Biomedical subjects

C Raitta

Publications and source records attributed to C Raitta.

At least 19 recordsLinked to original sources

PubMed2000

Ophthalmologic findings in Cohen syndrome. A long-term follow-up.

OBJECTIVE: To determine the nature and course of ophthalmologic abnormalities and their clinical significance in Cohen syndrome. STUDY DESIGN: Observational case series. PARTICIPANTS: Twenty-two Cohen syndrome patients aged 2 to 57 years were examined, and a retrospective review of ophthalmologic records was carried out for 14 of them. All but one were part of the Finnish study of refined mapping of the Cohen syndrome gene by linkage disequilibrium in chromosome 8. MAIN OUTCOME MEASURES: Visual acuity (VA), cycloplegic refraction, biomicroscopy, lens opacitometry, ophthalmoscopy, and fundus photography. RESULTS: With the exception of the two youngest patients, all had symptoms such as nyctalopia, impaired vision, and visual field loss. Progressive, often high-grade myopia, astigmatism, and retinochoroidal dystrophy resembling retinitis pigmentosa occurred in all, except for the youngest patients. The earliest fundus changes were pale disc and pale fundus with or without pigment granularity, followed by narrowed vessels, pigment clumps, and bone spiculelike pigment accumulations by 10 to 20 years of age. Pigment deposits increased and approached the posterior pole by 35 to 40 years of age. Patients more than 45 years of age had severe retinochoroidal atrophy. A bull's-eye macula was seen in most patients. Teenagers had peripheral lens opacities, and young adults had early nuclear sclerosis confirmed by lens opacitometry. Older patients also had posterior subcapsular cataracts, iris atrophy, and iridophacodonesis. Vision started to deteriorate at the age of 6 to 10 years, but remained relatively good (VA 0.5-0.1) in most patients until 30 and, in one case, 46 years of age. Older patients were severely visually handicapped (VA hand motion to light perception), but none were completely blind. CONCLUSIONS: Progressive myopia and retinochoroidal dystrophy are essential features in Cohen syndrome and, together with early lens opacities, lead to deterioration of vision. Cohen syndrome patients need careful ophthalmologic follow-up at all ages. Nyctalopia and restricted visual fields should be considered when planning the patient's daily activities.

Adolescent↗

PubMed1999

Optic disc changes in normotensive persons with unilateral exfoliation syndrome: a 3-year follow-up study.

BACKGROUND: If, at the time of glaucoma diagnosis, the intraocular pressure (IOP) is higher and the initial field loss more advanced in glaucomatous eyes with than without exfoliation, the cause of the optic disc damage has been suggested to be the high IOP associated with the exfoliation syndrome (EXS). We decided to investigate whether EXS alone, without the contributory effect of measured raised IOP, is a risk factor for optic nerve damage. METHODS: Twenty-two non-glaucomatous, normotensive persons with clinically unilateral EXS were examined for IOP, visual fields (Octopus G1) and disc topography (Imagenet, Topcon) and followed up for 3 years. RESULTS: At the start, the paired exfoliative (E) and non-exfoliative (NE) eyes did not differ in IOP, disc, rim, or cup areas, or cup volumes. They differed in R/D (rim/disc) radius ratio in the inferior section of the optic disc. During the follow-up period, the IOP increased in the E and the NE eyes, and changes indicative of nerve fiber loss were measured in both eyes. In those (n=14) in whom the IOP in the two eyes was equal throughout the follow-up period, disc changes took place only in the E eye. CONCLUSION: The exfoliative process in itself may be a risk factor for optic disc changes.

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PubMed1999

Biodegradable tube implants in experimental glaucoma surgery in the rabbit.

