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Biomedical subjects

C E Hugkulstone

Publications and source records attributed to C E Hugkulstone.

At least 19 recordsLinked to original sources
PubMed2000

Single injection peribulbar anaesthesia. Total upper eyelid drop as an end-point marker.

A prospective, observer blinded study on 51 patients undergoing cataract surgery was conducted to assess Total Upper Eyelid Drop as a new end-point marker to single injection peribulbar block. At present, no such clinical marker exists to stop clinicians injecting more than necessary volumes of local anaesthetic and therefore to prevent dangerous increases in intra-ocular pressure. Using this technique, satisfactory ocular akinesia was achieved in 90% of eyes 10 min after injection. Operating conditions were satisfactory in 98% of cases. The mean (range) volume injected was 9.1 (4-15) ml. The mean increase in intra-ocular pressure immediately after injection was 6.9 mmHg, decreasing to 0.7 mmHg after 5 min without the application of ocular compression. We found a negative correlation between the increase in intra-ocular pressure and the volume of injection (p < 0.002), which has never previously been reported. We conclude that Total Upper Eyelid Drop is a reliable endpoint marker for producing satisfactory operating conditions for cataract surgery while minimising increases in intra-ocular pressure and its use may therefore avoid the risks associated with ocular compression.

Aged↗
PubMed1999

Suction posterior capsulorhexis.

A technique for creating a posterior capsulorhexis during phacoemulsification is presented. It can be used in cases with posterior capsule tears or opacities. The free edge of the capsule is grasped with suction using a 2 mL syringe and a 27 gauge Rycroft cannula introduced via the paracentesis. The edge is then manipulated to produce a continuous curvilinear opening in the posterior capsule. The combination of a closed eye plus the use of a viscoelastic agent in the anterior chamber and capsular bag minimizes the possibility of vitreous prolapse during the maneuver. Occlusion of the cannula tip by the posterior capsule reduces the risk of vitreous aspiration. In-the-bag intraocular lens implantation is readily achieved.

Capsulorhexis↗
PubMed1999

The effect of fluorescein on the accuracy of blood glucose determination by glucose meters.

PURPOSE: To investigate whether intravenous fluorescein significantly affected the accuracy of a glucose meter. METHODS: Thirty-four consecutive patients undergoing fluorescein angiography were recruited. Venous blood was removed immediately before and 1 hour after injection of 5 mls of 20% Sodium Fluorescein solution (1 mg). Whole blood glucose was measured with a glucose meter and plasma glucose levels were measured by the Department of Biochemistry for both samples. The results were analysed using Wilcoxon matched pairs test. RESULTS: Mean glucose results before fluorescein injection were 7.4 mmol/l (SD 4.5) with the glucose meter and 8.1 mmol/l (SD 5.0) biochemically (p=0.02). The post dose levels were 7.2 mmol/l (SD 4.7) and 8.5 mmol/l (SD 4.8), respectively (p=0.001). The difference between the mean results of the two tests was 0.7 mmol/l before fluorescein and 1.3 mmol/l after fluorescein (p=0.001) CONCLUSION: Intravenous fluorescein appears to influence minimally the difference between glucose levels measured in the laboratory and by glucose meter. The degree of difference, whilst achieving statistical significance, should not affect insulin dosage clinically.

Adult↗
PubMed1997

The effect of heparin-coated intraocular lenses on intraocular pressure following combined trabeculectomy and cataract surgery.

PURPOSE: To review the effects on intraocular pressure control of the use of standard and heparin-coated intraocular lenses (IOLs) following combined cataract and glaucoma surgery after a minimum period of 2 years. METHODS: Case note review of all patients with glaucoma who required cataract extraction combined with trabeculectomy and who were randomized to either of the two IOL types. The number of ocular hypotensive medications and the intraocular pressures were recorded pre-operatively and at 3, 6, 18 and 24 months following surgery. RESULTS: The two groups (9 receiving standard IOLs and 10 heparin-coated IOLs) were comparable for age, sex and follow-up, as were the pre-operative intraocular pressures and number of treatments. Post-operatively, all patients achieved an intraocular pressure < 21 mmHg at the final visit, with only one patient in each group requiring topical medication, but the standard lens group had a higher intraocular pressure at 2 years (p<0.05). The magnitude of the fall from the pre-operative values was greater in the heparin-coated lens group at 2 years after surgery (p<0.02). The presence of a visible drainage bleb occurred equally frequently in the two groups. CONCLUSIONS: Use of a heparin-coated IOL does not adversely affect the intraocular pressure control following combined cataract and drainage surgery. The greater fall in intraocular pressure at 2 years in those receiving a heparin-coated IOL may have occurred by chance.

