Biomedical subjects

D O Hodge

Publications and source records attributed to D O Hodge.

At least 55 records · Page 3Linked to original sources

PubMed1999

Pulmonary function monitoring during adenosine myocardial perfusion scintigraphy in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To determine whether adenosine could be safely administered to patients with chronic obstructive pulmonary disease (COPD) for coronary vasodilatation during perfusion scintigraphy without causing bronchospasm. MATERIAL AND METHODS: The study was divided into two phases. In the monitoring phase, patients with COPD were pretreated with an inhaled bronchodilator (albuterol) and had pulmonary function monitored during the infusion of a graduated dose of adenosine. Eligibility for entry into this phase of the study was determined on the basis of results of pulmonary function testing (PFT) during resting. Once we had shown that adenosine could be safely administered to patients with COPD, an implementation phase was begun. Entry did not require resting PFT, and patients were administered adenosine without monitoring of pulmonary function. Differences between patients with normal pulmonary function or mild COPD and those with more severe COPD were analyzed statistically. RESULTS: Of 94 patients entered into the monitoring phase, none had obvious bronchospasm. The dosage of adenosine was reduced in four patients because of a decrease in forced expiratory volume in 1 second (FEV1) of 20% in comparison with baseline (FEV1 before administration of albuterol). The mean FEV1 decreased slightly from 1.83 L after administration of albuterol to 1.78 L during the maximal adenosine dose. Patients with a remote history of asthma, positive result of a methacholine challenge test, or mild COPD (FEV1 60 to 80% of the maximal predicted value for age) did not differ significantly in their response to infusion of adenosine from those with moderate or severe COPD (FEV1 30 to 59% of the maximum predicted for age). Of 117 patients in the implementation phase, 2 had bronchospasm during infusion of adenosine that was quickly terminated by stopping the administration in one patient and reducing the dose of adenosine in the other. CONCLUSION: This study shows that adenosine can be safely administered intravenously to selected patients with known or suspected COPD to produce coronary vasodilatation for myocardial perfusion imaging. Patients who are within the guidelines established for this study should be considered for adenosine coronary vasodilatation with use of bronchodilator pretreatment, a graduated dose of adenosine, and regular chest auscultation during the infusion.

Adenosine↗

PubMed1999

Estimation of corneal endothelial pump function in long-term contact lens wearers.

PURPOSE: To study the effects of long-term contact lens wear on morphologic and physiologic properties of corneal endothelial cells. METHODS: The endothelial permeability to fluorescein and the rate of corneal deswelling from hypoxia-induced edema were measured in 20 long-term (mean, 17+/-9 years; range, 5-33 years) contact lens wearers and 20 age-matched control subjects. From these data, the relative endothelial pump rate in each subject was estimated, based on the pump-leak hypothesis of corneal hydration control. Corneal autofluorescence and the aqueous humor flow rate were determined by fluorescein fluorophotometry. Images of corneal endothelial cells were recorded by using specular microscopy, and morphologic indices (cell density, coefficient of variation of cell area, percentage of hexagonal cells, and skewness) were determined. RESULTS: No statistically significant differences were found between the contact lens and control groups in endothelial permeability, corneal deswelling, relative endothelial pump rate ([mean +/- SD] 1.07+/-0.33 relative pump units versus 1.01+/-0.25 relative pump units; contact lens versus control; P = 0.57), and endothelial cell density. Contact lens wearers had a significantly higher aqueous humor flow rate (3.57+/-1.03 microl/min versus 2.77+/-0.51 microl/min; P = 0.005), coefficient of variation of cell area (0.35+/-0.09 versus 0.28+/-0.04; P = 0.006), and corneal autofluorescence (3.1+/-0.6 ng/ml versus 2.3+/-0.3 ng/ml fluorescein equivalents; P < 0.001) than did non-contact lens wearers. CONCLUSIONS: Despite the known effects of long-term contact lens wear on corneal endothelial morphometry, no effect on endothelial function was found.

Adult↗

PubMed1999

Cell death during corneal storage at 4 degrees C.

