Search PubMed⌕ Search

Biomedical subjects

A M Brooks

Publications and source records attributed to A M Brooks.

At least 19 recordsLinked to original sources
PubMed1992

Multiple endocrine neoplasia syndrome--type 2b. Case report and review.

The multiple endocrine neoplasia syndromes are an association of tumours of 2 or more endocrine glands. Multiple endocrine neoplasia type 2b (MEN 2b) patients develop medullary thyroid carcinoma and pheochromocytomas as well as unique physical characteristics. Most commonly, MEN2b is inherited with an autosomal dominant pattern although sporadic cases are not uncommon. If untreated the disease may be lethal. The facial, oral and ocular characteristics are reliable markers of the disease. These patients give a history most commonly of slipped capital femoral epiphysis, hypertension and life-long diarrhoea and/or constipation. MEN2b is most commonly characterised by nodules on the anterior aspect of the tongue, thickened lips with nodules, thickened upper eyelids, broadened nasal bridge, thickened corneal nerves and dilated, symmetrical, pedunculated nodules on the cheek mucosa. The patient described has most of these characteristics. Radiographic features of the jaws which have not been previously described are reported. These include a markedly enlarged and bifurcated inferior alveolar canal and shortened roots of the lower incisor teeth. Due to the lethality of the disease, patients who present with the above physical characteristics must be further investigated to exclude MEN2b.

Adrenal Gland Neoplasms↗
PubMed1992

Preservation of residual field after surgical lowering of intraocular pressure.

A 52-year-old Caucasian woman with pigmentary glaucoma underwent a left cyclodiathermy procedure for raised intraocular pressure (IOP) in 1962 and right sclerectomy the following year. Over 25 years later a low IOP was still maintained though pilocarpine was needed in the left eye. After a left cataract extraction with insertion of a posterior chamber lens, field loss had not progressed very much in either eye though the visual acuity was reduced in the more affected eye. Both drainage operation and a cyclodestructive procedure controlled IOP over a long period of time in this patient and were associated with only a very gradual progression of field loss.

Cataract Extraction↗
PubMed1992

The effect of cataract extraction with implant in glaucomatous eyes.

The effect of cataract surgery in patients with glaucoma controlled by either topical medication or surgery was assessed in 64 patients. At one year there was a small significant fall in intraocular pressure (IOP) for eyes without previous surgery (preoperative IOP 18.9 +/- 4.7, range 12 to 35 mmHg; postoperative IOP 16.3 +/- 3.4, range 10 to 26 mmHg; P < 0.01) and also for those with previous surgery (preoperative IOP 15.0 +/- 4.3, range 3 to 22 mmHg; postoperative IOP 14.2 +/- 3.7, range 6 to 22 mmHg, P < 0.05). There was a significantly greater incidence of high rise in IOP to 30 mmHg or more immediately after operation in patients without (32%) than those with previous surgery (13%) (chi 2 = 3.9; P < 0.05). Complications were minimal in each group. Iridotomy to deliver the nucleus was necessary in nine eyes without and 21 with previous surgery. Cataract extraction usually causes only a small fall in IOP in glaucomatous patients. If a separate corneal section is used there is no loss of function of the filtering bleb in patients with previous glaucoma surgery.

Aged↗
PubMed1992

The results of combined cataract extraction and trabeculectomy using separate incisions.

A method of combined cataract extraction with posterior chamber intraocular lens and trabeculectomy using separate incisions was tested in 44 operations on 38 patients. The mean preoperative intraocular pressure (IOP) of 28.1 +/- 11.7 (range 12 to 56) mmHg on maximum medication was lowered to 13.9 +/- 3.4 (9 to 23) mmHg at one year, with half the eyes still requiring topical medication. The IOP was 40 mmHg or more preoperatively in eight eyes and 20 mmHg or more in only two patients at one year. There were no rises in IOP above 20 mmHg in the early postoperative period (days 1 and 2). Visual acuity was 6/9 or better in 27 and 6/12 in three eyes. There was an expulsive haemorrhage in one case, rupture of the posterior capsule in two eyes and a choroidal detachment in one eye, but no flat anterior chambers. The two-incision method allowed placement of an intraocular lens with good post-operative pressure control.

Adult↗
PubMed1992

Progressive myopia in early onset chronic angle closure glaucoma.

A 19-year-old girl presented with advanced unilateral chronic angle closure glaucoma and myopia with gross cupping and field loss in a previously hyperopic eye with a marked increase in corneal curvature. This emphasises that a marked myopic shift may be an important sign of glaucoma in a young patient.

Adult↗
PubMed1992

Design and results of trabeculectomy operation for use with 5-fluorouracil.

We revised our trabeculectomy technique in an effort to minimize the complications associated with the use of 5-fluorouracil (5-FU) in these procedures and then compared the results obtained with this procedure both with (25 patients) and without (25 patients) the use of 5-FU. There was no significant difference between the two groups in terms of mean postoperative IOP at 1 year, number of patients that required needling of the bleb to control postoperative IOP, and number of patients requiring postoperative topical medications to control IOP. Since more (although not significantly more) patients who did not receive 5-FU required needling of the bleb to maintain filtration, and since we were able to achieve satisfactory results in the great majority of cases using only a small total dose of 5-FU, we suggest that it may be simpler to use low doses of 5-FU in all trabeculectomy procedures.

