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Biomedical subjects

D Minassian

Publications and source records attributed to D Minassian.

At least 19 recordsLinked to original sources
PubMed2000

Anterior chamber flare after trabeculectomy and after phacoemulsification.

AIMS: To evaluate and compare prospectively the anterior chamber inflammatory response after phacoemulsification cataract surgery and after trabeculectomy with peripheral iridectomy. METHODS: Anterior chamber inflammation was measured using the Kowa FM-500 laser flare meter in 131 patients undergoing trabeculectomy and 148 patients undergoing phacoemulsification cataract extraction with intraocular lens implantation. Flare was measured before surgery and on each postoperative visit up to 12 months. RESULTS: Before surgery there was no significant difference in flare readings between the two groups. Following trabeculectomy flare returned to baseline levels 4 weeks after surgery, while following phacoemulsification cataract extraction it remained significantly higher at week 6 (p<0.006) and month 3 (p<0.05). CONCLUSIONS: Anterior chamber inflammation is more prolonged after cataract surgery than after trabeculectomy. This may have implications for the timing of trabeculectomy in relation to cataract surgery.

Aged↗
PubMed1999

Risk factors for treatment outcome of suspected microbial keratitis. Ofloxacin Study Group.

BACKGROUND: Primary treatment for suspected microbial keratitis is generally successful. Although risks such as contact lens use are well recognised as causative factors for microbial keratitis, little is known about the risk factors that influence treatment outcome. The present study evaluates the risk factors assessed at diagnosis as prognostic indicators of primary treatment failure. METHODS: Patients were prospectively enrolled in the ofloxacin treatment trial and data concerning symptoms, treatments, past and concurrent eye disease were collected along with the measurement of corneal ulcer size at the slit lamp. All patients were scraped for microbiological investigation, and treated with either ofloxacin (0. 3%) or standard therapy of fortified cefuroxime and gentamicin drops. Treatment success was complete healing of the ulcer with zero dimensions of the epithelial defect within 2 weeks of start of treatment. The important prognostic indicators were selected by comparison among those who failed treatment, had delayed healing, or were culture positive with other patients using univariate and stratified analysis. These were then used in a Poisson model for multiple regression analysis to estimate the relative risk of the main prognostic variables. RESULTS: Of the 118 patients enrolled in the study, 14 were identified as primary treatment failures, 17 had slow healing, and 15 indolent ulcers. There were 49 culture positive patients. The multivariate analysis identified that large culture positive ulcers in patients 60 years or older had 5.5 times the risk of primary treatment failure (p<0.001). Significant predictors of slow healing were previous ocular disease and a positive culture; significant predictors of indolent ulceration were previous ocular disease and steroid use at diagnosis; the main predictor of a culture positive result was ulcer size. CONCLUSIONS: Elderly patients with large ulcers were more likely to be culture positive, fail primary therapy, and require surgical intervention. A positive microbial culture provided prognostic information regardless of the organism isolated. However, this information was of less value for those with small ulcers and for younger patients.

Adolescent↗
PubMed1997

Reduction of trachoma in a sub-Saharan village in absence of a disease control programme.

BACKGROUND: Trachoma is a leading cause of blindness in the developing world and is most prevalent among people who live in poor rural communities in arid locations. METHODS: We analysed the results of surveys of trachoma prevalence in Marakissa, a rural village in The Gambia. These surveys were undertaken in 1959, by the Medical Research Council, and in 1987 and 1996 by the Gambian National Eye Care Programme. FINDINGS: During this 37-year period, the prevalence of active inflammatory trachoma among children aged 0-9 years fell from 65.7 cases per 100 children in 1959 to 2.4 cases per 100 children in 1996. The prevalence also fell dramatically among people of 10-19 years (52.5 to 1.4 per 100) and among people of 20 years and older (36.7 to 0 cases per 100). INTERPRETATION: The dramatic fall in disease occurrence was paralleled by improvements in sanitation, water supply, education, and access to health care in the village. Of particular importance is that the decline in trachoma occurred without any trachoma-specific intervention.