PURPOSE: To evaluate cell death in human donor corneas stored at 4 degrees C, to determine whether terminal deoxynucleotidyl transferase-mediated dUTP-fluorescein nick-end labeling (TUNEL) discriminates between apoptosis and necrosis in corneas stored at 4 degrees C. METHODS: Ten human corneas were stored in Optisol (Chiron Ophthalmics, Irvine, CA) at 4 degrees C for periods ranging from 0 to 21 days and then fixed for histologic examination. Central corneal sections from each cornea were examined by transmission electron microscopy (TEM) and by the TUNEL assay. Electron micrographs of at least 15 keratocytes each from the anterior, middle, and posterior stroma were examined by three masked observers who graded each cell as normal, apoptotic, or necrotic. Central sections from the same corneas were processed by the TUNEL assay and evaluated with a laser scanning confocal microscope to determine the percentage of apoptotic cells. RESULTS: By TEM, apoptosis occurred in 23% of the keratocytes and necrosis in 12%. By TUNEL assay, apoptosis occurred in 11% of the keratocytes, with the results in individual corneas being similar to the findings by TEM for apoptosis, rather than for necrosis. By TUNEL assay, apoptosis occurred in 13% of the epithelial cells and in 8% of the endothelial cells. The percentage of apoptotic cells and storage time correlated significantly for the epithelium, but not for the keratocytes or endothelium in this small sample. CONCLUSIONS: Both apoptosis and necrosis occur in cells during corneal storage at 4 degrees C, with apoptosis appearing to predominate. The TUNEL assay identifies cells undergoing apoptosis, but not necrosis, in corneal tissue. Inhibition of apoptosis in corneas stored at 4 degrees C may prolong acceptable storage times.

Adult↗

PubMed1999

Morphologic changes in corneal endothelial cells during 3 years of fluorocarbon contact lens wear.

PURPOSE: To record morphologic changes that occur in corneal endothelial cells during daily wear of rigid, gas-permeable fluorocarbon contact lenses during 3 years. METHODS: Nineteen new wearers and 32 previous wearers were fitted with daily-wear fluorocarbon contact lenses. Photographic images of the central corneal endothelium and central corneal thickness measurements were recorded at baseline, 2 months, and 1, 2, and 3 years after fitting. RESULTS: In the new wearers, an increase in the coefficient of variation of cell area was present by 2 months after lens fitting and increased further over the subsequent 3 years. The increase in coefficient of variation of cell area was correlated with the oxygen transmissibility of the lens. Endothelial cell density was decreased at 2 and 3 years. Corneal thickness did not change. In the previous lens wearers after 3 years, there were no significant changes from baseline in any morphologic value. Corneal thickness was decreased significantly. CONCLUSIONS: Although oxygen transmissibility in fluorocarbon contact lenses is improved over previous hard and soft lenses, polymegethism still was induced within 2 months by these lenses, and morphologic changes present from past lens wear did not improve during 3 years of daily wear.

Adolescent↗

PubMed1998

Prognostic value of a Doppler index combining systolic and diastolic performance in idiopathic-dilated cardiomyopathy.

This study sought to investigate, in patients with idiopathic-dilated cardiomyopathy, the clinical and prognostic value of a Doppler-derived index of myocardial function that combines systolic and diastolic time intervals of the left heart cycle. The Doppler index was measured in 75 patients (aged 61 +/- 13 years; 45 men and 30 women) in sinus rhythm and 75 age- and sex-matched controls. Ejection time was measured from the left ventricular outflow Doppler signal. The sum of isovolumic times was obtained by subtracting the ejection time from the interval between cessation and onset of mitral inflow measured from the mitral inflow velocity profile. The index was the sum of isovolumic times divided by ejection time. The values of the Doppler index in patients with idiopathic-dilated cardiomyopathy (0.85 +/- 0.32) were significantly higher than values in controls (0.37 +/- 0.08, p < 0.001). During follow-up of 5 years, 1 patient underwent cardiac transplantation and 36 patients died, 29 of cardiac, 5 of noncardiac, and 2 of unknown causes. Univariate analysis demonstrated that the Doppler index (chi-square = 18.3, p < 0.001), ejection fraction (chi-square = 15.2, p <0.001), symptom status (chi-square = 9.2, p = 0.002), and mitral deceleration time (chi-square = 5.2, p = 0.02) were significant predictors of outcome. However, multivariate stepwise analysis of these variables showed that the Doppler index (chi-square = 10.7, p = 0.001) and ejection fraction (chi-square = 6.7, p = 0.01) were the most significant independent predictors of outcome. The Doppler index reflects disease severity and has incremental prognostic value in dilated cardiomyopathy. Ease of use, nongeometric dependency, excellent separation of clinical groups, and a strong relation to outcome enhance its appeal.