Although ocular drainage implants are manufactured from biocombatible materials to reduce foreign-body reaction, the formation of excessive scar tissue around the implant is a common cause for implant failure. In this study, the suitability of poly(D, L-lactide-co-glycolide) copolymer, impregnated with an antiproliferative agent retinoic acid, was evaluated as a material for biodegradable tubular implants, as well as the duration and magnitude of the intraocular pressure reduction obtained with the prototype implant. Subconjunctivally placed retinoid-impregnated polymer particles caused a milder inflammatory reaction than plain polymer, and the layer of connective tissue around the material was thinner after the follow-up period of 60 d. In the anterior chamber, the inflammatory response elicited by the material was milder than subconjunctivally. The plain polymer caused a transiently stronger reaction than the retinoid-impregnated polymer, but after 60 d no difference was evident between the two materials. In all operated eyes with the tubular implant, the intraocular pressure was statistically significantly lower (p<0.05) than in control eyes for 9 wk after the operation. The intraocular pressure of the eyes with the retinoid-impregnated implant was statistically significantly lower (p<0.05) than in eyes with a plain polymer implant for up to 7 wk post-operatively. However, the use of retinoid did not prolong the effective functioning time of the implants.

Journal Article↗

PubMed1997

A review of the outcome of trabeculectomy in open-angle glaucoma.

BACKGROUND AND OBJECTIVE: The outcome of trabeculectomy in the treatment of primary open-angle glaucoma and exfoliative glaucoma was reviewed. PATIENTS AND METHODS: The study included 87 consecutive eyes of 87 patients with open-angle glaucoma. The outcome of trabeculectomy was correlated with a biomicroscopic appearance of the filtering bleb. Visual acuity, myopic shift in refraction, and lens opacity measurements were used as indicators for cataract progression. The effect of viscoelastics on complications and short-term outcome was studied in a randomized series of 107 eyes. RESULTS: In a series of 87 eyes, 61% had intraocular pressure (IOP) of less than 22 mm Hg without glaucoma medication 1 year after surgery. After 3 years, the corresponding success rate was 74% in a series of 85 eyes that had preoperative pupillary dilation of 4 mm or more. CONCLUSION: The diffuse filtering bleb type was associated with the greatest decrease in IOP. Unfavorable flap-sized blebs and bleb failures were associated with preoperative treatment with miotics, anterior fistulation, and postoperative hypotony. These patients also tended to be younger. In a randomized, prospective study of 107 eyes, the use of sodium hyaluronate had no significant effect on the incidence of complications or on the short-term outcome. Age 61 years or older, exfoliative glaucoma, postoperative hypotony, and IOP peaks were identified as risk factors for accelerated cataract progression after trabeculectomy.

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PubMed1996

Optic disc topography before and after trabeculectomy in advanced glaucoma.

BACKGROUND AND OBJECTIVE: To analyze changes in the optic disc topography after filtration surgery. PATIENTS AND METHODS: Laser scanning tomography was performed in 10 eyes of 9 patients (mean age 65.6 +/- 8.1 years; age range 55 to 75 years) after a mean follow-up of 3.7 months, and in 8 eyes of 7 patients (mean age 63.1 +/- 7.6 years; age range 55 to 75 years) after a mean follow-up of 13.1 months. RESULTS: Preoperatively, the mean intraocular pressure (IOP) was 24.4 +/- 6.9 mm Hg with maximal medication. Postoperatively at 3.7 months it was 11.0 +/- 2.2 mm Hg, and at l2.1 months it was l3.6 +/- 2.8 mm Hg. An initial reduction in IOP of more than 30 percent at 3.7 months was achieved without medication in all but 1 eye. After 12.1 months, an IOP reduction of more than 30 percent was achieved in 6 of 8 eyes (1 with medication), while 2 eyes had IOP reductions of less than 15 percent (< or = 3 mm Hg) despite medication. In the 6 eyes, the optic disc cup volume showed a decrease of more than 30 percent, while the 2 eyes without marked IOP reductions had slight increases in cup volume. Of the 2 eyes without marked decreases in cup size, 1 had normal-tension glaucoma and 1 experienced an increase in IOP of more than 25 mm Hg during the first postoperative week. CONCLUSION: The postoperative IOP should be kept low enough to permit reversal of optic disc changes.

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PubMed1995

Clinically successful contact transscleral krypton laser cyclophotocoagulation. Long-term histopathologic and immunohistochemical autopsy findings.

