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Biomedical subjects

A Mermoud

Publications and source records attributed to A Mermoud.

At least 91 records · Page 5Linked to original sources
PubMed1993

Trabeculectomy with mitomycin C for refractory glaucoma in blacks.

The use of one intraoperative application of mitomycin C at the filtration site has been effective in eyes at increased risk for failure of routine trabeculectomy. To study the efficacy and safety of this technique in patients with refractory glaucoma, we prospectively examined 30 eyes of 26 black patients in whom a 0.2-mg/ml solution of mitomycin C was applied between Tenon's capsule and the sclera for five minutes before trabeculectomy. The results were compared to those found in a matched group of 30 eyes of 28 patients who underwent trabeculectomy without mitomycin C. The mean postoperative intraocular pressures were significantly lower in the mitomycin C group than in the control group (P = .001). Of the 30 eyes in the mitomycin C group, 25 (83%) had an intraocular pressure of less than 21 mm Hg without glaucoma medication, compared to 11 of 30 (37%) in the control group (P = .00006). In the mitomycin C group, 19 eyes (63%) developed a cystic avascular thin-walled filtering bleb, four eyes (13%) a late positive Seidel test, and one eye slight scleral thinning over the area where the mitomycin C was applied. Although mitomycin C is effective when used in this manner, further study is required to determine the long-term complications.

Adult↗
PubMed1993

Anti-inflammatory effect of diclofenac drops after argon laser trabeculoplasty.

Using a laser flare-cell meter, the anti-inflammatory effect of diclofenac sodium drops was evaluated after argon laser trabeculoplasty in a double-masked placebo-controlled study. Fifty-three eyes with pseudoexfoliative (43 eyes) or pigmentary glaucoma (10 eyes) were randomly assigned to treatment (n = 27) or placebo (n = 26) groups. Diclofenac (0.1%) or placebo drops were administered once before and after trabeculoplasty and then four times daily for a total of 4 days. Visual acuity, intraocular pressure, and anterior chamber flare, measured with the laser flare-cell meter, were evaluated before trabeculoplasty, 3 and 6 hours after trabeculoplasty, and 1, 2, 4, 7, and 14 days after trabeculoplasty. Flare increase after argon laser trabeculoplasty was completely blocked by 0.1% topical diclofenac and the mean of maximal flare increases was reduced significantly in the diclofenac group. Therefore, 0.1% diclofenac drops represent a very efficient anti-inflammatory therapy after argon laser trabeculoplasty.

Aged↗
PubMed1993

The prevalence of primary angle closure glaucoma and open angle glaucoma in Mamre, western Cape, South Africa.

OBJECTIVE: To determine the prevalence of primary angle closure glaucoma in the so-called Cape people of mixed ethnic background. DESIGN: A population-based prevalence study. SETTING: Mamre, a village near Cape Town, South Africa. PARTICIPANTS: Individuals aged 40 years or older. Historically, their ancestors were Southeast Asians and indigenous Africans and, to a lesser extent, Europeans. Of a total of 1194 people, 987 (82.7%) were examined. MAIN OUTCOME MEASURE: Primary angle closure glaucoma was diagnosed in individuals with previous acute or intermittent symptoms of angle closure and in individuals with an "occludable" angle and an intraocular pressure of greater than 21 mm Hg or a glaucomatous visual field. MAIN RESULTS: An age-related trend toward hypermetropia was found, which was greatest in women older than age 50 years. Gonioscopy identified Shaffer grade 1 angles in 89 (9%) of 987 subjects. The prevalence of primary angle closure glaucoma was 2.3% (23 subjects) and increased with age in both sexes. Women were affected more than four times as often as men and the sex difference persisted across all age groups. In comparison, the prevalence of primary open angle glaucoma was 1.5% (15 subjects). Primary glaucoma (angle closure plus open angle) was the leading cause of bilateral blindness in the community, with a prevalence rate of 0.5% (five subjects). CONCLUSIONS: This study identified primary angle closure glaucoma as a significant public health problem in the Western Cape Province. Because of the ethnic back-ground of the people studied, these findings may also apply to the populations of Southeast Asia.

Adult↗
PubMed1993

Surgical management of post-traumatic angle recession glaucoma.

