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Biomedical subjects

A Sugar

Publications and source records attributed to A Sugar.

At least 73 records · Page 4Linked to original sources
PubMed1989

Penetrating keratoplasty for corneal scarring due to herpes zoster ophthalmicus.

We retrospectively studied the postoperative results in nine patients with corneal scarring due to herpes zoster ophthalmicus who underwent penetrating keratoplasty. This was a highly selected group that satisfied all of the following criteria: (a) absence of active disease of the ocular surface and eyelids, (b) intraocular pressure under control, and (c) absence of active keratouveitis. Penetrating keratoplasty after herpes zoster ophthalmicus may do well in patients with long preoperative quiescent periods in whom these restrictive preoperative criteria are observed.

Aged↗
PubMed1989

An analysis of corneal endothelial and graft survival in pseudophakic bullous keratopathy.

PBK has become an important complication of cataract surgery and a leading indication for keratoplasty. While there are many potential causative factors, erroneous concepts of IOL positioning and design appear to have led to PBK with many iris-supported and anterior chamber lens styles. Underlying host endothelial abnormalities are an important risk factor with posterior chamber lenses. Previous studies of keratoplasty for PBK have shown variable early results in terms of graft clarity and visual rehabilitation. Specular microscopy and life-table survival analysis have been infrequently used to study endothelial and graft survival after keratoplasty. This study combined these techniques to evaluate several approaches to the original IOL at PKP for PBK. Four-hundred sixty-nine patients having PKP for PBK between 1976 and 1986 were studied in five retrospective cohorts on the basis of whether their IOL was retained, removed, or exchanged. Specular microscopy was performed prospectively on 390 patients. Survival analysis showed overall failure in 20% of IOL-removed, 24% of IOL-retained, and 16% of IOL-exchanged grafts, without significant differences. Within the retained group, however, graft failure rate for posterior chamber IOLs (6%) was significantly less than for anterior chamber (34%) and iris-supported (29%) lenses. With lens exchange, the failure rate was 8% for sutured posterior chamber lenses, 5% for one-piece anterior chamber lenses, and 24% for closed-loop anterior chamber lenses. Graft failure rates exceeded rejection rates for retained iris-supported and anterior chamber lenses, and exchanges for closed-loop anterior chamber lenses, suggesting nonimmunologic causes. The survival curve for all groups combined showed cumulative survival of 93% at 1 year, decreasing to 62% by 6 years. Survival was lowest for retained anterior chamber and iris-supported lenses and exchanged closed-loop anterior chamber lenses. Visual acuity results were best for retained posterior chamber IOL eyes and exchange for one-piece anterior chamber IOLs. Exchange for one-piece anterior chamber IOLs gave significantly better visual acuity than exchange for sutured posterior chamber IOLs. There was not a significant relationship between duration of corneal edema prior to PKP and visual outcome, refuting earlier findings. Cystoid macular edema was related to poor vision in 62% of those with visual acuity of less than 20/40 and in 36% of all patients. Specular microscopy findings at 1 year were predictive of longer term survival results. The least cell loss was for retained and exchanged posterior chamber lenses and exchange for one-piece anterior chamber lenses.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

Reactive membrane on a foldable silicone lens implant in the posterior chamber of a human eye.

A foldable silicone posterior chamber intraocular lens implant caused irritation and glaucoma postoperatively in the eye of a diabetic patient who subsequently was treated with steroids and a laser capsulotomy. Because the lens implant was loose in the capsular bag and caused considerable glare, it was removed about 4 months after placement. Pathologic study revealed the entire surface of the implant to be covered by a continuous and firmly adherent protein membrane with excrescences and of irregular thickness. Sessile macrophages found on the membrane were not firmly attached.

Cataract Extraction↗
PubMed1989

Problems associated with penetrating keratoplasty for corneal edema in congenital glaucoma.

Corneal edema from congenital glaucoma is a rare indication for penetrating keratoplasty. We report the complications and problems associated with eight consecutive penetrating keratoplasties performed in adult eyes with a history of congenital glaucoma. Only 25% of the eyes achieved 20/40 or better vision after surgery. These generally poor results can be attributed to previous glaucomatous optic nerve damage, to complications related to previous surgery, and possibly to amblyopia. The most common surgical complication was postoperative elevation of intraocular pressure, which occurred in all the cases (8/8 eyes), and required permanent augmentation of glaucoma medications in seven eyes (88%), and glaucoma surgery in four eyes (50%). Two eyes (25%) developed corneal graft failure, one from immune rejection and the other from severe postoperative glaucoma necessitating cyclocryotherapy. In view of these complications and the multiple impediments to good postoperative vision, we advise that penetrating keratoplasty be reserved for patients with severe visual disability whose preoperative glaucoma is well controlled.