Aged↗
PubMed1996

Endoscopic holmium:YAG laser dacryocystorhinostomy.

The early results of the first 50 primary endonasal laser dacryocystorhinostomies in 49 patients performed with the holmium:YAG laser are presented. Overall, 35 (70%) were successful in relieving symptoms of nasolacrimal obstruction after a mean follow-up period of 4 months. This improved to 79% in the subgroup of patients who underwent intubation of the naso-lacrimal system. These results were similar to the results of a retrospective study of 67 patients undergoing conventional dacryocystorhinostomy in our unit. Conventional surgery was performed under general anaesthesia in all but 1 case and all were treated as inpatients, with a mean hospital stay of 2.3 days, whereas all but 1 of the laser group had their surgery under local anaesthesia and 46 operations (94%) were performed as an outpatient procedure. Surgery was significantly quicker with the endonasal laser technique and 90% of patients questioned found this technique to be entirely acceptable.

Aged↗
PubMed1996

Low-dose perioperative 5-fluorouracil in trabeculectomy.

BACKGROUND AND OBJECTIVES: 5-Fluorouracil (5-FU) has been used to improve the outcome of trabeculectomy in high-risk cases, employing a postoperative regimen of subconjunctival injections. In light of recent laboratory evidence of the use of perioperative exposure to 5-FU, the authors investigated the outcome of this approach in their patients. PATIENTS AND METHODS: Twenty-three eyes of 21 patients who underwent trabeculectomy with a perioperative application of low-dose (25 mg/ml) 5-FU, with a minimum follow-up of 1 year, were reviewed retrospectively. RESULTS: At 1 year postoperatively, 15 (65%) of the eyes had an intraocular pressure (IOP) of less than 21 mm Hg without treatment and 3 (13%) of the eyes achieved the same IOP with the same number of or fewer medications compared with on admission. The outright successful patients had a significantly shorter disease duration than the remaining patients (P < .05), despite having used a similar number of treatments on admission, and also had a significantly lower mean number of indications for antimetabolite use (P < .02). Few complications attributable to 5-FU were noted. CONCLUSION: This route of administration appears to be safe and effective in patients requiring trabeculectomy who are not at a high risk for failure.

Antimetabolites↗
PubMed1994

Congenital hypertrophy of the retinal pigment epithelium and mandibular osteomata as markers in familial colorectal cancer.

Congenital hypertrophy of the retinal pigment epithelium (CHRPE) and multiple mandibular osteomata are markers of familial adenomatous polyposis (FAP). We have assessed their prevalence in non-polyposis familial colorectal neoplasia. Multiple mandibular osteomata were present in 1/29 (3%) patients with familial colorectal neoplasia. CHRPE was present in 11/33 (33%) patients with familial colorectal neoplasia compared with 3/36 (8%) with sporadic disease (P = 0.01) and 4/32 (12.5%) control subjects (P = 0.04). Seven patients with familial colorectal neoplasia had multiple areas of CHRPE compared with one with sporadic disease (P = 0.02) and one control subject (P = 0.02). There was no obvious correlation between calculated familial colorectal cancer risk and the presence of multiple areas of CHRPE. A proportion of patients with familial colorectal cancer have a marker found in FAP and may therefore have a constitutional genetic defect, at least in part responsible for their cancer, making them an interesting group for genetic study. Ophthalmoscopy may contribute to risk assessment in familial colorectal cancer.

Adult↗
PubMed1994

Simultaneous bilateral trabeculectomy.