Adult↗
PubMed1991

The identification of corneal guttae.

The deposits of cornea guttata, which often precede Fuchs' endothelial dystrophy, represent a risk factor in patients undergoing intraocular surgery, rendering a cornea unsuitable for use as donor material. These corneal guttae clinically resemble subendothelial blebs that accompany various corneal and anterior segment inflammatory conditions so that confusion between the two groups is possible. In differentiating the two groups it is noted that (a) guttae are more elevated and usually appear in the relief mode; (b) the endothelial mosaic, if present, is usually relatively normal around the guttae; (c) both guttae and blebs may be contiguous and even confluent; (d) guttae are more regular and endothelial cells are often arranged regularly around them; (e) although small guttae may occur, if guttae are at all numerous, large ones are also usually present; and (f) inflammatory cells are rarely present in the relief mode with guttae but are always present with blebs associated with uveitis.

Adolescent↗
PubMed1991

Effect of angle closure glaucoma and surgical intervention on the corneal endothelium.

To assess the effect of acute angle closure glaucoma (AACG) and related surgical intervention on the corneal endothelium, specular microscopy was performed following surgery in a series of 69 patients: 27 for AACG, 9 for incipient angle closure, 17 for chronic angle closure glaucoma (CACG), and 16 for chronic open angle glaucoma (COAG). Peripheral iridectomy for incipient angle closure glaucoma caused no significant effect on the corneal endothelium, but, following peripheral iridectomy or drainage operation for AACG, significant lowering of the endothelial cell count was present in the affected eye (p less than 0.05) with 1,000 cells/mm2 in 7 cases. This was related to the presence of segmental iris atrophy (p less than 0.01). Peripheral iridectomy for CACG or incipient angle closure glaucoma was not accompanied by a significant effect, but drainage operation for CACG or COAG was associated with a significant fall in count (p less than 0.01). Thus, both AACG and drainage operation significantly affect the corneal endothelium, and this should be assessed before undertaking further surgery.

Acute Disease↗
PubMed1991

Restoring the function of the failed bleb.

Failure of the filtering bleb after trabeculectomy with a gonioscopically patent drainage cleft is likely to be due to: encapsulation of the bleb; flattening of the bleb; or cystoid bleb. Encapsulated blebs and flattened blebs are usually associated with a high intraocular pressure (IOP) while cystoid blebs are not, but corneal ulceration due to the prominent cystoid bleb may make revision of the bleb necessary. If the IOP is raised it is best to proceed quickly to needling of the bleb using 5-fluorouracil. Sixteen patients underwent needling of the bleb, eight with encapsulated, six flattened and two cystoid blebs. Chronic open-angle glaucoma (10 cases) was the commonest glaucoma. Twelve patients obtained satisfactory control of IOP with mean pre-needling IOP for encapsulated blebs of 32 mmHg (4.27 kPa), flattened blebs 36 mmHg (4.8 kPa) and cystoid blebs 16 mmHg (2.13 kPa), while post-needling IOP for encapsulated blebs was 12 mmHg (1.6 kPa), flattened blebs 13 mmHg (1.73 kPa) and cystoid blebs 12 mmHg (1.6 kPa). Mean follow-up for encapsulated blebs was 15, flattened blebs 11 and for cystoid blebs nine months. Mean time between trabeculectomy and needling was: for encapsulated blebs 16 days; flattened blebs 24 days; and cystoid blebs 19 months.

Adolescent↗
PubMed1991

The use of YAG cyclophotocoagulation to lower pressure in advanced glaucoma.

YAG cyclophotocoagulation is a non-invasive cyclodestructive procedure which may be used in a graduated dosage as an outpatient procedure in cases of refractory glaucoma. In a group of 60 patients treated there were 37 patients with absolute glaucoma and 23 patients with advanced glaucoma in most of whom drainage operation had failed to control the intraocular pressure (IOP). Following treatment IOP fell in all but one case with absolute glaucoma. In 21 cases with absolute glaucoma it fell to 22 mmHg or less, while in 21 cases with advanced glaucoma it was 22 mmHg or less. Treatment was graduated as mild, moderate or maximal. Reactions were more severe with maximal treatment. In advanced glaucoma mild treatment only was used and this was repeated if necessary. Hypotony only occurred with maximal therapy.

Adult↗
PubMed1991

Tolerance of the eye for implanted cilia.

Retained cilia in the eye following injury are rare. There are reports of long term tolerance to cilia in the anterior chamber but no information about the effect on the corneal endothelium. A 31-year-old man was seen with a 19-year history of a retained eyelash embedded in a corneal scar and extending across the anterior chamber to the chamber angle. The follicle was absent. There was no cellular inflammatory reaction, and the eye otherwise appeared normal on slit-lamp examination with normal vision. However, there was the appearance of an encrusted deposit on the surface of the lash and a markedly lowered endothelial cell count of 750 cells/mm2 compared with the fellow eye. The lash was not removed.

