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Biomedical subjects

A P Moriarty

Publications and source records attributed to A P Moriarty.

At least 19 recordsLinked to original sources
PubMed1996

Breakdown of the blood-aqueous barrier after argon laser panretinal photocoagulation for proliferative diabetic retinopathy.

BACKGROUND: Breakdown of the blood-aqueous barrier (BAB) after panretinal photocoagulation (PRP) was measured with a laser flare photometer over a study period of 8 weeks. METHODS: Twenty-five eyes of 25 patients who had no previous photocoagulation and required such treatment for proliferative diabetic retinopathy (PDR) were included in the trial. They received 2000 burns (0.1-second exposure, 200 mu m spot) via a panfunduscope and 500 burns (0.1-second exposure, 500-mu m spot) with a Goldmann lens. Power levels were adjusted to produce a mild blanching of the retina. Only an argon green laser (514 nm) was used. Laser photometry was performed on both eyes at 3, 24, 48, 72, 96, and 168 hours and 8 weeks after laser treatment. RESULTS: Including all of the eyes treated, there was a significant increase in flare value of 3, 24, and 48 hours compared with baseline (Student's t test) but not at 72, 96, and 168 hours or at 8 weeks. Peak values occurred at 24 hours. When blue and brown irides were analyzed separately, there was a significant increase in flare for blue irides compared with baseline levels at 3 and 24 hours, whereas for brown irides the increased flare was sustained at 3, 24, 48, 72, and 96 hours (Student's paired t test). In addition, when the increase in flare value from baseline was compared between blue and brown irides (pooled Student's test), there was a sustained increase at 24, 48, 72, and 96 hours for brown irides compared with blue. Clinically significant uveitis, posterior synechiae, or peripheral anterior synechiae did not develop in any of the patients. CONCLUSIONS: Breakdown of the BAB may occur after PRP, particularly in more heavily pigmented irides. The time course of this suggests that the phenomenon is related directly to laser effects in the anterior segment, although other factors may contribute.

Anterior Eye Segment↗
PubMed1995

Initial clinical experience with tissue plasminogen activator (tPA) assisted removal of submacular haemorrhage.

Tissue plasminogen activator (tPA) (250 micrograms/ml) was used to facilitate removal of submacular thrombus in 15 patients. Following a three-port vitrectomy and subretinal tPA injection (0.1 ml) via a 30 gauge needle, blood was evacuated after enzymatic dissolution for 20 minutes. Two injections were required in some cases. Nine women and six men were treated (mean age 75.5 +/- 8.6 years). Duration of symptoms ranged from 2 days to 8 weeks. One case was due to a retinal macroaneurysm, the others to age-related macular degeneration. Vision improved in 13 patients and remained the same or deteriorated in 2 (mean follow-up 11 +/- 4.9 months). Well-defined subretinal neovascular membranes were identified in 2 patients and occult neovascularisation suspected in 2 others. A cataract developed in 1 case and retinal detachments in 2 others; all were treated successfully. The poor visual prognosis associated with submacular haemorrhage may be obviated by the use of the technique we describe.

Aged↗
PubMed1994

Studies of the blood-aqueous barrier in diabetes mellitus.

We measured the breakdown of the blood-aqueous barrier in 63 patients with diabetes (126 eyes) by using a laser flare meter. Of 126 eyes, 40 had no retinopathy, 34 had proliferative retinopathy, 24 had regressed proliferative retinopathy, 14 had background retinopathy, and 14 had maculopathy. Eyes were classified into one category only. Mean flare was greater for proliferative retinopathy compared to background retinopathy (P = .0065), no retinopathy (P = .0001), and maculopathy (P = .0189). Flare values were greater for regressed proliferative retinopathy compared to no retinopathy (P = .0118) (paired Student's t-test). Diabetic eyes without demonstrable retinopathy still had higher flare values than control eyes without diabetes. The length of diabetes was greater for those eyes with proliferative diabetic retinopathy (P = .0195), regressed proliferative diabetic retinopathy (P = .0625), and background diabetic retinopathy (P = .006) compared to those with no retinopathy. No significant difference was noted in duration of diabetes for eyes with diabetic maculopathy when compared to those with no retinopathy (P = .5788). Breakdown of the blood-aqueous barrier precedes the development of retinopathy, and the more severe proliferative forms have greater blood-aqueous barrier dysfunction.