In a retrospective study, 24 patients who had undergone simultaneous bilateral trabeculectomy over a 6-year period were reviewed. The duration of disease was at least 2 years, indicating that surgery was not performed as a primary procedure. No patients suffered complications leading to bilateral blindness, although 6 (25%) patients had reduced vision in both eyes at the first postoperative visit, with 3 (13%) worse than 6/36 binocularly. There was no evidence of an asymmetric response in the fall in intraocular pressure following trabeculectomy, after a mean follow-up of over 3 years. Compared with a matched group of patients undergoing unilateral trabeculectomy, the simultaneous bilateral group had a similar period of hospital stay. However, this was no shorter than that found in a group having staged bilateral surgery during the same admission, over the same study period. When separate admissions were required for bilateral drainage operations, though, there was a significant increase in the total length of inpatient stay. No convincing advantage was found for simultaneous bilateral trabeculectomy.

Aged↗
PubMed1994

Argon laser suture lysis with different suture materials. An experimental study.

In an in vitro study, 10/0 nylon was found to require a significantly lower laser energy density to produce suture lysis following a single shot than either 10/0 Dacron or 10/0 prolene. Nylon and Dacron monofilament sutures ruptured at reproducible energy levels without significant observable changes at subthreshold irradiation. Prolene, however, was observed to stretch at energy levels below the lysis threshold, under the standard tension produced by a weight of 0.36 (SD 0.02) g. This feature may be of value when performing laser treatment to trabeculectomy flap sutures in the early postoperative period.

Lasers↗
PubMed1993

Trabeculectomy in diabetic patients with glaucoma.

Forty-one eyes of 41 patients with diabetes mellitus who underwent trabeculectomy over a 4-year period were compared with 41 age- and sex-matched controls, who were also matched for date of operation and surgical technique. The two groups were comparable for glaucoma diagnoses, duration of glaucoma before admission and number of ocular hypotensive medications. The intraocular pressures at diagnosis and on admission were similar. Post-operative complications were equally frequent. The mean intraocular pressure at 6 months was significantly lower in the control group, and fewer diabetic patients achieved either an intraocular pressure < 21 mmHg or successful drainage (defined as an intraocular pressure < 21 mmHg on no treatment) at 6 months and at the final visit, after similar periods of follow-up. Trabeculectomy in diabetic patients with pre-existing retinopathy resulted in a significantly higher intraocular pressure at 6 months than when no retinopathy was present.

Aged↗
PubMed1993

Two-year follow-up of intra-ocular pressure control with long duration argon laser trabeculoplasty.

The two-year results of intra-ocular pressure control in the first prospective study of standard (0.1 second) and long (0.2 second) duration argon laser trabeculoplasty are presented. The two groups were comparable for intra-ocular pressures and treatment scores at the start of the study. An early benefit in intra-ocular pressure reduction was found for 0.2 second trabeculoplasty in the first year, which disappeared during the second-ond year of follow-up. No reduction in medications occurred following laser trabeculoplasty. There was no difference in the frequency of further interventions (repeat trabeculoplasty or drainage surgery) between the two groups. There was a strong correlation between the intra-ocular pressures of the first and second treated eyes. No clinical benefit was demonstrated for the longer duration over standard argon laser trabeculoplasty.

Aged↗
PubMed1992

Blue versus white stimuli in ocular hypertension with the Friedmann Mark 1 Visual Field Analyser.

Fifty eyes of fifty patients with ocular hypertension had their visual fields tested on a Friedmann Mark 1 field analyser whilst wearing a Wratten 47B blue filter in a spectacle frame. All had normal visual fields to a white stimulus. Use of a scoring system with the blue field identified 11 patients (22%) with ocular hypertension as abnormal. The scores from this subgroup were indistinguishable from a group of subjects with early glaucomatous field loss, whilst the remaining scores were similar to normal subjects. These two subgroups of ocular hypertensive patients were similar in age and intraocular pressure. The use of a blue filter in front of the eye may offer a simple test to identify a subgroup of patients with ocular hypertension who are at increased risk of developing field loss.

Color↗
PubMed1992

Use of a bandage contact lens in perforating injuries of the cornea.

Four cases of perforating corneal injuries as a result of work-related injuries are presented. All were managed with a bandage contact lens and surgical intervention was avoided. Topical pilocarpine was used to free incarcerated iris in two cases. All patients received a course of broad-spectrum systemic antibiotics, and also used topical preservative-free chloramphenicol for the duration of contact lens wear. No lens related complications occurred. Final unaided visual acuities were the same or better than at presentation.

Adult↗