PURPOSE: The purpose of this study is to compare the results of three different drainage procedures performed for uncontrolled post-traumatic angle recession glaucoma. METHODS: A retrospective analysis was undertaken of 87 drainage procedures performed on 65 patients over an 8-year period. The results of trabeculectomy (47 procedures), Molteno single-plate implantation (20 procedures), and trabeculectomy combined with antimetabolite (20 procedures) were compared. Of those treated with antimetabolite, 11 received postoperative subconjunctival injections of 5-fluorouracil and 9 received an intraoperative application of 0.02% mitomycin C to the trabeculectomy site. RESULTS: In the group undergoing trabeculectomy with antimetabolite therapy, the intraocular pressure (IOP) drop was significantly greater, the percentage of successful cases at 3 and 6 months postoperatively was significantly higher, and the number of postoperative glaucoma medications was significantly lower than the other two groups. No statistically significant differences were found between the groups undergoing trabeculectomy without antimetabolite therapy and Molteno implantation. Of concern were three cases of late bleb infection in the group that received postoperative antimetabolite therapy. CONCLUSION: In medically uncontrolled post-traumatic angle recession glaucoma, trabeculectomy with antimetabolite therapy is the most effective surgical procedure. However, late bleb infection is a significant risk.

Adolescent↗
PubMed1993

Post-traumatic angle recession glaucoma: a risk factor for bleb failure after trabeculectomy.

In order to determine if post-traumatic angle recession is a risk factor for failure of glaucoma filtering surgery independent of age or race, the surgical results of trabeculectomy performed in 35 consecutive patients with angle recession glaucoma were compared with those of 35 matched patients with primary open angle glaucoma. A postoperative intraocular pressure of < or = 21 mm Hg (with or without glaucoma medication) was found in 15 of the 35 (43%) patients with angle recession glaucoma compared with 26 of the 35 (74%) patients with primary open angle glaucoma. The long term success of trabeculectomy was significantly worse in angle recession glaucoma when the results were analysed using Kaplan-Meier survival curves. Bleb failure occurred a mean period of 3.1 (SD 1.2) months after trabeculectomy in angle recession glaucoma compared with 9.4 (5) months in primary open angle glaucoma (p < or = 0.001). The finding that posttraumatic angle recession is a risk factor for failure of trabeculectomy, supports the use of antimetabolite therapy to suppress fibrosis after trabeculectomy in these patients.

Adult↗
PubMed1993

Molteno tube implantation for neovascular glaucoma. Long-term results and factors influencing the outcome.

BACKGROUND: The Molteno implant has been shown to be useful in the treatment of neovascular glaucoma. However, a wide range of success rates has been reported. This is related to the use of differing criteria for success, varying periods of follow-up, and difficulty in quantifying the preoperative condition of the eye. METHODS: The authors studied the long-term results of the Molteno single-plate implant in 60 eyes with neovascular glaucoma using Kaplan-Meier life-table analysis. Age, visual acuity, underlying retinal diseases, and preoperative retinal ablation treatment were evaluated to establish factors influencing the surgical outcome. The criteria for success included a postoperative intraocular pressure (IOP) of less than or equal to 21 mmHg and maintenance of vision. RESULTS: The success rate was 62.1% at 1 year, 52.9% at 2 years, 43.1% at 3 years, 30.8% at 4 years, and 10.3% at 5 years. The main causes for failure were loss of light perception in 48% of eyes (29/60), progression to phthisis bulbi in 18% (11/60), and encapsulation of the filtering bleb in 10% (6/60). The long-term surgical outcome was significantly better in patients older than 55 years of age (P = 0.048) and in those with a preoperative visual acuity equal to or better than 6/60 (P = 0.019). Eyes with neovascular glaucoma secondary to diabetic retinopathy had a better prognosis than those with a central retinal vein occlusion (P = 0.003). CONCLUSION: Although the IOP can be significantly reduced after Molteno implantation, this study suggests that in severely compromised eyes with neovascular glaucoma the main advantage of Molteno implantation is pain relief and avoidance of enucleation.

Adolescent↗
PubMed1992

Inflammation patterns after laser trabeculoplasty measured with the laser flare meter.

Anterior chamber inflammation was measured in 71 eyes after argon laser trabeculoplasty with the laser flare-cell meter (Kowa FC-1000). Visual acuity, tonometry, and laser flare measurement were performed before and 3, 6, and 18 hours and 2, 4, 7, 14, 30, and 90 days after argon laser trabeculoplasty. Anterior chamber inflammation peaked 2 days after argon laser trabeculoplasty. Forty-nine percent of the eyes showed significant inflammation, with a flare increase of more than 10 photon counts per millisecond over prelaser values. Inflammation was significantly more frequent in pseudoexfoliative glaucoma (69%) and pigmentary glaucoma (100%) than in primary open angle glaucoma (23%). Post-argon laser trabeculoplasty relative pressure decrease was significantly more important in the group of patients with inflammation than in the group without inflammation in the early and late follow-up periods. Topical nonsteroidal anti-inflammatory treatment (diclofenac sodium) was needed in 17 patients, who readily responded to treatment within 72 hours.

