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E J Poulsen

Publications and source records attributed to E J Poulsen.

4 recordsLinked to original sources
PubMed2000

Characteristics and risk factors of infections after glaucoma filtering surgery.

PURPOSE: To define characteristics and potential risk factors of endophthalmitis and blebitis after glaucoma filtering surgery in adults. METHODS: A chart review of all cases of endophthalmitis or blebitis treated at the Duke University Eye Center for 6 years (January 1993 to December 1998) was performed to identify patients with a history of incisional glaucoma surgery. RESULTS: Twenty patients were identified. The filtering bleb was located superiorly in all patients. Blebitis but not endophthalmitis developed in 3 (15%) of 20 patients, and all had visual outcomes of at least 20/25. Endophthalmitis (blebitis and vitritis) occurred in 17 (85%) of 20 patients. Cases of blebitis were treated with topical antibiotics. All cases of endophthalmitis were treated with intravitreal antibiotics, and 3 (18%) of 17 patients also underwent immediate vitrectomy. Initial visual acuity was less than hand motions in 5 (29%) of 17. Final visual acuity was less than 20/200 in only one case of endophthalmitis. In 15 (75%) of 20 patients, the bleb was noted to be thin, avascular, or both. On presentation, 11 (55%) of 20 blebs had Seidel-positive leaks with hypotony. A history of recurrent bleb leaks was documented in 7 (33%) of 20 patients. Pseudophakia was present in 13 (65%) of 20 eyes, and 7 (35%) of 20 had undergone combined cataract and filtering surgery. A prodrome, such as a browache, headache, or external eye inflammation or infection, was documented in previous physician visits in 7 (35%) of 20 patients. No cases occurred in eyes with glaucoma implants. CONCLUSIONS: Patients in whom endophthalmitis develops after trabeculectomy do poorly, even with aggressive medical and surgical intervention. As expected, several patients had thin, avascular, leaking blebs. In addition, hypotony, recurrent bleb leaks, pseudophakia, and more than one filtering surgery may also be associated with blebitis or endophthalmitis after glaucoma filtering surgery. In a surprising number of patients, prodromal signs or symptoms were documented by ophthalmologists days or weeks before the diagnosis of blebitis or endophthalmitis was made.

Adolescent↗
PubMed1997

Comparison of astigmatism after penetrating keratoplasty by experienced cornea surgeons and cornea fellows.

PURPOSE: We compared surgically induced astigmatism after penetrating keratoplasty performed by supervised cornea fellows and experienced cornea surgeons. METHODS: Data were collected by retrospective chart review of 166 cases (166 eyes) of penetrating keratoplasty: 63 performed by two cornea surgeons and 103 by four cornea fellows. Astigmatism was calculated using scalar and vector methods. Vector analysis was performed on 109 of 166 eyes. Two techniques were compared: intraoperative keratometry and suture adjustment and the torque-antitorque running suture technique with no intraoperative keratometry or suture adjustment. RESULTS: Mean surgically induced scalar astigmatism changed from preoperative astigmatism by 3.27 diopters (fellows) and 2.94 diopters (attending surgeons). In 109 cases, surgically induced vector cylinder changed from peroperative astigmatism by 4.21 diopters at 98 degrees (fellows) and 4.25 diopters at 114 degrees (surgeons). Surgically induced vector astigmatism changed from preoperative astigmatism by 4.67 diopters at 93 degrees in the first 6 months (fellows) and by 3.79 diopters at 103 degrees in the second 6 months. Analysis of x-axis and y-axis components of the surgically induced vector cylinder showed that the majority of the astigmatism was induced in the y-axis and that this difference was significant (P < .001) in all comparisons, independent of technique or surgeon group. CONCLUSIONS: Penetrating keratoplasty performed by supervised cornea fellows resulted in similar rates of surgically induced vector astigmatism, surface asymmetry, and surface regularity as that by experienced surgeons. Fellows induced significantly more with-the-rule astigmatism, but this tendency decreased with further training. Penetrating keratoplasty astigmatic outcomes were not significantly different whether or not intraopertive keratometry and suture adjustment were utilized. This study supports the concept that increased experience with corneal transplantation improves the outcome of penetrating keratoplasty by using the criterion of postoperative astigmatism as a measures.

Astigmatism↗
PubMed1996

Keratitis in methamphetamine abusers.

We report four cases of severe corneal ulceration in methamphetamine abusers. Methamphetamine abuse has been increasing in California and may exceed cocaine abuse in some regions. Methamphetamine's extensive physiologic effects, inconsistent street purity, and multiple routes of administration offer many possibilities for injury to the cornea. Potential causes of methamphetamine-related keratitis can be divided into four categories resulting from (a) direct pharmacologic and physical effects of methamphetamine; (b) the toxic effects of diluting or "cutting" agents such as lidocaine and quinine; (c) effects related to the route of drug administration (intravenous, inhalation, smoking); and (d) manufacture-related effects of exposure to unintentional caustic contaminants in the final product. The increasing prevalence of methamphetamine abuse and the severity of the associated ulcers should alert ophthalmologists to the problem of methamphetamine-related keratitis.

Adult↗