OBJECTIVE: To report long-term histopathologic findings 10 months after contact transscleral krypton cyclophotocoagulation. METHODS: The tissue response in a successfully treated eye was analyzed by light microscopy and a panel of 11 antibodies to epithelial, mesenchymal, and inflammatory cells. RESULTS: A 75-year-old man with uncontrolled angle recession glaucoma was treated with transscleral contact krypton cyclophotocoagulation (17 burns, 3.5 J each) 10 months before his death. The intraocular pressure fell from 28 to 17 mm Hg 6 months after therapy. Confluent scars straddled the posterior pars plicata and the anterior pars plana. The ciliary processes were destroyed, but the sclera and zonules were intact. Vimentin and cytokeratin 8 and 18 persisted in the degenerated ciliary epithelium. The inner connective-tissue layer and the ciliary muscle had atrophied, as shown with antibodies to the HNK-1 epitope, desmin, and alpha-smooth-muscle actin. Macrophages with phagocytized pigment and single T cells were present instead. No unusual inflammatory infiltrate was present in the choroid of either eye. CONCLUSIONS: Clinically effective ablation of ciliary processes is achieved with contact krypton laser. Little chronic inflammation and no signs of sympathetic ophthalmia were present. Atrophy of the ciliary muscle may reduce accommodative capacity in younger patients undergoing cyclophotocoagulation.

Actins↗

PubMed1994

Correlation of asymmetry of visual field loss with optic disc topography in normal-tension glaucoma.

OBJECTIVE: To compare the differences in optic disc configuration with different stages of visual field loss in normal-tension glaucoma. DESIGN: Interocular pairwise comparisons. SETTING: Glaucoma clinic of a teaching hospital. PATIENTS: Thirteen patients with normal-tension glaucoma and asymmetric visual field loss of at least 2.5 dB in the mean defect of the visual field indexes. INTERVENTIONS: Areas under the optic disc profiles mapped from values for radial sections of the optic disc measured at intervals of 30 degrees and expressed as percentages of the area of a rectangle were obtained from stereophotographs with a computerized image analysis system. Visual fields were tested with automated perimetry (OCTOPUS), using program G1. MAIN OUTCOME MEASURE: Correlation analyses between the interocular differences in the areas under the optic disc profile and the interocular differences in the visual field indexes. RESULTS: The correlation coefficients between the interocular differences in mean defect and those of the area under the optic disc profile in the superior to temporal sections ranged from -.71 to -.61 (.007 < P < .028). The interocular differences in loss variance correlated with the differences in the area under the optic disc profile in the superior section (r = -.61, P = .0252). CONCLUSION: The differences in visual field loss between the two eyes in normal-tension glaucoma appear mainly to reflect morphometric changes in the superior half of the optic disc.

Aged↗

PubMed1994

Interocular asymmetry of optic disc size and its relevance to visual field loss in normal-tension glaucoma.

We evaluated the relevance of interocular asymmetry of optic disc size to the level of intraocular pressure and the extent of optic disc and visual field changes in normal-tension glaucoma (NTG). Fifty-two eyes of 26 patients with NTG were measured for optic disc topography using a computerized image analysis system (IMAGEnet, Topcon), diurnal intraocular pressure (IOP), and Octopus automated visual field. Of the 26 patients, 22 had interocular asymmetry of the optic disc area of at least 0.01 mm2 and of mean IOP of at least 0.3 mmHg. Of these 22 patients, 8 had the higher mean IOP in the eye with the larger optic disc. In these 8 patients, the visual field defect was significantly more advanced in the eye with the larger optic disc (Wilcoxon signed ranks test, P < 0.05). These findings appear to support the hypothesis that an eye with a large optic disc may be more vulnerable to a rise in IOP.

Adult↗

PubMed1994

Transscleral contact krypton laser cyclophotocoagulation for treatment of glaucoma.