Adult↗
PubMed1994

Clinical experience with a fixed dose combination therapy of timolol and pilocarpine used twice daily in the management of chronic open angle glaucoma.

Twenty-five eyes of 25 patients with primary chronic open angle glaucoma deemed controlled for 12 months were converted from timolol 0.25% or 0.5% b.d. and pilocarpine 2% q.i.d. to a combination drop (TP2) of combined timolol 0.5% and pilocarpine 2% given b.d. Mean intraocular pressures (IOP) were 18.68 +/- 2.84 mmHg at 1 month, 18.81 +/- 2.56 mmHg at 3 months and 18.56 +/- 2.01 mmHg at 6 months. These values were significantly higher than the initial IOP of 17.48 +/- 2.2 mmHg (p values 0.0006, 0.0001 and 0.0004 respectively). However, 1 month following reconversion to initial therapy the IOP was 17.68 +/- 2.67 mmHg, which was not significantly higher than the initial IOP (p = 0.46). In addition, of 8 eyes uncontrolled during the course of the study, 6 became controlled following reconversion to initial treatment. Combination therapy of TP2 b.d. cannot be recommended to control IOP satisfactorily in patients maintained on timolol 0.25% or 0.5% b.d. and pilocarpine 2% q.i.d.

Aged↗
PubMed1993

Severe corneoscleral infection. A complication of beta irradiation scleral necrosis following pterygium excision.

OBJECTIVE: To assess the precipitating factors, clinical course, and treatment of 11 cases of severe intraocular infections of radionecrosis after pterygium excision in an attempt to minimize the devastating ocular sequelae. DESIGN AND SETTING: From the database of cases of radionecrosis at Royal Perth (Australia) Hospital and Lions Eye Institute, Perth, we identified 11 cases of severe intraocular infection complicating radionecrosis. We reviewed the case notes and the available radiotherapy records (n = 8). PATIENTS: Eleven patients admitted during an 8-year period. RESULTS: Mean (+/- SD) dose of radiotherapy was 22.7 +/- 1.0 Gy and mean latency period, 14.45 +/- 2.5 years. Among the six proven bacterial cases, Pseudomonas was identified in four, Staphylococcus aureus in one, and Streptococcus pneumoniae was involved in one bilateral case. Among the four fungal cases, Petriellidium boydii was indicated in two, and Fusarium and Scedosporium inflatum in one each. The condition may remain undiagnosed for some time and mimic a posterior scleritis, serous retinal detachment, or pseudotumor. INTERVENTIONS: Early débridement and culture; close microbiological assistance; and systemic antimicrobials for a prolonged period. Perforation or incipient perforation necessitated penetrating keratoplasties in seven patients and repeated keratoplasties in three. MAIN OUTCOME MEASURES: The use of radiotherapy following pterygium excision should be limited and only low doses used. Ulcer beds and calcific plaques at sites of radionecrosis should not be directly covered without first performing adequate sterilization. Removal of plaques may precipitate sepsis; ulcer beds and plaques harbor infective agents. CONCLUSION: Severe radionecrosis may expose a patient to a lifelong risk of intraocular sepsis and profound visual morbidity. Conjunctival autografting is a safer method to reduce recurrence rate after pterygium excision.

Aged↗
PubMed1993

Long-term follow-up of diode laser trabeculoplasty for primary open-angle glaucoma and ocular hypertension.

