Showing papers on "Cataract surgery published in 1973"

Postoperative Endophthalmitis Following Cataract Surgery: Effects of Subconjunctival Antibiotics and Other Factors

Abstract: Experience with over 77,000 consecutive cataract extractions performed mainly by two surgeons over a 16-year period in a village hospital in Pakistan is reviewed. The incidence of immediate postoperative endophthalmitis is studied in some detail in 54,000 of these cases. In about 10,000 cases, prophylactic subconjunctival injections of antibiotics, such as framycetin, chloramphenicol, gentamicin sulfate, and penicillin sodium, were given. The incidence of immediate postoperative endophthalmitis was not notably reduced by these medications. Techniques and complications that added to the intraocular instrumentation were accompanied by an increased rate of endophthalmitis.

Autotrichograft sutures in cataract surgery.

Abstract: Suturing in cataract surgery is now practised almost universally. Advances in materials and techniques are enabling us to achieve more satisfactory wound healing with a shorter duration of postoperative inflammation. The suture material needs to be of fine calibre, non-irritant, absorbable, non-antigenic, strong enough to withstand the intraocular pressure, and able to maintain a knot without slipping. The sutures in general use are of proteinaceous material derived from other species of the animal kingdom, and synthetic materials, such as Orlon, Perlon, and Monofilament Nylon (Aquavella and Sheehey, i969), are also used. The latter, being non-absorbable may lead to physical irritation. Aichmair (i963), comparing 6-o catgut (Ethicon) and 6-o silk (Ethicon), investigated the incidence of wound dehiscence and flat anterior chamber, with resultant secondary glaucoma or other complications. Wound leakage through suture sites was studied by Sugar and Deen (i963), who stressed the importance of coaptation of the wound edges as determined by the even penetration of the needle at the two edges. Epithelial downgrowth, a very discouraging complication of cataract surgery, has been found to occur less frequently with catgut than with silk sutures (Dunnington and Regan, I953). This is perhaps because the catgut is absorbed more quickly. Limbus-based conjunctival flaps with buried sutures eliminate the involvement of the epithelial layers in the track of the suture. Histological studies have shown that the reaction provoked by catgut has a preponderance of polymorphonuclear leucocytes (O'Donoghue, Clarke, and Pokhrell, I969). To reduce the antigenic property of sutures, Vorosmarthy and Scheid (i963), working on rat-tail tendon fibres, treated them with iodine and alcohol. Zauberman and Nathan (i967) compared the reaction to commonly-used suture materials in the corneae of laboratory animals with that evoked by autograft fibres obtained f om tendons. They found that, with silk and catgut, infiltration with polymorphonuclears occurred and was followed by necrotic changes and proliferation of highly vascular fibroblastic tissue, whereas with the autograft tendon fibres there was vascular invasion followed by regression. The common ectodermal origin of corneal tissue and hair suggested the use of the patients' own hair as sutures.

Diagnosis and Treatment of Common Eye Diseases in the Aged: Guidelines for the Practicing Physician*

Abstract: Several common eye diseases in the aged can be diagnosed and treated by the practicing physician. Techniques for eye examination are outlined. Both distant and near vision should be tested in any patient complaining of visual disturbances. Cataract formation is the most common cause of visual loss in the aged. When necessary, cataract surgery should be performed regardless of the patient's age or many physical ailments. Practicing physicians should make a determined effort to detect cases of glaucoma and start the treatment that may prevent blindness. Macular disease, although difficult to treat, often can be helped by low-vision aids. Occlusions of the central retinal artery or vein are emergencies and should be referred to the ophthalmologist as soon as possible.

The use of phacoemulsification in cataract surgery.

Abstract: THE IDEA of removing cataracts from adult eyes through a small opening, after first breaking up the lens, has been one of the dreams of ophthalmic surgery. The advantages of being able to do this are clear. The wound, being small, would heal much more quickly than a full cataract section, and the postoperative redness of the surgical field, since this is largely dependent on the size of the wound, would be reduced. The dream has materialized. It was remarkable to see patients operated upon on Monday discharged from hospital on Tuesday with instructions that they might return to work the following day, the eyes being relatively white and quiet. The pioneer of this method, working at the Manhattan Eye, Ear and Throat Hospital, New York, has at the time of writing about 900 cases to his credit. News of this sort, once it has started to spread, will travel fast and be prone to be distorted by exaggeration. It is thought advisable, therefore, to give a short description of the operation so that practitioners may be able to answer the flood of inquiries about it which must sooner or later confront them.