PURPOSE: To evaluate the usefulness of the krypton laser for transscleral contact cyclophotocoagulation. METHODS: Transscleral contact krypton laser cyclophotocoagulation was performed in 62 eyes of 57 patients with therapy-resistant glaucoma. A minimum follow-up for 6 months was obtained for 59 eyes. The krypton laser was delivered via a fiberoptic probe with compression of the sclera by the probe. The energy used was 4 to 5 J per application at the tip of the probe with an exposure time of 10 seconds. RESULTS: The intraocular pressure (IOP) decreased from the baseline mean of 34.8 +/- 11.0 mmHg to 20.4 +/- 8.3 mmHg within 10 days, to 22.6 +/- 12.5 mmHg at 1 month, to 21.3 +/- 11.3 mmHg at 3 months, and to 20.9 +/- 9.1 mmHg at 6 months postoperatively. Intraocular pressures of 8 to 24 mmHg were obtained in 62% of the eyes at 1 month, 60% at 3 months, and 73% at 6 months postoperatively with one or more cyclophotocoagulations but no other hypotensive procedures. The corresponding success rates after 6 months were 82% for eyes in which the procedure was performed to preserve vision and 50% for eyes in which the procedure was performed to relieve pain. No clinical signs of scleral injury or cyclodestruction-related loss of vision were detected. CONCLUSIONS: Krypton laser cyclophotocoagulation appears to be an effective and well-tolerated means of lowering IOP in therapy-resistant glaucoma. An advantage of the method is that standard retinal krypton photocoagulators can be used for the procedure.

Ciliary Body↗

PubMed1994

Interocular differences in optic disc configuration in the unilateral exfoliation syndrome.

Thirty-seven patients with normal visual fields and open angles in both eyes, and lens exfoliation in only one eye, were examined for intraocular pressure, and optic disc topography was determined from stereophotographs of the fundi with the computerized three-dimensional image analyzer. The rim-to-disc radius ratios at intervals of 30 degrees were obtained with the instrument. The mean intraocular pressure of the exfoliative eyes (17.5 +/- 2.9 mmHg) was significantly higher than that of the nonexfoliative eyes (15.9 +/- 2.8 mmHg). In the exfoliative eyes, the mean rim-to-disc radius ratio at the inferior-temporal was significantly smaller, and the higher the intraocular pressure of the exfoliative eye in comparison with that of the nonexfoliative eye, the smaller were the rim-to-disc radius ratios at the inferior-temporal and inferior radii. In the exfoliative eyes, pressure-dependent changes are observable in the inferior and inferior-temporal areas of the optic disc prior to visual field loss.

Aged↗

PubMed1994

A randomized, prospective study on the use of sodium hyaluronate (Healon) in trabeculectomy.

The effect of injecting sodium hyaluronate (Healon) before fistulization in trabeculectomy was investigated in a prospective, randomized study of 107 consecutive eyes. Fifty-two eyes were operated on with the viscoelastic and 55 without. An early postoperative intraocular pressure (IOP) peak of 21 mm Hg or more occurred in 27% of the study eyes versus 17% of the control eyes, an insignificant difference. The mean peak IOPs of the study and the control eyes did not differ significantly (29.8 +/- 9.0 mm Hg versus 32.7 +/- 10.2 mm Hg), nor did the mean IOPs and the need for glaucoma medications 1 month after surgery. Shallow/flat anterior chamber and choroidal detachment were equally frequent in both groups, but hyphema occurred significantly more often in the study group (40%) than in the control group (18%).

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PubMed1993

Peripapillary atrophy in unilateral capsular glaucoma.

Pairwise comparisons of peripapillary crescents and haloes were performed for 56 eyes of 28 patients with early or moderate unilateral capsular glaucoma and no signs of exfoliation in the contralateral eye. The eyes differed highly significantly in rim area, rim/disc area ratio, cup area, and cup volume. They did not differ in disc areas, scleral ring areas, or size of peripapillary crescents. In the nonglaucomatous and glaucomatous eyes a significant correlation existed between the intraocular pressure (IOP) and the area of peripapillary atrophy. The area of peripapillary atrophy was significantly correlated with the damage to the glaucomatous optic nerve head. We concluded that the area of peripapillary atrophy is largely an inborn feature, and that nerve fiber loss can occur without differences in the peripapillary tissues. Nevertheless, an IOP-induced change in the retinal pigment epithelium cannot be ruled out.

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PubMed1992

Dose response and duration of action of dorzolamide, a topical carbonic anhydrase inhibitor.