Aged↗
PubMed1992

Aqueous humor analysis after Nd:YAG laser capsulotomy with the laser flare-cell meter.

Using the laser flare-cell meter (Kowa FC-1000), we conducted a prospective study analyzing the effect of Nd:YAG posterior capsulotomy on the quantity of aqueous particles, aqueous flare, and intraocular pressure in 65 eyes (58 patients). Aqueous particles increased at six hours, followed by flare rise which was significant at 18 hours after capsulotomy. Only 22 eyes (34%) had a significant flare rise over prelaser values. Anti-inflammatory therapy was necessary in only one patient. The mean intraocular pressure value did not rise significantly after capsulotomy. Acute intraocular hypertension (AIOHT) (> 7 mm Hg increase) occurred between three and six hours after laser therapy in 12 patients (19%), was related in time to particle rise, and always responded to a single dose of acetazolamide. Acute intraocular hypertension was strongly correlated with elevated aqueous particles (P < .0001) and somewhat correlated with flare rise (P < .036), but was not correlated with the intraocular lens position (bag or sulcus fixation). Our findings strongly suggest that trabecular meshwork clogging by debris generated by the capsulotomy is the mechanism at the origin of AIOHT.

Adult↗
PubMed1992

[Anti-inflammatory effect of topical diclofenac sodium (Voltarène Ophta) after argon laser trabeculoplasty: preliminary results of a prospective double-blind method].

Using the laser flare-cell meter (LFMC), we have previously determined the intensity and pattern of post-ALT ocular inflammation. Inflammation peak occurs 48 hours after ALT and clinically relevant inflammation is seen in 100% of pigmentary glaucomas (PIG), 75% of pseudoexfoliative glaucomas (PEXG) but only in 25% of primary open angle glaucomas (POAG). We also showed that topical diclofenac reduced inflammation in all 17 treated patients. Prostaglandins are thought to play a major role in ALT-inflammation and it is therefore logical to assume that NSAID are effective in that situation and will probably advantageously replace corticosteroids. In order to assess the anti-inflammatory effect of diclofenac drops (Voltaren Ophtha) we included a total of 37 PIG or PEXG (19 in the diclofenac and 18 in the placebo group) scheduled for ALT in prospective randomized placebo-controlled study. Visual acuity, tonometry, and LFCM flare measure were performed before, 3, 6 hours, 1, 2, 4, 7, 14 days after ALT. Topical diclofenac or placebo was given before and after ALT and then QID for a total of 4 days. Mean maximal flare increase was significantly less in the diclofenac group than in the placebo group (4.6 +/- 3.8 ph/msec v. 17.4 +/- 19 ph/msec; p less than 0.01). Flare increase compared to pre-ALT values was significant at 1 and 2 days after ALT in the placebo group only (p less than 0.02; p less than 0.05); no significant flare increase occurred in the diclofenac group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Comparison of the effects of trabeculoplasty using the Nd-YAG laser and the argon laser].

We compared the effect of Argon Laser trabeculoplasty (ALT) and Nd-YAG-Laser trabeculoplasty (YLT) on inflammation and intraocular pressure (IOP). Twenty-two patients scheduled for bilateral trabeculoplasty were treated with an Argon laser in one eye and with Nd-YAG laser in the controlateral eye. Visual acuity, IOP and anterior chamber inflammation (measured with the laser flare-cell meter) were controlled at 0, 3, 6, 18 hours, 2, 4, 7, 14, 30, 90 and 180 days after trabeculoplasty. Our results showed a similar pressure lowering effect in both groups (-24.5 +/- 23% after YLT versus -32.9 +/- 16.3% after ALT at 90 days post-laser; p = 0.26). The anterior chamber inflammation was delayed and more important in the ALT-group (inflammation peaked at 24.8 hours after YLT versus 44.5 hours after ALT; p = 0.034) (maximal mean flare increase: 19.4 +/- 12 pH/msec. after ALT, versus 16.1 +/- 11.4 ph/msec. after YLT). All eyes with inflammation were successfully treated with topical diclofenac QID (Voltaren Ophtha), a nonsteroidal anti-inflammatory agent. YLT is a safe and effective alternative technique to perform laser trabeculoplasty, which is especially useful in poorly pigmented angles where ALT is known to be less effective.

Aged↗
PubMed1992

[Effect of naftidrofuryl (Praxilene) in primary open angle glaucoma: prospective double-blind study].