Adolescent↗
PubMed1997

Outcome of psychotherapy among early adolescents after trauma.

OBJECTIVE: The authors evaluated the effectiveness of brief trauma/grief-focused psychotherapy among early adolescents exposed to the 1988 earthquake in Armenia. METHOD: Posttraumatic stress and depressive reactions among treated and not treated subjects were evaluated pre- and postintervention, at 1 1/2 and 3 years after the earthquake, respectively. RESULTS: Severity of posttraumatic stress symptoms significantly decreased among the subjects given psychotherapy, while severity of these symptoms increased significantly among the subjects not treated with psychotherapy. The improvement in posttraumatic stress symptoms was attributable to improvement in all three symptom categories (intrusion, avoidance, and arousal) of posttraumatic stress disorder (PTSD). There was no change in severity of depressive symptoms among subjects given psychotherapy. However, depressive symptoms among subjects not treated with psychotherapy significantly worsened over time. The changes in severity of posttraumatic stress and depressive symptoms were positively correlated within both groups. CONCLUSIONS: The findings demonstrate the efficacy of trauma/grief-focused brief psychotherapy in alleviating PTSD symptoms and preventing the worsening of comorbid depression among early adolescents after a catastrophic disaster. The results support the broad use of such school-based interventions after major disasters and demonstrate the cross-cultural applicability of Western psychotherapeutic approaches.

Adolescent↗
PubMed1994

[Macular drusen. Changes in the retinal pigment epithelium and angiographic characteristics as prognostic markers].

Drusen in the macular area may precede other manifestations of age-related macular disease associated with severe visual loss. To identify fundus changes that might be predictive of advanced age-related maculopathy, we examined 79 patients with drusen for up to 3 years. Fundus photographs and fluorescein angiograms were independently analysed by two readers in a masked fashion using a standardized grading scheme. Fourteen patients (17.7%) developed a new exudative or nonexudative lesion involving the fovea. Delayed choroidal perfusion on the fluorescein angiogram, interpreted as an indicator for diffuse thickening of Bruch's membrane and relative atrophy of the choriocapillaris, was observed in 12 patients, 5 of whom developed geographic atrophy of the retinal pigment epithelium during follow-up (P < 0.009). Additional predictive characteristics included focal hyperpigmentations (P < 0.005) and focal extrafoveal areas of atrophy of the retinal pigment epithelium within 1600 microns of the center of the fovea (P < 0.031). These ocular features allow identification of patients with macular drusen at high risk for the development of complicating macular lesions.

Aged↗
PubMed1993

Risk factors with contact lens related suppurative keratitis.

Risk factors in contact lens related suppurative keratitis were investigated. Over 12 months, sixty contact lens wearers presented with presumed microbial keratitis and 147 presented with presumed sterile keratitis. The control group consisted of contact lens wearers without lens related disorders (n = 507). The relative risk of microbial keratitis for extended wear soft contact lens users were 36.8 times (12.6-107.6) that of rigid gas permeable (RGP) contact lens users; while the relative risk of sterile keratitis among extended wear soft lens users was 4.6 times (2.2-9.9) that of RGP lens users. For daily wear soft contact lens users, the relative risk of microbial keratitis was 4.2 times (1.1-16.0) that of RGP lens wearers; for sterile keratitis the relative risk was 2.3 times (1.3-4.3) greater than RGP contact lens users. A multivariable logistic regression analysis was used to examine associated risk factors for daily and extended wear soft lens users. The type of disinfection system and its frequency of use were associated with both microbial keratitis and sterile keratitis in daily wear users. Duration of overnight wear and gender were associated with microbial keratitis, while a patient's age and socioeconomic class were associated with sterile keratitis. Different relative risks and risk factors for microbial keratitis and sterile keratitis support the use of a clinical definition to differentiate the diseases.

Adult↗
PubMed1992

Evolution of age-related macular degeneration with choroidal perfusion abnormality.