Adult↗
PubMed1991

Identifying anterior segment crystals.

A series of 22 patients with crystals in the anterior segment of the eye was examined by specular microscopy. Of 10 patients with hypermature cataract and hyperrefringent bodies in the anterior chamber cholesterol crystals were identified in four patients and in six of the 10 in whom aspirate was obtained cholesterol crystals were demonstrated in three, two of these having shown crystals on specular microscopy. In 10 patients with intracorneal crystalline deposits, cholesterol crystals were found on specular microscopy, including one case of Schnyder's crystalline corneal dystrophy. Of two patients with multiple myeloma, corneal crystals were demonstrated in one. Crystals of the anterior segment of the eye are most likely to be cholesterol, and identification is important for future treatment.

Aged↗
PubMed1990

Comparison of specular microscopy and examination of aspirate in phacolytic glaucoma.

Although phacolytic glaucoma is well known and the clinical picture is well recognized, the nature of the polychromatic hyperrefringent granules is less well understood. A series of five cases was examined by specular microscopy, and the anterior chamber aspirate obtained at operation was subsequently examined by direct microscopy of the wet aspirate. Direct microscopy showed that the macrophages identified histologically in the aspirate corresponded to regular round cells about three times the size of an erythrocyte seen in the relief mode of specular microscopy. This finding aided in the interpretation of cellular deposits seen on specular microscopy. One hyperrefringent granule was seen on the posterior endothelium on specular microscopy, and results of subsequent examination of the aspirate showed this and the crystals in another patient to be morphologically identical with cholesterol crystals. The findings confirm that cholesterol crystals are present in the exudate in phacolytic glaucoma and are responsible for hyperrefrigent granules.

Adult↗
PubMed1990

The development and management of neovascular glaucoma.

Patients with neovascular glaucoma (NVG) often present with neovascularisation of the iris (NVI) already established and prompt energetic treatment of these patients is needed to reverse or stabilise the condition with possible retention of some visual function. In this series if the ocular media were still clear panretinal photocoagulation (PRP) caused regression of NVI in about 60% of cases and if a persistent rise in intraocular pressure (IOP) were still present this could be dealt with by drainage operation, Molteno implant or cyclophotocoagulation. If the media were already opaque or NVI did not regress then a Molteno implant or cyclophotocoagulation was used to reduce the IOP, preserving corneal endothelial function so that a comfortable eye could be obtained. Some regression of the NVI process was likely with time if the IOP were controlled by surgical treatment. Of 32 patients reviewed here, 20 patients developed NVG following a central retinal vein occlusion; in six patients NVG followed diabetic proliferative retinopathy, in five it followed arterial occlusion, and in one it followed an old traumatic retinal detachment. In those patients where NVG followed venous or arterial occlusion the common risk factors were always present. Patients were usually under treatment for their systemic condition but this treatment should be reviewed.

Adult↗
PubMed1990

Bullous keratopathy due to nonguttate corneal endothelial dystrophy.

Corneal oedema and bullous keratopathy may occur following intraocular surgery or arise spontaneously in nonguttate eyes. In some patients the fellow eye shows a relatively normal endothelial cell count with abnormal pleomorphism and polymegathism of the endothelial cells, while in others it shows a markedly lowered endothelial cell count with no evidence of corneal guttae. A survey of 17 such patients suggested the following classification. 1. Nonguttate corneal endothelial dystrophy with irregular endothelial cell morphology but a relatively normal endothelial cell count occurring following surgery (eight patients) or spontaneously (four patients). 2. Nonguttate corneal endothelial dystrophy with grossly reduced endothelial cell count occurring spontaneously (two patients). Three additional post-surgical patients showed a relatively normal endothelial cell count and only mild changes in the morphology of the corneal endothelium. These findings support the presence of a nonguttate corneal endothelial dystrophy in both the spontaneous and some of the post-surgical cases.

Aged↗
PubMed1989

Differentiation of posterior polymorphous dystrophy from other posterior corneal opacities by specular microscopy.

Deep corneal opacities due to posterior polymorphous dystrophy, especially if they are mild, are frequently confused with changes due to other corneal conditions. In a series of 64 patients with deep corneal opacities (14 with Descemet's tears, 8 with posterior polymorphous dystrophy, 12 with interstitial keratitis, and 30 with keratoconus), specular microscopy enabled the differentiation of deep corneal changes provided some degree of corneal clarity was retained. The parallel "rail track" borders of old Descemet's tears were characteristic and differed from the "snail tracks" seen in posterior polymorphous dystrophy, which also showed characteristic rounded vesicular or doughnut-like lesions in Descemet's membrane. The appearances in interstitial keratitis were varied with poor detail in most cases because of corneal opacity. However, fine opacities consistent with ghost vessels were seen in interstitial keratitis and a resolving case showed fine, intersecting straight lines different from the bundles of parallel fine vertical lines of deep corneal striae in keratoconus. Specular microscopy also enables an assessment of the corneal endothelium which is important if intraocular surgery is contemplated.

Adolescent↗