BACKGROUND: Initial studies of laser trabeculoplasty using infrared energy (810 nm) emitted by diode semi-conductor lasers have been encouraging. A 2-year study of diode laser trabeculoplasty (DLT) in the control of primary open-angle glaucoma (POAG) and ocular hypertension has been completed. METHODS: Patients with uncontrolled POAG or ocular hypertension were treated with DLT to one half of the trabecular meshwork using a trabeculoplasty lens. Spot size was 100 microns, exposure time was 0.2 second, and mean power was 1096 mW (+/- 46.5 mW). The desired endpoint was a mild blanching of the meshwork only. RESULTS: Twenty-five eyes of 16 patients were treated. Mean intraocular pressure reduction was 9.24 mmHg (+/- 3.4 mmHg) at 6 weeks, 9.32 mmHg (+/- 3.6 mmHg) at 3 months, 9.34 mmHg (+/- 3.8 mmHg) at 6 months, 8.42 mmHg (+/- 2.62 mmHg) at 12 months, 8.14 mmHg (+/- 3.42 mmHg) at 18 months, and 7.9 mmHg (+/- 3.63 mmHg) at 24 months. No pressure peaks (> 5 mmHg) were recorded after therapy. Inflammation and discomfort were minimal after laser treatment. Of 16 eyes examined at 2 years, there were no peripheral anterior synechiae. During the course of the study, six eyes became uncontrolled, despite one session of DLT. Four eyes regained control with a further session of DLT, but two required trabeculectomy. CONCLUSION: Diode laser trabeculoplasty is an effective form of therapy in POAG and ocular hypertension. Hypotensive effects and success rates are comparable with argon laser trabeculoplasty (ALT). Reduced inflammation after laser treatment may be due to reduced absorption of infrared energy by the melanin of the anterior segment. The portable nature of these lasers may allow for laser delivery in developing countries and remote situations.

Aged↗
PubMed1993

Comparison of the anterior chamber inflammatory response to diode and argon laser trabeculoplasty using a laser flare meter.

BACKGROUND: Diode laser trabeculoplasty (DLT) has a similar hypotensive action to argon laser trabeculoplasty (ALT). However, anterior chamber inflammatory response and laser-induced discomfort are less pronounced with DLT. The authors compared the breakdown of the blood-aqueous barrier after DLT and ALT over the time course of 1 week and the hypotensive action over 8 weeks. METHODS: Twenty-five patients with uncontrolled intraocular pressure (IOP) were randomized to either DLT or ALT. If two eyes required treatment, then the second eye would be treated with the alternative laser to the first. Flare values were measured at 1, 3, 24, 48, 72, 96, and 168 hours using a laser flare and cell meter. Intraocular pressures were measured at similar intervals and at 8 weeks. RESULTS: Of 38 eyes treated, 21 underwent ALT and 17 DLT. Both forms of treatment induced a similar hypotensive effect with a significant reduction in IOP at 8 weeks compared with initial IOP (P < 0.01) (paired Student's t test). However, there was a significantly greater disruption of the blood-aqueous barrier with ALT when compared with DLT at 1, 3, and 24 hours (P < 0.001) and at 48, 72, and 96 hours (P < 0.01) (unpaired Student's t test). By 1 week, however, there was no significant difference in flare values between the two groups. Postlaser pain occurred in seven eyes treated with ALT but in no eyes treated with DLT. In addition, peripheral anterior synechiae occurred in four eyes after ALT by 8 weeks but none occurred in the DLT group. CONCLUSION: Argon laser trabeculoplasty produces a greater disruption of the blood-aqueous barrier than DLT. This may be associated with the development of complications in the anterior segment.

Aged↗
PubMed1993

Fungal corneoscleritis complicating beta-irradiation-induced scleral necrosis following pterygium excision.

Four cases of fungal corneoscleritis complicating beta-irradiation-induced scleral necrosis after pterygium excision have presented to our institution in recent years. Two cases were due to Petriellidium boydii and one each to Fusarium and Scedosporium inflatum. The condition may remain undiagnosed for weeks to months and becomes chronic with perforation or incipient perforation. The infections may masquerade as a chronic red eye, posterior scleritis or serous retinal detachment. Penetrating or lamellar keratoplasty is required following debridement of necrotic tissue. Prolonged systemic antifungal therapy may still fail to eradicate infection. Visual outcome is usually poor, and one of our patients required enucleation. Removal of calcific plaques from ulcer beds should be accompanied by disinfection, debridement and culture, since these beds and plaques are frequently a nidus of infection. Subsequently these ulcers may be covered with lamellar grafts or conjunctiva. We would caution against the use of radiotherapy to prevent recurrence of pterygia.

Aged↗