Lipid fuel metabolism after abdominal surgery.

The work investigated fuel interrelationships in surgical patients infused with saline (Group I) or glucose (Group II) (13 patients in each group) on the day of surgery and subsequently maintained solely on saline until the fifth postoperative day. Blood concentrations of non-esterified fatty acids (NEFA) and ketone bodies were markedly increased in response to surgical stress on the day of surgery only in patients who were not administered carbohydrate. Increased concentrations of lactate and glucose were observed on the day of surgery in patients infused with either saline or glucose. As both fatty acid and ketone body concentrations were decreased by glucose infusion, impaired glucose utilization immediately after surgery is not a simple consequence of increased oxidation of lipid fuels. Glucose and lactate concentrations declined after the day of surgery. Despite a progressive fall in plasma non-esterified fatty acid concentrations from the first to fifth post-operative days, blood ketone body concentrations were strikingly elevated in both groups of patients. The findings emphasize the role of the liver in post-operative fatty acid turnover.

Perfluorocarbon liquids (perfluorodecalin) in vitreoretinal surgery--a local experience.

A low viscosity perfluorocarbon liquid (perfluorodecalin) known commercially as DKLine was used intraoperatively as a temporary vitreous substitute in 20 patients undergoing vitrectomy surgery for a variety of complicated vitreoretinal conditions. The indications for its use included giant retinal tears (9), proliferative vitreoretinopathies (2), dislocated lenses (2), dislocated posterior chamber implant (1), endophthalmitis with retinal detachment (2), traction retinal detachment (1), pseudophakic retinal detachment (2) and exudative retinal detachment (1). In all cases with retinal detachment, perfluorodecalin was successful in flattening the retina intraoperatively. It was also successful in permitting the safe removal of dislocated lenses that were lying on the retina. In all except four cases, removal of perfluorodecalin was complete. We observed no toxic effects from remnant bubbles of perfluorocarbon in the eye.

Ophthalmic screening for diabetics: the importance of physician-ophthalmologist collaboration in the prevention of blindness.

Diabetes mellitus as a disease is a dragon with many heads. To cope with it, each manifestation must be deftly handled by family physician and specialists in unison. Similarly, the spectre of diabetic retinopathy is best exorcised before it manifests - by effective prophylactic screening. This programme can only be successful through a co-ordinated effort of both physicians and ophthalmologists. In this paper, we present one such agenda which we have adopted, The result indicate that a fifth of diabetics have retinopathy, and that sight threatening disease affects 7% of those screened. More critically, it also establishes that a cost-effective method of screening can be achieved through a synergetic endeavour of primary care physician and specialist.

Idiopathic subretinal neovascularization.

Idiopathic subretinal neovascularization is a potentially blinding condition and often strikes patients in their prime of life. It appears to be seen in more females, at an earlier age than males. Treatment is possible by photoablation of the subretinal new vessel by Argon or Yag laser. There is a clinical impression that Argon laser is more effective than the Yag laser for this purpose.

Implantation and diabetes: analysis of 525 cases.

This is a retrospective study of 525 posterior chamber implants in diabetics performed by A S M Lim and B C Ang of Singapore. The patients were reviewed by visiting ophthalmologists--J E Kennedy (Sydney), M Ngui (East Malaysia) and P M Hart (Belfast). This study did not show any significant difference in the complication of post-operative visual acuity between diabetics and non-diabetics. 95% obtained 6/12 vision or better when pre-existing disease was excluded. It also showed that posterior chamber implants can be inserted in eyes with maculopathy or proliferative retinopathy if laser treatment was effectively done before or after surgery.

Cryoapplication in diabetic retinopathy.

Thirty-five patients with diabetic retinopathy were treated with cryoapplication. This was used as an alternative to Argon laser or Zenon photocoagulation because the media was opaque from vitreous hemorrhage or cataract. It was difficult or impossible to treat with photocoagulation. The clinical impression indicates that cryoapplication is effective, showing adequate pigmentation and chorioretinal scarring with regression of diabetic retinopathy changes. However patients with vitreo-retinal fibrosis became frequently worse weeks later. This is considered a contraindication. The use of cryoapplication in diabetic retinopathy is recommended in situations where the ocular media is not clear, such as vitreous hemorrhage and cataract. It can also be used if there is difficulty with laser photocoagulation following lens implantation. It may be valuable in some developing countries where photocoagulation is not available. Cryomachines are frequently used in eye camps. It is inexpensive and does not necessarily require electricity.

Argon laser photocoagulation in diabetic retinopathy: five year review of 697 treated eyes.

Diabetic retinopathy has now become a common cause of blindness in Singapore. Fortunately, laser photocoagulation has prevented blindness in the majority of patients who were treated. An analysis of 872 patients treated with argon laser photocoagulation showed that 424 patients (48.6%) were for diabetic retinopathy. Patients with adequate treatment retained useful vision. Those who lost vision frequently had associated target organ involvement besides inadequate laser treatment. Patients with proliferative diabetic retinopathy were treated with peripheral retinal photocoagulation. Patients with diabetic maculopathy especially those with focal leaks were treated with localised photocoagulation. A common cause of blindness is failure to recognise the condition early. Physicians and general practitioners must, in the management of diabetics, examine their patients periodically with the pupils dilated in a darkened room.

Indications for intraocular lens implantation: an analysis of 1033 cases.

The posterior chamber implant has increased safety in intraocular lens implantation. Implants are now inserted in one-eyed patients, in eyes with high myopia, endothelial corneal problems, senile macular degeneration, diabetic retinopathy and glaucoma. The percentage of implant from 1975-1981 was 10.3% but increased to 83.9% from 1983-1984. This is mainly because there are today fewer situations where lens implantation is contra-indicated in the hands of surgeons, skilled and experienced in posterior chamber implant surgery.