Aged↗

PubMed1998

Accuracy of single-photon emission computed tomography myocardial perfusion imaging in patients with stents in native coronary arteries.

Strategies to noninvasively evaluate patients after coronary stenting have not been evaluated. To determine the accuracy of single-photon emission computed tomography (SPECT) myocardial perfusion imaging in patients after coronary stenting, 209 patients who had undergone stenting followed by late stress SPECT myocardial perfusion imaging were evaluated. Quantitative coronary angiography was performed in 33 patients following SPECT imaging. SPECT restenosis was defined as a reversible or fixed defect within the stented vascular territory. Angiographic restenosis was examined using 2 definitions: total area narrowing > or =50% or > or =70% of the stent site or stented artery. The SPECT and angiographic findings were concordant in 22 of 33 stented vascular territories using the 50% definition of restenosis and in 29 of 33 stented territories using the 70% definition. Use of the 70% definition of restenosis resulted in improved accuracy of SPECT to detect a significant stenosis in the stented artery. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SPECT were 95%, 73%, 88%, 89%, and 88% respectively. In patients with positive SPECT scans, the most significant stenosis in the stented artery was outside the stent site in 50% of cases. SPECT imaging appears to be accurate to predict significant stenosis in the stented artery, although the most severe stenosis is frequently distant from the stent site.

Case-Control Studies↗

PubMed1998

Twelve-year outcome of patients with an abnormal exercise radionuclide left ventricular angiogram and angiographically insignificant coronary artery disease.

This study examines the long-term prognosis of patients with an abnormal exercise radionuclide angiogram in the absence of significant angiographic coronary artery disease (CAD). In general, patients without significant CAD have an excellent prognosis, but the long-term outcome for the subset of patients with an "ischemic" exercise test is not known. In this study, 161 patients with normal coronary arteries or insignificant CAD (< 50% left main and < 70% left anterior descending, left circumflex, or right), resting left ventricular (LV) ejection fraction > or = 0.50, and an abnormal exercise radionuclide angiogram (LV ejection fraction that decreased with exercise or peak exercise LV ejection fraction < 0.60) were followed for a median duration of 11.3 years. The mean delta LV ejection fraction was -0.07, 98 patients (61%) had a decrease in LV ejection fraction of > or = 5 units, and 40 patients (25%) had peak exercise LV ejection fraction < 0.50. During follow-up there were 19 deaths (only 1 of which was cardiac), 7 nonfatal myocardial infarctions, and 9 revascularization procedures. At 12 years, overall survival was 88%, better than the expected survival for the age- and sex-matched general population. Survival free of cardiac death or myocardial infarction was 94% and survival free of any cardiac event including revascularization was 88%. Thus, patients with an abnormal exercise radionuclide angiogram but without significant CAD have an excellent long-term prognosis.

Coronary Angiography↗

PubMed1998

Usefulness of technetium-99m sestamibi infarct size in predicting posthospital mortality following acute myocardial infarction.

In this multicenter study, 249 patients who underwent tomographic technetium-99m sestamibi infarct size measurement at hospital discharge were followed up for a median duration of 7 months. Infarct size was significantly associated with mortality (chi-square = 5.8, p = 0.02) and could stratify patients into lower and higher risk subsets: 1-year mortality 2% for infarct size < 14% versus 8% for infarct size > or = 14% of the left ventricle.

Aged↗

PubMed1998

Correlation of resting first-pass left ventricular ejection fraction and resting myocardial infarct size.

