Szemészet, 2006 (143. évfolyam, 1-4. szám)

2006-12-01 / 4. szám

Szemészet Supplementum I.

Következtetés: Nehéz terhek emelése extrém megterhelést jelent az edzetlen egyének szemének ereire, ami végül retinalis vagy preretinalis vérzést eredményezhet. Egy ilyen típusú vérzést sikeresen kezeltünk vitrectomiával, amit rövid video filmen is bemutatunk. Érdekességképpen a másik szemén tompalátó beteg subjectív élményeit is összefoglaljuk.

Serious premacular haemorrhage caused by Valsalva effect, treatement by succesful vitrectomy and screening for predisposing factors

István Hatvani,1 Zsuzsanna Pelle,2 Péter Rácz,3 Ágnes Janovics,1 György Bátor,3 Ilona Bódis2

1National Medical Centre, Budapest 2Pándy Kálmán County Hospital Gyula 3Markusovszky Teaching Hospital, Szombathely

Purpose: To present a successful treatment for preretinal haemorrhage caused by Valsalva effect which did not resolve spontaneously; and also to investigate whether there was any difference in capillary fragility between weightlifting professionals and non-trained control subjects who were suffering from Valsalva retinopathy.

Patients and methods: 19 patients with Valsalva retinopathy and 22 professional weight-lifters were investigated with binocular indirect ophthalmoscopy and with a special vascular fragility test.

Result: The occurrence of Valsalva haemorrhagic retinopathy was not closely related to physical strain, but showed a closer relation to the increased capillary fragility of the untrained controls.

Conclusion: Lifting of heavy objects is an extreme stress to the ocular vessels of an untrained person and may result in retinal or preretinal haemorrhage. In one patient this type of premacular haemorrhage was successfully cured by a meticulous and complete vitrectomy; the surgery will be demonstrated by a short video. In addition, the patient’s subjective feelings will be presented.

Stabilisation of subluxated lenses using intracapsular rings and segments and capsule/iris retractors

Marko Hawlina

University Eye Clinic, Medical Centre Ljubljana (Slovenia)

Background: Subluxated lenses are one of the major problems in phacoemulsification. Besides intracapsular rings, iris retractors have been used to stabilise the capsule. Several different techniques were evaluated in this study. Patients and Methods: Several cases are presented with subluxated cataract caused by uveitis, trauma, or congenital zonular weakness. In the intervention, intracapsular tension rings are introduced into the capsule with or without additional scleral fixation by sutures. A special flexible ring designed by Burkhardt Dick will be shown that was implanted through the IOL injector. Special Ahmed segments will be shown that stabilise local zonular dehiscences. Capsule retractors are introduced into the eye and hooked behind the capsulorhexis margin. Two types of retractors may be used, ones designed for the iris, or a specially-designed type for the capsule. All operations were done under topical or peribulbar anaesthesia with phacoemulsification performed through a temporal clear corneal incision. Results: Intracapsular rings, segments and capsule retractors made phacoemulsification possible in most cases in which foldable IOLs were inserted. The IOL was inserted in the bag or in the sulcus with optical capture, with the IOL optic in the bag and the haptics in the sulcus.

Conclusion: In most cases, after application of intracapsular rings and capsule retractors, subluxated lenses can be successfully managed by phacoemulsification.