Prolonged choroidal filling on fluorescein angiography in age-related macular degeneration is thought to indicate diffuse thickening of Bruch's membrane. To test the importance of this clinical sign, we reviewed the evolution of disease in eyes of patients with good visual acuity and a readable transit phase of fluorescein angiography at the time of recruitment into a longitudinal study of age-related macular degeneration. Ninety-six eyes satisfied these criteria. Of the 32 eyes with prolonged choroidal filling, 12 (38%) lost two or more lines, of visual acuity by two years, whereas only nine of 64 (14%) eyes with normal choroidal filling did so. The difference was caused by the higher incidence of geographic atrophy in the first group. The proportion of eyes that developed subretinal neovascularization was the same in the two groups, and no pigment epithelial detachments occurred. These findings indicate that this clinical sign has implications concerning visual prognosis in age-related macular degeneration.

Aged↗
PubMed1992

Nonulcerative complications of contact lens wear. Relative risks for different lens types.

A case-control study was used to evaluate the relative risk (RR) of acute contact lens-related disorders. The study sample comprised new patients wearing contact lens presenting at the accident and emergency department at Moorfields Eye Hospital, London, England, in 12 months. Disorders were classified by pathogenesis. Compared with gas-permeable hard contact lenses (the referent), extended-wear soft contact lenses were related to the largest overall RR for any complication (2.7 [95% confidence limits, 1.73, 4.16]), whereas for daily wear soft contact lenses the overall RR was 1.3 (confidence limits, 1.0, 1.72). Relative risks were greatest for extended-wear soft contact lens wearers with metabolic disorders (2.1 [confidence limits, 1.28, 3.4]) and for such wearers with sterile infiltrates (2.4 [confidence limits, 1.22, 4.84]). Among those using daily wear contact lenses, RR was highest for those with toxic/hypersensitivity disorders (5.9 [95% confidence limits, 3.27, 10.49]). Severe complications involving greater morbidity occurred more frequently with extended-wear soft contact lenses. This could be reduced by selecting a more appropriate lens type to correct low refractive errors.

Acute Disease↗
PubMed1992

AgNOR counts in conjunctival malignant melanoma lack prognostic value.

Using a silver staining technique, argyrophilic nucleolar organiser region-associated proteins (AgNORs) have been studied in routinely processed paraffin sections of 46 invasive malignant melanomas (MM) of the conjunctiva. The aim of this retrospective study was to assess the value of the AgNOR method as a prognostic indicator for this neoplasm. The 46 cases were divided into two groups: (A) 14 cases of MM that metastasised and caused death of the patient within 5 years of (histological) diagnosis, and (B) 32 cases of MM that did not metastasise and in which patients survived beyond 5 years. The mean of the AgNOR counts per nucleus was 7.03 (95% CI: 5.81-8.24) in group A, and 7.15 (95% CI: 6.53-7.77) in group B. A comparison using a multifactor analysis of variance (ANOVA) model, which corrected for possible confounding effect of tumour thickness, site, and cell type showed no significant difference in AgNOR counts between groups A and B (p = 0.8). Analysis by the Cox proportional hazards regression model showed that survival was not influenced significantly by the mean AgNOR number (hazard ratio: 0.92). Whereas the AgNOR technique may be used to distinguish benign from malignant melanocytic lesions of the conjunctiva, we conclude it has no value in predicting the outcome for patients with conjunctival MM.

Cell Count↗
PubMed1991

Contact lenses and other risk factors in microbial keratitis.

Microbial keratitis is a potentially binding disease that is rare in normal eyes unless associated with contact lens (CL) wear. To assess the risks of CL use, and other major causes, for keratitis, a case-control study of 91 cases of keratitis including 60 CL users was done. Relative risks (RR) and population attributable risk percentages (PAR%) for keratitis were estimated for different causes and for the different types of CL. The RR (95% confidence intervals) for CL wear was 80 (38-166) and for trauma cases 14 (6-32) compared with cases of keratitis without a predisposing condition. The PAR% for microbial keratitis attributed to CL wear was 65%. The RR for overnight wear soft lenses was 21 (7-60), for daily-wear soft lenses 3.6 (1-14), and for polymethylmethacrylate hard lenses 1.3 (0-9) compared with gas-permeable hard lenses. Continuous periods of CL wear for more than 6 days was associated with increased risk. CL wear is now the commonest cause, and has the highest risk, for new cases of microbial keratitis at Moorfields Eye Hospital. Soft CLs, especially extended-wear lenses, carry a significantly higher risk than do hard lenses for this disease.