The multiple-dose, dose-response relationship and duration of action of the novel topical carbonic anhydrase inhibitor dorzolamide (previously known as MK-507) were investigated in a double-masked, randomized, placebo-controlled, parallel study in 73 patients with bilateral primary open angle glaucoma or ocular hypertension. Dorzolamide (0.7%, 1.4%, or 2%) or placebo was administered every 12 hours for 5 days and then every 8 hours for 7 days. Intraocular pressure was investigated with multiple 12-hour diurnal curves. All concentrations of dorzolamide demonstrated substantial lowering of intraocular pressure throughout the day when given twice daily (9% to 21%) or three times daily (14% to 24%). Although a dose-dependent response was observed immediately following the first dose, there were no significant differences between concentrations or dose response at either the twice or three times daily dosing regimen. Three times daily administration of 2% dorzolamide demonstrated a mean percent decrease in intraocular pressure of 18% to 22% throughout the day (mean decrease, 4.5 to 6.1 mm Hg). Dorzolamide appears to have substantial potential in the treatment of glaucoma and ocular hypertension.

Administration, Topical↗

PubMed1992

Electrocardiographic changes in institutionalized geriatric glaucoma patients.

A geriatric study was conducted on 213 institutionalized geriatric glaucoma patients (mean age 83.9 years) and 100 control patients (mean age 81.3 years). A 12-lead electrocardiogram (ECG) analyzed according to the Minnesota code was recorded for 212 glaucoma patients and 95 control patients. The most frequent finding (in 56% of the glaucoma patients and in 38% of the control patients, P less than 0.05) was a negative or isoelectric T-wave, suggestive of ischemic heart disease. ECG findings suggestive of coronary heart disease (Q/QS patterns, ST-segment depression, negative or isoelectric T-wave, third or second degree AV block, left bundle branch block or right bundle branch block, intraventricular block or atrial fibrillation or flutter) was seen significantly more often in glaucoma patients (164/212; 77%) than in the control patients (59/95; 62%). Seventeen percent of the glaucoma patients had atrial fibrillation (AF), which was significantly more than for the control group (8/95; 8%). There was no difference in the number of ECG changes between patients with bilateral open-angle glaucoma and bilateral angle-closure glaucoma. The mean intraocular pressure of patients having AF (15.9 +/- 8 mmHg) was significantly lower than that of the other patients (18.4 +/- 11 mmHg) (P less than 0.05). Fifty-five glaucoma patients were considered blind (visual acuity less than 0.05 in the better eye). The visual acuity of patients having AF was lower than that of the other patients, and severe visual field defects (arcuate scotoma or a residual field in the temporal periphery) occurred, slightly more frequently in patients with AF (in 70% vs 51% of the other patients). Arrhythmias, especially AF, are connected with impairment of visual acuity and visual field defects in glaucoma patients. The result of this retrospective study indicate that ECG changes occur frequently, suggesting coronary heart disease in elderly glaucoma patients.

Aged↗

PubMed1992

Exfoliation syndrome as a risk factor for optic disc changes in nonglaucomatous eyes.

Exfoliation syndrome as a possible risk factor for morphologic changes of the optic nerve was examined in 66 patients with unilateral exfoliation and no glaucoma. K-readings (7.74 +/- 0.3 mm and 7.75 +/- 0.3 mm), axial lengths (23.1 +/- 1.1 mm and 23.1 +/- 1.1 mm), and refraction (+ 0.9 +/- 2.3 mm and + 1.1 +/- 2.3 mm) did not differ in exfoliative and contralateral nonexfoliative eyes. The mean intraocular pressure (IOP) difference, 17.2 +/- 3.3 mmHg and 15.6 +/- 3.2 mmHg, respectively, was statistically highly significant (P < 0.001). The mean visual acuity difference, 0.8 +/- 0.3 and 0.9 +/- 0.2, respectively, was significant (P < 0.05). The difference in visual acuity between the pairs of eyes was explained by the more frequent subcapsular cataract in exfoliative eyes. Lens opacity values (opacity lens meter), 27.9 +/- 8.3 and 28.0 +/- 8.4 opacity units, respectively, were similar. Disc area, neuroretinal rim area, rim/disc ratio, cup area, and cup volume values analyzed with the Imagenet (Topcon) nerve head analyzer did not differ significantly between the eyes. It was concluded that exfoliation as such does not induce optic nerve head changes but indicates a risk factor for elevated IOP and lens opacification.