This study determined the correlation between the extent of the resting perfusion defect by technetium-99m sestamibi tomographic imaging and the first-pass left ventricular (LV) ejection fraction (EF). A total of 1,955 patients underwent technetium-99m sestamibi tomographic imaging with measurement of first-pass resting LVEF. Twenty-five percent of patients had a prior history of myocardial infarction. First-pass LVEF was measured using a peripheral intravenous injection and a multicrystal gamma camera with standard software. Resting tomographic perfusion defect size (infarct size) was quantitated using previously published methods. Mean LVEF for the study group was 0.60 +/- 0.11. Mean LV infarct size was 5 +/- 11%. For the 1,265 patients (65% of the study group) with no measurable perfusion defect, the prevalence of a normal (> or = 0.50) LVEF was 96% (1,212 of 1,265 patients). For patients with a measurable defect (n = 690, 35%), the inverse linear correlation with LVEF was highly significant (r = -0.60, p <0.0001) but with wide confidence limits (SEE = 10 LVEF points), thereby limiting the predictive value in individual patients. Thus, in the absence of known cardiomyopathy, valvular heart disease, or left bundle branch block, patients without a quantifiable resting perfusion defect are highly likely to have a normal resting LVEF and may not require determination of LV function. For patients with resting perfusion defects, LVEF cannot be predicted with confidence and should therefore be measured.

Aged↗

PubMed1998

Prognostic value of exercise thallium-201 imaging performed within 2 years of coronary artery bypass graft surgery.

OBJECTIVES: We sought to determine the prognostic capabilities of exercise thallium (Tl)-201 tomographic imaging performed relatively early (within 2 years) after coronary artery bypass graft surgery (CABG). BACKGROUND: Exercise testing is commonly performed after CABG, but few data exist demonstrating its prognostic value in this setting. METHODS: Four hundred eleven patients were followed up for a median duration of 5.8 years. Eleven prospectively chosen clinical, exercise and Tl-201 variables were tested for their associations with outcome end points by means of proportional hazards regression models. RESULTS: During follow-up there were 60 deaths from any cause, 53 initial cardiac deaths or nonfatal myocardial infarctions (MIs) and 22 late (>3 months after the Tl-201 study) revascularization procedures. The number of abnormal Tl-201 segments on the postexercise image was the only variable in the multivariate analyses to show a significant association with all three outcome end points: chi-square 7.3, p = 0.007 for overall mortality; chi-square 8.1, p = 0.004 for cardiac death or MI; chi-square 7.8, p = 0.005 for any cardiac event. Other independent predictors of outcome were exercise duration (chi-square 10.7, p = 0.001) and age (chi-square 3.9, p = 0.049) for overall mortality and exercise angina score (chi-square 8.7, p = 0.003) for cardiac death or MI. The 5-year survival rate free of cardiac death or MI was 93% for patients without angina and a normal image or small postexercise perfusion defect versus 71% for patients with angina and a medium or large defect. CONCLUSIONS: Exercise Tl-201 imaging performed within 2 years of CABG can stratify patients into low and high risk subgroups.

Aged↗

PubMed1998

Prognostic value of exercise thallium-201 imaging in a community population.

BACKGROUND: The prognostic value of exercise thallium-201 imaging has been well established in referral patient populations at tertiary care centers, but these results may be influenced by referral bias. METHODS: This study was performed to evaluate the prognostic value of thallium imaging in a community-based population of 446 residents of Olmsted County, Minn. Eleven variables were prospectively selected and tested for their associations with outcome end points. RESULTS: Four variables (age, history of myocardial infarction, number of abnormal thallium segments on the postexercise images, and increased thallium lung uptake) contained the most independent prognostic information. For the end point overall mortality rate, the multivariate chi-square values were 17.2 (p < 0.0001) for age and 20.9 (p < 0.0001) for the number of abnormal thallium segments on the postexercise images. Five-year survival rate for patients older than the median age of 59 years with an abnormal scan was 84% versus 97% for patients < or = 59 years of age with a normal scan. CONCLUSION: Exercise thallium imaging was useful for prognostic purposes in this relatively low-risk community population, confirming the findings of referral population studies.

Adult↗

PubMed1998

Second nonocular tumors in survivors of heritable retinoblastoma and prior radiation therapy.