Adult↗
PubMed1991

Outcome of cataract surgery in central India: a longitudinal follow-up study.

An epidemiological follow-up study of patients who had intracapsular cataract extraction in a voluntary hospital and its associated eye camps in Central India has for the first time evaluated the outcome one year after surgery in terms of visual acuity, use of spectacles, and improvement in income and mobility. The findings indicate that under these fairly typical conditions, 92% of the cases have adequate vision of 6/18 or better one year after surgery. Information on high usage of spectacles and on considerable improvements in income and mobility after cataract surgery is also reported. The outcome for patients operated upon in eye camps was almost as favourable as for those operated upon in hospital. Although the small differences are not statistically significant, the comparative findings require cautious interpretation and give rise to the epidemiological issues which are briefly discussed in this paper.

Activities of Daily Living↗
PubMed1990

Drusen as risk factors in age-related macular disease.

In a study of 150 consecutive patients with age-related macular disease and unilateral visual loss, the drusen in the better eye were analyzed for size, number, density, and fluorescein angiographic appearance, and these characteristics were compared with the type of the lesion causing visual loss in the contralateral eye. In the fellow eye of an eye with avascular detachment of the retinal pigment epithelium, the drusen were more densely packed, larger, and less fluorescent than in the fellow eye of an eye with primary neovascularization. The characteristics of drusen in fellow eyes of those eyes with pigment epithelial detachments and evidence of subpigment epithelial new vessels were intermediate between the other two groups. Because there is significant symmetry of drusen between fellow eyes, these data imply that the characteristics of drusen are important in the determination of the form of the lesion complicating age-related macular disease.

Aged↗
PubMed1990

Bilaterality of drusen.

The characteristics of drusen in 81 patients with bilateral drusen as a manifestation of age related disease were analysed for symmetry between the two eyes. It was found that there was close concordance with respect to drusen size, number, density, and fluorescence which was greater than would have been expected by chance alone. This finding implies that drusen may result from metabolic malfunction specific to the patient rather than the non-specific result of aging.

Aged↗
PubMed1990

[Drusen and their significance in age related macular degeneration].

In 81 patients with bilateral drusen and 150 patients with unilateral disciform lesions drusen were analyzed with respect to number, size, density and early and late angiographic behavior. In patients with bilateral drusen excellent symmetry was observed for all parameters. Drusen in fellow eyes of patients with avascular pigment epithelium detachments were larger, more confluent and less fluorescent than drusen in fellow eyes of patients with choroidal neovascularization. These results reveal drusen as products of specific metabolic failures of the pigment epithelium rather than unspecific aging changes. These metabolic failures result in specific individual patterns of drusen, which predispose to the development of specific complications of age-related macular degeneration.

Fluorescein Angiography↗
PubMed1989

National survey of blindness and low vision in The Gambia: results.

A population based survey of blindness and eye disease has been conducted throughout the whole country of The Gambia, and 8174 people were examined. The prevalence of blindness (best acuity less than 3/60) was 0.7% and low vision (6/24-3/60) 1.4%. The causes of blindness were cataract (55%), non-trachomatous corneal opacity/phthisis (20%), and trachoma (17%). An estimated 5500 people in The Gambia require cataract surgery, 4600 eyelid surgery for entropion, and 4600 people spectacles to correct a refractive error which causes a visual acuity of less than 6/18. More than half the current burden of blindness in The Gambia is potentially remediable through the provision of cataract surgery and aphakic spectacles.

Adolescent↗