The positive effect of Naftidrofuryl (Praxilène), a specific serotonine-S2 receptor antagonist, has already been described in the treatment of normal pressure glaucoma. Despite the fact that in POAG intraocular pressure (IOP) is the primary ethiopathogenic mechanism, vascular factors could also influence the progression of the disease, especially in old patients with cardiovascular risk factors. We have studied the effect of Naftidrofuryl versus placebo in a randomised double-blind study on 42 POAG patients. Visual acuity, IOP, Visual field (Octopus program G1), Arterial pressure, Plasma viscosity have been recorded at 0, 12 and 24 weeks. Our results showed no difference between the Naftidrofuryl and the Placebo group for each studied parameter except a decrease of CLV at 12 weeks in the Naftidrofuryl group (p = 0.012). This suggests that Naftidrofuryl is not as effective in POAG as it is in normal tension glaucoma. Other studies with a greater patient - collective and the use of other vasoactive substances will be necessary in the future.

Aged↗
PubMed1992

[Modification of the visual field during temporary interruption of miotic treatment].

The visual field of 27 eyes with chronic open angle glaucoma was examined with the "Octopus 1-2-3" automatic perimeter. The visual fields with and without miotics were compared using the "mean defect" (MD) as parameter. The MD decreases significatively (p = 0.003) after interruption of the miotic treatment. As presumed, the IOP and the pupillary diameter increased significantly (p less than 0.001). The CLV insignificatively decreased. The short term modifications of the pupillary diameter seem to be a more important factor than this of IOP.

Aged↗
PubMed1992

[Ocular toxocara canis in a 30-year-old adult].

Pars plana vitrectomy was performed in a 30-year-old patient who presented a posterior traction detachment due to an inflammatory granuloma. The granuloma removed in toto during surgery revealed characteristic features of toxocariasis lesion (first case described in the literature). An ELISA test performed on a vitreous sample was strongly positive. Retinotomy around the granuloma was necessary to re-attach the retina and silicone oil was used as a tamponade for 4 months. VA improved from HM to 15/200 after silicone removal.

Adult↗
PubMed1992

[Anterior ischemia of the optic nerve and anemic retinopathy].

We report on the case of a 59-year-old man with the association of an anterior ischemic optic neuropathy on the left eye and a bilateral anemic retinopathy following an extreme and prolonged post-operative anemia, because the patient had refused blood-transfusion. After one year of follow-up, the visual acuity did improve on the left eye. This association is rare, and only few cases have been reported.

Anemia↗
PubMed1992

Use of the single-plate Molteno implant in refractory glaucoma.

During a 5-year period, 60 patients with uncontrolled glaucoma in one eye, who were considered to have a poor surgical prognosis with conventional drainage surgery, were treated with a single-plate Molteno implant. The surgery was performed in one operation and the tube tied with an absorbable suture in all cases. The overall follow-up was 20.3 +/- 11 months (range 3-60). A successful outcome (defined as an intra-ocular pressure < or = 21 mm Hg with or without treatment) was achieved in 56% of the 16 eyes with either aphakic or pseudophakic glaucoma, in 71% of the 14 eyes with uncontrolled glaucoma despite a previous filtering procedure, in 46% of the 13 eyes with traumatic glaucoma and in 64% of the 17 eyes with traumatic glaucoma and lens involvement. The visual acuity remained the same or better in 70% (42/60). Early complications of the surgery were transient and easily treated. Late complications included tube exposure in 3 (5%), tube retraction in 2 (3.3%), bleb encapsulation in 5 (8.3%) and corneal decompensation in 1 (1.65%). This study suggests that the single-plate Molteno implant is a useful drainage device with satisfactory results when used for the treatment of refractory secondary glaucoma.

Adult↗
PubMed1992

Pain upon eye movement following digoxin absorption.

A patient who had received digoxin for 6 months experienced glare and ocular pain induced by eye movement. The symptoms lasted for 2 days and disappeared within hours after the treatment was discontinued. Four months later, digoxin was readministered. After 2 days, the symptoms reappeared but disappeared again within hours of stopping treatment. The origin of the pain is uncertain, although mechanisms related to optic nerve or ocular muscle involvement should be considered. Digoxin toxicity should be included in the differential diagnosis of pain evoked by ocular movements.

Adult↗
PubMed1991

[Treatment of normal pressure glaucoma with a serotonin S2 receptor antagonist, naftidrofuryl (praxilen)].

35 normal tension glaucoma patients were followed during 8 to 11 month. 12 patients received 2 x 200 mg/day Naftidrofuryl, a serotonine S2 receptor antagonist. As controles, another 23 patients were followed without treatment. The treated group, compared with the 23 non treated patients showed a significant increase in visual acuity (p = 0.001), a significant increase of the MS (p = 0.03), and a non significant decrease of the MD and CLV on the Octopus visual field (p, NS). The physiology and physiopathology of serotonine and S2 receptor antagonist are discussed.

Aged↗