PURPOSE: The principal objectives of this study were to estimate the incidence of second tumors among children treated for heritable retinoblastoma during a 50-year period and to investigate the relationship between these tumors and previous radiation therapy. METHODS: The records of all retinoblastoma patients examined at the Mayo Clinic from 1941 through 1990 were retrospectively reviewed. The therapeutic modality used to manage the tumor, the occurrence of any second malignancy, and current follow-up on all patients were evaluated. RESULTS: Eighty-two (46%) of 180 children with retinoblastoma had bilateral tumors (76 patients) or unilateral disease and a positive family history (six patients) and were followed for an average of 21.8 years (range, 1 month to 53 years). The Kaplan-Meier estimates of second nonocular tumors among the 82 patients with heritable retinoblastoma were 12% at 10 years, 16% at 25 years, and 30% at 40 years. Although 14 of the 15 patients who developed second malignancies had received radiation therapy, only four of the malignancies occurred within the field of irradiation. CONCLUSIONS: The relatively low incidence of second tumors among long-term survivors of heritable retinoblastoma in this series of patients occurred predominantly outside the field of irradiation. The variable incidence of second nonocular malignancies in previous reports may reflect variations in radiation technique and dosage.

Brachytherapy↗

PubMed1998

Long-term outcome of patients who undergo tonometry as part of a general physical examination.

OBJECTIVE: To determine the value of including tonometry as part of a general physical examination. MATERIAL AND METHODS: Between Feb. 14, 1977, and Dec. 31, 1980, 849 residents of Rochester, Minnesota, underwent measurement of intraocular pressure by trained ophthalmic technicians at the request of a nonophthalmologist physician as part of a general physical examination. In 1995 and 1996, these cases were reviewed to determine how many patients in this study cohort had subsequently been diagnosed as having glaucoma. The outcome was derived from the examination of medical records and from the responses to mailed questionnaires and telephone interviews with study patients and their physicians. RESULTS: In patients whose intraocular pressures were less than 16 mmHg at baseline, the risk of being diagnosed as having glaucoma within 10 years was 1% (95% confidence interval [CI], 0 to 2%) and within 15 years was 2% (95% CI, 0 to 4%). In patients whose pressure in the higher-pressure eye was 16 to 21 mmHg at baseline, the risk of having glaucoma in 10 years was 3% (95% CI, 2 to 5%) and in 15 years was 5% (95% CI, 3 to 7%). Twenty-four patients were found at baseline to have an intraocular pressure of 22 mmHg or higher in at least one eye or a difference of 5 mmHg or more between the two eyes. In this group, the risk of having glaucoma in 10 years was 17% (95% CI, 0 to 31%) and in 15 years was 26% (95% CI, 6 to 43%). CONCLUSION: When included as part of a general physical examination of older persons, tonometry and a few simple questions provide information that can be used to help the clinician determine the advisability of more detailed ophthalmic examinations.

Adult↗

PubMed1998

Clinical determinants of hemodynamic and symptomatic responses in 2,000 patients during adenosine scintigraphy.

OBJECTIVE: To determine whether subsets of patients referred for a clinically indicated radionuclide adenosine stress study respond differently to a standard infusion of adenosine. MATERIAL AND METHODS: We assessed multiple clinical and hemodynamic variables in the first 2,000 patients who underwent adenosine perfusion studies in our laboratory. A relevant clinical variable was defined as one that was significantly associated with changes in heart rate and blood pressure during adenosine infusion. Relevant clinical variables that were most significantly related to hemodynamic variables included age, gender, rhythm (atrial fibrillation), diabetes, and left ventricular function. These variables were then related to symptomatic responses (adverse effects) to adenosine infusion. To determine whether the different peripheral responses to adenosine reflected clinically important differences in coronary vasodilatation, we compared perfusion imaging with coronary angiographic findings in the 408 patients who underwent both studies within 6 months of each other. RESULTS: The decrease in systolic blood pressure was greater and the reflex tachycardia was less in patients 70 years of age or older and in those with insulin-dependent diabetes in comparison with younger patients and those without type 1 diabetes. Men had smaller decreases in blood pressure and smaller increases in heart rate than did women. Patients with atrial fibrillation and those with left ventricular ejection fraction less than 40% had smaller decreases in blood pressure and smaller increases in heart rate than did those in sinus rhythm or those with an ejection fraction of 40% or more. Age 70 years or older, male gender, atrial fibrillation, and left ventricular ejection fraction less than 40% were associated with fewer symptoms and less severe chest pain in comparison with patients without these variables. For patients with coronary angiograms, the relationship between coronary artery disease evident on angiography and perfusion abnormalities noted on scintigraphy was not different for any of the relevant clinical variables. CONCLUSION: Common clinical patient subsets are associated with different peripheral hemodynamic and symptomatic responses to infusion of adenosine. Despite these observations, however, the ability to detect coronary artery disease with perfusion imaging is not obviously altered.