Adolescent↗
PubMed1988

A study of race matching between donor and recipient in corneal transplantation.

We investigated the influence of a racial match or mismatch between the corneal donor and recipient on the risk of endothelial rejection and subsequent graft failure in 998 corneal transplant recipients. Actuarial survival analysis showed no significant difference in the cumulative risk of endothelial rejection between the 676 race-matched and 322 race-mismatched recipients. Recipients who had preoperative factors that placed them at a higher risk of endothelial rejection (n = 208) also were not subject to a higher incidence of endothelial rejection if they received race-mismatched tissue. Graft failure after endothelial rejection was not found to differ among race-matched or -mismatched groups.

Black People↗
PubMed1988

The effect of removing running sutures on astigmatism after penetrating keratoplasty.

To evaluate astigmatic change after removal of the double running sutures used in penetrating keratoplasty, all patients (N = 131) in the Michigan Corneal Transplantation Patient Registry, Ann Arbor, whose eyes were phakic after penetrating keratoplasty were evaluated. The primary reasons for surgery in this group were keratoconus (n = 44, 34%) and Fuchs' corneal dystrophy (n = 19, 15%). The average effect of 10-0 suture removal in 58 eyes with documented keratometry readings was a 0.30-diopter (D) decrease in astigmatism, with 59% showing 2 D or less of astigmatic change. In 83 eyes with keratometry readings before and after 11-0 suture removal, an average increase of 0.37 D of astigmatism was observed, with 81% showing less than 2 D of astigmatic change. In eyes that were highly astigmatic (greater than 6 D) before suture removal, a reduction in astigmatism exceeding 2 D was observed in 39% and 11% after 10-0 and 11-0 suture removal, respectively.

Astigmatism↗
PubMed1988

Clinical significance of common eye changes in older patients.

The limbus is often affected by degenerative lesions, many associated with the aging process. Some degenerations may cause irritation, discomfort, and poor vision, thus requiring ophthalmological treatment, while a few require systemic evaluation and treatment. As the limbus is also subject to neoplasms and inflammatory processes, any limbal lesion whose identity is less than obvious should prompt an ophthalmologic consultation.

Aged↗
PubMed1988

Synchronous bacterial and fungal septicemia. A marker for the critically ill surgical patient.

Mixed septicemia (synchronous fungal and bacterial septicemia) is an occasional, but often fatal occurrence in the critically ill patient. We reviewed 14 such cases at two hospitals. Twelve of 14 patients were in the surgical intensive care unit. Eleven patients had an average of 2.7 major surgical procedures (range 2 to 4); persistent post-operative peritoneal sepsis was common occurring in 9 patients. Bacteremia preceded mixed septicemia in 8 of 14 cases and gram negative enteric bacilli were the most common causes of bacteremia. Fungemia was due to Candida species in 13 of 14 patients and followed prolonged antibiotic therapy. The diagnosis of disseminated candidiasis was suspected during life in 13 patients and proven in six. Mixed septicemia is a marker for a distinct population of critically ill surgical patients with a high overall mortality (78% in this study). Culture of both a fungal and bacterial pathogen in a blood culture, especially if preceded by bacteremia, should alert the physician to strongly suspect disseminated fungal infection and to commence appropriate treatment. Mortality is likely to remain high unless the underlying disease states can be rapidly corrected and infection controlled.

Adult↗
PubMed1987

Septic arthritis of the temporo-mandibular joint--a problematic diagnosis.

A rare case of chronic septic arthritis of the temporo-mandibular joint is described, which presented as a pre-auricular swelling several weeks after a blow to the chin. Although the history indicated an inflammatory process precipitated by trauma, the clinical findings suggested a neoplastic aetiology. The treatment and problems in making an early diagnosis in this condition are discussed.

Aged↗
PubMed1987

Posterior chamber IOL implantation during keratoplasty for aphakic or pseudophakic corneal edema.

Because of their many advantages, posterior chamber (PC) intraocular lenses (IOLs) were sutured to the posterior iris (in the absence of a lens capsule) in combination with penetrating keratoplasty for aphakic and pseudophakic corneal edema in 53 cases. Secondary PC IOL implantations were performed in aphakic corneal edema (nine cases), and IOLs were exchanged for PC IOLs in pseudophakic corneal edema (44 cases). Ninety-six percent of the grafts remained clear. Forty-three percent of the eyes had 20/40 or better visual acuity, 38% between 20/50 and 20/200, and 19% worse than 20/200, with an average follow-up time of 6.4 (range 3-13) months. The most common cause of poor vision was cystoid macular edema present preoperatively in 20 eyes and postoperatively in 22 eyes. Other causes of persistent visual impairment included macular degeneration (five cases), retinal detachment (two cases), preoperative glaucoma damage (one case), severe postoperative glaucoma damage (one case), endophthalmitis (one case), and graft rejection (one case). Our short-term results indicate that this procedure may be a viable alternative to the use of secondary anterior chamber IOL implantation during penetrating keratoplasty.

