technique in the treatment of retinal detachment caused by dialyses up to 180 degrees. In a previous study, the management yielded a 95.7% success rate in retinal detachment caused by equatorial break operated by one of us. No comparison can be made between the success rate of these two types of tears (P>0.05) since all gave consistently excellent result.

Clinical Study on Extracapsular Lens Extraction in Cataract Surgery

An extracapsular lens extra.ction usually provides an excellent functional result and leaves an eye whose anatomic integrity in some ways exceeds that seen after an intracapsular lens extraction. This technique has the advantage of a smaller incision and a shorter convalescence. In the prevention of certain complications such as operative vitreous loss and postoperative cystoid macular edema, well planned extracapsular lens extraction before surgery is followed by far fewer complications than the misfortune of a ruptured capsule of an immature cataract. Cataract extraction was performed as usual conventional method. Intracapsular lens extraction was performed in 21 eyes and extracapsular lens extraction in 15 eyes. Although the incidence of iris adhesion to the cornea or vitreous, iris peaking, vitreous adhesion to the posterior corneal wound and operative rupture of the anterior hyaloid membrane were higher than those of the intracapsular lens extraction, sorious complications were not resulted. Fundus fluorescein angiograms were taken in all patients within 6 months postoperatively. The incidence of cystoid macular edema in the extracapsular lens extraction (33%) was lower than that of the intracapsular lens extraction(43%).

Two Cases of Meibomian Gland Adenocarcinoma

The Clinical Resemblance of the rare carcinoma of the meibomian gland to the relatively frequent chalazion should be kept in mind by anyone performing eye lid surgery. The author recently experienced two cases of Meibomian gland adenocarcinoma of upper lid. In the first case a 65-year old female visited our hospital in March, 1976 with a large mass in the right upper eyelid which had showed progressive enlargement of two years duration. A Diopsy was carried out and the histopathological examination revealed sebaceous adenocarcinoma. She was treated with local resection with full thickness containing normal tissue around the lesion of upper lid and reconstructive surgery for upper eyelid. A radiation therapy was performed with good result. In second case, a 80-year old female visited our hospital in Dec. 1975 with a large mass in the left upper eye lid which had showed progressive enlargement of one year duration. The tumor was resected and the histopathologic examination revealed sebaceous adenocarcinoma. A radiation therapy was performed with good result.

Fundus Findings in Leukemia and Various Anemias

The authors carried out the funduscopic examination in 53 cases of leukemia (acute myeloblastic leukemia 17, acute lymphoblastic leukemia 2.0, acute monocytic leukemia 9, chronic myelogenous leukemia 5, acute progranulocytic leukemia 2) and 51 cases of various anemias (aplastic anemia 37, iron deficiency anemia, secondary anemia due to bleeding 4, miscellaneous 4) which were confirmed by hematological studies at Kyung-Pook National University Hospital from October 1969 to October 1975. The following results were obtained. 1) Of 53 cases of leukemia, 62% revealed retinopathy with retinal homorrhage. In 65% of 17 cases of acute myeloblastic leukemia, 55% of 2.0 cases of acute lymphoblastic leukemia, 77 % of 9 cases of acute monocytic leukemia, and 4.0% of 5 cases of chronic myelogenous leukemia, retinopathies were noted. 2) Of 51 cases of anemia, 45% revealed retinopathy with retinal hemorrhage. In 49% of 37 cases of aplastic anemia, and 33% of 6 cases of iron deficiency anemia, retinopathies were noted, but none of secondary anemia due to blood loss had retinal hemorrhage. 3) Acute leukemia had more retinal hemorrhage frequency than chronic leukemia. 4) The extent of the retinal hemorrhages seemed to parallel the severity of the anemia in aplastic anemia. 5) Generally the thrombocytopenia was noted in the aplastic anemia but the extent of the retinal hemorrhages not seemed to parallel the severity of the thrombocytopenia. 6) The extent of the retinal hemorrhages seemed to parallel the severity of the anemia in iron deficiency anemia. 7) Specific retinal pictures could not be noted in the various blood dyscrasias. 8) With the retinal pictures, no differentiation on type of the leukemia and the anemia could be noted.

Review on Current Status of Pterygium Surgery

Many surgical procedures for pterygium and the postoperative cares for the prevention of recurrences have been employed, but no satisfactory methods are available yet. The authors analyzed the surgical procedures and postoperative cares doing ordinarily by 64 ophthalmologists who replied the questionnaire sent by us to 135 all regbteted Korean Ophthalmologists. The results are as follows; 1. The most preferred surgical procedure utilized was the bare scleral method. 2. 90Sr. irradiation was done, in the majority, to prevent the postoperative recurrence then long time instillations of mitomycin-c and steroid were utilized in the remainder. 3. The most utilized dosage of total 90Sr. irradiation were 4,000-6,000 rep. and 2 or 3 fractionated irradiations were performed in the majority. 4. The recurrence rates were 4.3% at 90Sr. irradiation, 5.2% at mitomycin-c instillation and 4.7% in average.

Slit Lamp Biomicroscopic Findings in Retiaal Detachment Findings before and after Retinopexy and/or Vitrectomy

Of 43 eyes with retinal detachment reviewed for this slit lamp biomicroscopic study, 35 eyes (81.4%) were associated with retinal breaks. Most attention has been concerned with the degenerative changes that so frequently occur in the retina: these together with associated degenerations of the vitreous gel, posterior vitreous detachments and the part played by the adherence of membranes and bands to the retina in determining the origin of a tear in this tissue. The authors are of the opinion, that total posterior vitreous detachment with collapse, is one of the predisposing factors to lead to a horseshoe tear. In posterior vitreous detachment with collapse, the solid vitreous in the superior part is found only anteriorly next to the vitreous base. In event of trauma and sudden movement of the eyeball, vitreoretinal adhesion, which when located in superior part of peripheral fundus may be pulled anteriorly and tangentially from the internal surface of the retina and so the base of the operculum deflects toward the ora serrata. (S.Fig. 9A) On the other hand, in simple total posterior vitreous detachment, a round hole often occurs in the equator as well as in the macular region, because the solidification power or the formed vitreous operates as the force on the vitreoretinal adhesion toward the center of the eyeball. (S.Fig. 9 Band C) With various advantages of the slit lamp biomioroscopic findings of vitreous and retina, retinopexies (diathermies and cryothermies) and vitrectomies could be effectively performed. Postoperative progress of 32 eyes were observed with slit lamp and compared with postoperative findings related with various methods of operations. In emmetropic and slight myopic eyes, only surface diathermy produced sufficient effects for retina surgery; so far there is no mechanical hindrances to the apposition of the retina to its bed caused by retraction bands in the vitreous or fixed retinal folds. In macular break, we prefer to manage by mean of cryopexy; a more dramatic effect could be attained by additional implantation of amniotic tissue in the posterior pole. Dextran, as a vitreous substitute, which was proposed by Won Sik Yoon in his animal experiments, is not suitable, because it has a tendency to retract solid vitreous.