Adenosine↗

PubMed1998

Advanced multiple beam equalization radiography: receiver operating characteristic comparison with screen-film chest radiography.

OBJECTIVE: To test the hypothesis that the advanced multiple beam equalization radiography (AMBER) imaging system is superior to conventional chest radiography in the demonstration of diffuse infiltrative lung disease, emphysema, pulmonary nodules, calcification within nodules, and mediastinal or hilar masses and lymphadenopathy. MATERIAL AND METHODS: The study involved 115 patients, each of whom underwent chest computed tomography (CT), AMBER, posteroanterior chest radiography, and conventional posteroanterior stereoscopic chest radiography (two films). All radiographs were obtained with the InSight Thoracic Imaging System. Four chest radiologists independently analyzed the 115 AMBER studies, 115 unpaired single conventional radiographs (a single film from a stereoscopic pair), and 115 stereoscopic conventional radiographs (2 films) for the presence of diffuse infiltrative lung disease, emphysema, pulmonary nodules, calcification within nodules, and mediastinal or hilar masses and lymphadenopathy. For each abnormality detected, the radiologists described their level of confidence based on a scale of 1 to 5. The 115 CT examinations were interpreted by consensus among 3 of the chest radiologists. The CT results were considered the standard. Receiver operating characteristic (ROC) techniques were used for statistical analysis. RESULTS: No statistically significant differences were found with ROC techniques between the AMBER system and single or stereoscopic conventional screen-film radiography for the abnormalities studied. CONCLUSION: We noted no clinically significant difference between AMBER and either single or stereoscopic conventional screen-film radiography in this prospective study of 115 patients in which CT (performed within 1 week of both radiographic examinations) was the standard.

Humans↗

PubMed1998

Ten-year postoperative results of penetrating keratoplasty.

OBJECTIVE: To investigate the changes in central corneal endothelial cells and corneal thickness in transplanted corneas from 5 to 10 years after grafting. This study also aimed to investigate the development of glaucoma, graft rejection, and graft failure during the first 10 postoperative years. DESIGN/PARTICIPANTS: Longitudinal cohort study of 500 consecutive penetrating keratoplasties by 1 surgeon. Patients were asked to return for follow-up examinations at 2 months and at 1, 3, 5, and 10 years after grafting. The authors excluded eyes regrafted during the study and the fellow eyes of bilateral cases, leaving 394 grafts in 394 patients for analysis. INTERVENTION: Penetrating keratoplasty was performed. MAIN OUTCOME MEASURES: Using specular microscopy, the authors measured endothelial cell density, coefficient of variation of cell area, percentage of hexagonal cells, and corneal thickness. The authors performed clinical examinations to determine graft rejection or failure and the development of glaucoma. RESULTS: By 10 years postkeratoplasty, 80 of the 394 patients had died and 68 grafts had failed. Of the remaining 246 patients, 119 (48%) returned for their 10-year examinations. For the 72 patients who returned for all of the scheduled postoperative visits and had no rejection episodes, reoperations, or failure, endothelial cell loss from preoperative donor levels at 10 years was 67 +/- 18% (mean +/- standard deviation), endothelial cell density was 958 +/- 471 cells/mm2, coefficient of variation was 0.32 +/- 0.11, hexagonal cells were 56 +/- 12%, and corneal thickness was 0.58 +/- 0.05 mm. The 5- to 10-year changes for all these values were significant (P < or = 0.004). The mean rate of late endothelial cell loss from 5 to 10 years postkeratoplasty was 4.2% per year. Eyes that were aphakic after grafting had the lowest endothelial cell loss (57 +/- 24%) and the lowest interval cell loss from 5 to 10 years postkeratoplasty (4 +/- 19%). Eyes that were phakic had the highest endothelial cell loss (73 +/- 8%) and 5- to 10-year-interval cell loss (17 +/- 31%). Eyes with posterior chamber lenses had a greater endothelial cell loss (71 +/- 9%) than did eyes with anterior chamber lenses (51 +/- 25%, P = 0.03). The 10-year cumulative risk of glaucoma, rejection, or failure was 21%, 21%, and 22%, respectively. Late endothelial failure became the major cause for graft failure, accounting for 9 of the 11 failures after 5 postoperative years. CONCLUSIONS: From 5 to 10 years after penetrating keratoplasty, the annual rate of endothelial cell loss was seven times the normal rate. The endothelial cell loss, pleomorphism, polymegethism, and corneal thickness increased significantly during this time, indicating continued endothelial instability and dysfunction, resulting in an increasing rate of late endothelial failure.