Aged↗
PubMed1987

Vertical rupture in posterior corneal layers after cataract extraction.

The histopathological description of a 3 mm vertical cut in the posterior layers of a corneal button removed for pseudophakic bullous keratopathy is presented. The corneal complications became clinically evident several weeks after extracapsular cataract extraction with placement of a posterior chamber lens implant. Outstanding histological features were: wall-like elevation of the borders of the cut with swelling of the posterior stromal layers; rolled-in edges of Descemet's membrane; double interruption of Descemet's membrane on one side; regional endothelial atrophy; and total lack of any signs of endothelial regeneration.

Aged↗
PubMed1986

Treatment of experimental Pseudomonas corneal ulcers with enoxacin, a quinolone antibiotic.

Enoxacin is a broad-spectrum quinolone-derivative antibiotic. In a rabbit model of keratitis caused by a Pseudomonas species, enoxacin (3 mg/mL) was as effective as gentamicin sulfate (3 mg/mL) and enoxacin (10 mg/mL) in reducing viable bacterial counts in corneas after 24 hours of hourly therapy with eye drops. Bacterial counts were reduced by about 5000-fold by enoxacin treatment when compared with placebo-treated controls. Penetration studies of topical enoxacin (3 mg/mL) showed that concentrations in cornea and aqueous humor reached levels above reported minimal inhibitory concentrations when an epithelial defect was present. Further investigation of enoxacin for treatment of ocular disease is warranted.

Animals↗
PubMed1986

Retinal detachment following penetrating keratoplasty.

The time-related risk of retinal detachment during the follow-up of 1146 penetrating keratoplasty procedures was evaluated, using survival analysis techniques. Twenty-eight retinal detachments were observed during follow-up. The Kaplan-Meier estimate of the risk of developing retinal detachment increased from 1.5% at three months to 2.1% at one year after surgery. Further follow-up showed a gradual increase in the cumulative proportion developing retinal detachment to 4.7% at 3.5 years after surgery. Of the preoperative and intraoperative factors available for study, performing an anterior vitrectomy during penetrating keratoplasty was associated with a greater risk of postoperative retinal detachment. The outcome of visual acuity following retinal detachment in these patients' eyes was poor; five patients could not perceive light with the affected eye, and 82% (23/28) had visual acuity of 20/200 or less.

Corneal Transplantation↗
PubMed1986

Corneal hydrops in Terrien's marginal degeneration.

We present four cases of Terrien's marginal degeneration that developed spontaneous ruptures in Descemet's membrane resulting in corneal hydrops. In all cases, the hydrops was characterized by a clear intracorneal pocket of aqueous humor rather than by stromal clouding. In two cases, the pocket extended peripherally to form a conjunctival filtering bleb. Although a lamellar corneal patch graft was used in one case for severe astigmatism, hypotony, and impending perforation, most cases were merely observed without treatment.

Adult↗
PubMed1986

Surgical correction of residual facial deformity following treatment of acromegaly.

The features and treatment of acromegaly are described and emphasis placed on the apparent failure of the bone deformities to regress. A method of one stage correction of such residual facial deformity is described and illustrated in a patient with deformities of the mandible, frontal, zygomatic and nasal bones, nine years after hypophysectomy.

Acromegaly↗
PubMed1985

Oversized donor grafts in penetrating keratoplasty. A randomized trial.

One hundred seventy-three aphakic or phakic corneal transplants were analyzed in a prospective randomized study to determine the effect of oversized corneal donor buttons on intraocular pressure, corneal curvature and astigmatism, wound dehiscence, and anterior chamber depth. We compared 93 oversized grafts with 80 same-sized grafts. In aphakic eyes, oversized grafts showed a trend toward lower incidence of elevated intraocular pressure during the early post-operative period and lower prevalence of glaucoma at the final visit, although this was not statistically significant. No such trends were seen in phakic eyes. Postoperative corneal curvature was significantly steeper in oversized than same-sized grafts, in both phakic and aphakic eyes; there was no difference in postoperative astigmatism. Anterior chamber depth was significantly greater in oversized grafts. Of four wound dehiscences, all occurred in same-sized grafts.

Aphakia↗