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PubMed1992

Optic nerve fiber loss in relation to atrial fibrillation and blood pressure.

This study investigates the relationship of atrial fibrillation, systemic blood pressure and nerve fiber loss. 213 institutionalized glaucoma patients (mean age 83.9 years) and 100 control patients (mean age 81.8 years) were examined ophthalmologically and analyzed for blood pressure. A 12-lead electrocardiogram, analyzed according to the Minnesota code, was taken for 212 glaucoma patients and 100 control patients. 17% of the glaucoma patients had atrial fibrillation (AF), which was significantly more than in the control group (8%). Patients with AF had lower systolic blood pressures (mean 146.5 mmHg) than the other patients (mean 153.7 mmHg). Visual acuity (VA) of the patients having AF was lower than that of the other patients. Severe visual field defects occurred more frequently in patients having AF (in 70% v.s. 42%). Patients with severe visual field defects and lower VA had lower systolic blood pressures than the patients with better visual fields and VA. 75% of geriatric glaucoma patients with AF and 64% of geriatric glaucoma patients without AF had intraocular pressures < 18 mmHg. Atrial fibrillation and low systolic blood pressure are connected with impairment of ocular functions of geriatric glaucoma patients.

Aged↗

PubMed1992

The value of visual evoked potentials in optic neuropathy of Graves' disease.

Visual evoked potentials (VEP) were tested in patients with ophthalmopathy (OP) of Graves' disease (GD) before treatment and half-a-year and 5-7 yr after orbital decompression (7 patients) or retrobulbar irradiation (3 patients). Five patients not requiring treatment for OP and 16 healthy subjects served as controls. Treatment of OP was given on clinical grounds including decreased visual acuity (VA) indicating optic neuropathy. Before treatment VA was decreased in 5 out of 19 eyes whereas VEP were abnormal in all. The mean latency at N60 both in the operated (83.1 +/- 21.6 ms) and in the irradiated groups (80.9 +/- 7.0 ms) was significantly different from that in the untreated group (62.6 +/- 8.2 ms; p < 0.001) and the healthy subjects (58.9 +/- 6.3; p < 0.001). At P120 only the latency of the operated group differed significantly from that of the other groups (p < 0.001). There was a relationship between the eye muscle changes seen on CT scans and the ophthalmopathy score (according to the classification of the American Thyroid Association) and the latency both at N60 and P120. A change from a V-shape to a W-shape of the waves occurred more often in the treated patients before therapy than in the other groups. Two patients had multiphase VEP in both eyes which improved after treatment. After adequate clinical response the visual acuity improved in one of the 5 patients with initially depressed VA. VEP, initially abnormal in all, improved in 7 of the 19 eyes (37%) but further deterioration was observed in 8 (42%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Trabeculectomy at the inferior limbus.

Fourteen eyes (12 with open-angle glaucoma and 2 with secondary glaucoma) of 14 patients were operated by trabeculectomy at the inferior limbus. The surgical technique is described and results of 6-12 months follow-up are reported. Complication rate was reasonably low. Early postoperative IOP higher than 30 mmHg occurred in one eye where a blood clot and sodium hyaluronate obstructed filtration of aqueous. Postoperative mean IOP was 16.3 mmHg (6-29 mmHg) in 13 eyes at 3 months, 17.1 mmHg (13-26 mmHg) in 12 eyes at 6 months and 20.1 mmHg (11-31 mmHg) in 12 eyes at 12-16 months. Three eyes had follow-up of 19-21 months and corresponding IOPs were 14, 15 and 22 mmHg. IOP was less than 22 mmHg in 10/12 eyes at 6 months and in 8/12 eyes at 12-16 months. 6/12 eyes managed without medication at 6 months and 2/12 eyes at 12-16 months. Trabeculectomy at inferior limbus is a safe procedure and it is recommended as a surgical procedure in eyes after previous cataract surgery.

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