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      Microsurgical treatment of lens capsule perforations--Part II: Clinical applications and results.

      Ophthalmic surgery

      surgery, Wounds, Penetrating, therapeutic use, Thrombin, methods, Microsurgery, injuries, Lens, Crystalline, Lens Capsule, Crystalline, Humans, Fibrinogen, Fibrin Tissue Adhesive, Factor XIII, Drug Combinations, prevention & control, Cataract, Aprotinin

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          A microsurgical technique using human fibrinogen concentrate for the closure of anterior lens capsule wounds and through-and-through perforations was developed, experimentally tested and clinically applied. I consider here the first consecutive 31 patients treated. All these patients had perforating injuries of the lens and still localized lens damage; they showed no spontaneous healing tendencies. Successful treatment of lens capsule wounds, where an otherwise clear lens is locally scarred, has been rare. The technique described here was effective in more than 50% of the patients with anterior lens capsule lesions. Removal of degenerated lens cortex matter before fibrinogen application further improved the healing rate. The healing rate was low, however, in through-and-through perforations of the lens when the posterior lesion was not treated at all (of 11 cases, 1 success, 10 traumatic cataracts). It was not much better when the posterior lesion was approached via a basal iridectomy and around the lens equator (of 4 cases, 1 success). But translental fibrinogen application, following the foreign body pathway, together with removal of degenerated cortex matter from the anterior and posterior capsule lesion area, resulted in the prevention of traumatic cataract in all 4 patients treated so far. There were no undesirable local or systemic side-reactions. (Intraocular complications could be avoided by not exceeding the recommended amount of fibrinogen concentrate, 0.01-0.02 ml). The case histories of 3 patients are shown in three photographs.

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