Adolescent↗

PubMed1998

The probability of blindness from open-angle glaucoma.

OBJECTIVE: This study aimed to determine the probability of a patient developing legal blindness in either one or both eyes from newly diagnosed and treated open-angle glaucoma (OAG) after starting medical or surgical therapy or both. DESIGN: The study design was a retrospective, community-based descriptive study. PARTICIPANTS: Two hundred ninety-five residents of Olmsted County, Minnesota, newly diagnosed with, and treated for, OAG between 1965 and 1980 with a mean follow-up of 15 years (standard deviation +/- 8 years) participated. INTERVENTION: Kaplan-Meier cumulative probability of blindness was estimated for patients treated and followed for OAG. MAIN OUTCOME MEASURES: Legal blindness, defined as a corrected visual acuity of 20/200 or worse, and/or visual field constricted to 20 degrees or less in its widest diameter with the Goldmann 1114e test object or its equivalent on automated perimetry, secondary to glaucomatous loss, was measured. RESULTS: At 20-years' follow-up, the Kaplan-Meier cumulative probability of glaucoma-related blindness in at least one eye was estimated to be 27% (95% confidence interval, 20%-33%), and for both eyes, it was estimated to be 9% (95% confidence interval, 5%-14%). At the time of diagnosis, 15 patients were blind in at least 1 eye from OAG. CONCLUSION: A retrospective study of a white population determined that the risk of blindness from newly diagnosed and treated OAG may be considerable.

Aged↗

PubMed1998

Congenital esotropia in Olmsted County, Minnesota.

OBJECTIVE: To determine the birth prevalence of and risk factors associated with congenital esotropia. DESIGN: Population-based prevalence study with nested case-control study. PARTICIPANTS: All residents of Olmsted County, Minnesota who were diagnosed with congenital esotropia and born between January 1, 1980 and December 31, 1989 (n = 47). Control subjects were chosen by selecting the next two sequential births to parents residing in Olmsted County, Minnesota (n = 94). METHODS: Cases were identified through the Medical Diagnostic Index of Mayo and the Rochester Epidemiology Project. The community medical records were reviewed to confirm case status and ascertain risk factor information. MAIN OUTCOME MEASURE: Birth prevalence of congenital esotropia. RESULTS: Forty-seven cases were identified from 17,536 live births, for a birth prevalence of 27 per 10,000 (95% confidence interval [CI], 20-35). Congenital esotropia was associated with prematurity (odds ratio [OR], 11.5; 95% CI, 3.4-39.2), a birth weight less than 2500 grams (OR, 4.6; 95% CI, 1.7-12.9), a low Apgar score at 1 minute (OR, 4.3; 95% CI, 1.7-11.2) and at 5 minutes (OR, 6.3; 95% CI, 1.3-30.7), and a family history of strabismus (OR, 3.5; 95% CI, 1.5-8.3). CONCLUSIONS: The birth prevalence of congenital esotropia in Olmsted County, Minnesota is lower than previous estimates. Prematurity, low birth weight, low Apgar scores, and a family history of strabismus are significant risk factors for congenital esotropia.

Apgar Score↗