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Biomedical subjects

E L Greve

Publications and source records attributed to E L Greve.

At least 19 recordsLinked to original sources
PubMed1992

Astigmatism following cataract surgery: comparison of a scleral and a corneal incision in a mixed group of patients with and without glaucoma.

We retrospectively analysed the course of postoperative corneal astigmatism and corrected visual acuity after extracapsular cataract extraction and posterior chamber lens implantation with either a corneal or a scleral incision in 170 eyes of 155 patients with and without glaucoma. A continuous 10/0 nylon shoelace suture was used for wound closure in two groups. In a third group, corneal wound closure was performed with a shorter shoelace suture in combination with two vicryl wing sutures at 11 and 1 o'clock. Although early postoperative mean astigmatism in eyes operated through a corneal incision was high (range 2.92-6.67 diopters at 1 month postoperatively) and significantly different when compared to eyes operated through a scleral incision (1.96 diopters), final mean astigmatism did not differ significantly between those two groups. Moreover, in 27% of eyes operated through a corneal incision, mean astigmatism at 2 months postoperatively was not significantly different from the scleral group and suture removal was not necessary. There was no statistically significant difference in corrected visual acuity over the entire study period between groups. Since safety and functional results of the corneal incision were not different from the scleral incision, we prefer a corneal incision in cataract surgery because of its surgical advantages, especially in patients with cataract and coexisting glaucoma.

Astigmatism↗
PubMed1992

Oculokinetic perimetry compared with standard perimetric threshold testing.

To calibrate oculokinetic perimetry (OKP) as developed by Damato in terms of conventional perimetric threshold values, 33 eyes with either glaucoma or ocular hypertension were tested with a standard Humphrey Field Analyzer using the Central 30-2 test and twice with a 26-point OKP chart. The frequency of seeing of the OKP test spot was plotted against 30-2 thresholds. This showed a weak relation between the two tests. Subsequently eyes that were considered to have had poor fixation were omitted, but false positive and false negative results still occurred in 19 remaining eyes. To check whether Troxler's effect (local adaptation) might have caused false positives, 6 subjects were tested with OKP, controlling the fixation times. Increasing the fixation time from 'very short' to 2 and 5 seconds yielded more 'not seen' responses in OKP. False negative data were found to occur preferentially in border areas of visual defects. The average frequency of seeing curve over all data showed a 50% frequency of seeing for the OKP stimulus at a 14.6 dB equivalent conventional threshold value. The spreading of the curve was 7 dB (95% confidence interval 28 dB).

Adult↗
PubMed1992

Mitomycine, suterelysis and hypotony.

In 35 patients 37 trabeculectomies (TE) were performed using mitomycin as a fibrosisinhibitor. Mitomycin (0.5 mg/ml) was applied to the sclera (under the scleral flap) and conjunctiva in the area of the projected TE during 5 minutes using a small sponge. The indications for operation were: visual field progression in 15 eyes, too high IOP in 13 eyes and severe visual field defects (central island and/or centro coecal visual field defects) in 9 eyes. Six patients had Normal Pressure Glaucoma, 17 Primary Open Angle Glaucoma and 12 had other forms of glaucoma. There were 22 first TE's and 15 re-operations. The scleral flap was sutured with 5 to 8 10/0 nylon sutures. The system of a large number of sutures and subsequent suturelysis was our routine management for reducing complications after TE. This report deals with the postoperative period of the first three months. Suturelysis in combination with mitomycine caused an unexpected high number of postoperative hypotonies (IOP < = 6 mmHg with reduced visual acuity and/or retinal folds or large persistent choroidal detachment and shallow anterior chamber) In the 27 eyes who had suturelysis performed, 7 developed a hypotony. The hypotony may develop as late as three weeks postoperative after suturelysis!. Two eyes developed a hypotony without suturelysis. Seven patients needed resuturing of the scleral flap. The use of mitomycine to enhance filtration after TE may cause serious hypotonies if the scleral flap is not securely closed and if suturelysis is used too early or too extensively.

Adult↗
PubMed1992

Early posterior capsular opacification after intercapsular cataract extraction and rigid Galand disc intraocular lens implantation.

From retrospective studies of implantation of the rigid Galand disc intraocular lens (IOL) and the Sinskey style J-loop IOL, we found that posterior capsular opacification was more common and developed faster in eyes implanted with a Galand disc IOL than in eyes implanted with a Sinskey style J-loop IOL. We investigated this further in a clinical study of 20 patients implanted with a Galand disc IOL. We found a specific type of posterior capsular haze, resembling a "moon landscape," in 10 (50%) of the 16 eyes (80%) with capsular fibrosis.

Cataract↗
PubMed1992

The effects of 5-fluorouracil and mitomycin C on the corneal endothelium.

5-Fluorouracil (5-FU) and Mitomycin C (MMC) are used as adjunct chemotherapy during glaucoma filtering surgery to suppress conjunctival fibroblast proliferation. Since part of these agents may gain access to the anterior chamber and cause cytotoxicity to the corneal endothelium we set up an in vitro system to establish a dose-response effect. Cytotoxicity of MMC and 5-FU was quantified using Mosmann's colorimetric assay in a bovine endothelial cell culture system. In this assay the respiratory activity of the cells is used as a marker for cell viability. After incubation for 5 minutes the 3.0 mg/ml concentration of MMC showed endothelial cytotoxicity, whereas no endothelial toxicity of 5-FU was noted in concentrations up to 50 mg/ml. After incubation for 30 minutes endothelial cytotoxicity was demonstrated for 50 mg/ml of 5-FU and 1 mg/ml of MMC. After an exposure-time of 60 minutes the toxicity level remained 50 mg/ml for 5-FU but decreased to 0.5 mg/ml for MMC. We conclude that with respect to the clinically used concentrations and methods of application of 5-FU and MMC in vivo endothelial toxicity is not to be expected. However, in cases of accidental access of MMC to the anterior eye chamber and following a reduction of aqueous turnover rate the safety of MMC is unwarranted.

Animals↗
PubMed1991

Uncontrolled primary angle closure glaucoma: results of early intercapsular cataract extraction and posterior chamber lens implantation.

In this study we retrospectively evaluated the effect of intercapsular or extracapsular cataract extraction and posterior chamber lens implantation in 67 eyes of 57 patients with different types of primary angle closure glaucoma (PACG) in combination with cataract. We subdivided this patient population into three groups, based on the preoperative methods of intraocular pressure (IOP) control. The best results were obtained in patients with acute PACG (55% IOP reduction) and in patients with uncontrolled PACG (44% IOP reduction). In the other PACG groups an IOP reduction of between 20 and 33% was achieved. A long-term postoperative IOP of less than 21 mmHg was established in 63 eyes or 94%. In 91% the glaucoma medication was reduced, 65% of all eyes needed no glaucoma medication postoperatively. We conclude that an intercapsular cataract extraction with PC-IOL implantation should be considered in both controlled and uncontrolled PACG in patients with cataract, instead of filtering surgery or combined procedures. Even in eyes with relatively good visual acuity, cataract extraction might be considered as a means of achieving glaucoma control.

Acute Disease↗
PubMed1991

Intercapsular cataract extraction with implantation of the Galand disc lens: a retrospective analysis in patients with and without glaucoma.

We studied the results of intercapsular cataract extraction and implantation of the rigid Galand disc intraocular lens (IOL) in 164 cataract patients with and without glaucoma. Eighty-eight percent of the glaucomatous eyes and 98% of the eyes without glaucoma had a postoperative visual acuity of 20/40 or better after best-case analysis. Intercapsular bag placement appeared satisfactory in all but two cases, in which the IOL was slightly tilted. Cataract extraction favorably affected glaucoma control, especially in patients with angle-closure glaucoma (7.3 mm Hg intraocular pressure [IOP] reduction) and in those with primary open-angle glaucoma (2.6 mm Hg IOP reduction). The complications encountered, cystoid macular edema and hyphema, occurred in 1% and 0.5% respectively, and were not more frequent in the glaucoma subgroup. Posterior capsular opacification (30%) and inflammatory complications such as posterior synechiae (7.6%) and prepupillary fibrin (6%) were more often noted in the glaucomatous eyes. Pupillary capture or significant IOL decentration did not occur. We conclude that a circular type of IOL is the best currently available lens for use in glaucoma patients.

Aged↗
PubMed1990

Focal ischaemic normal pressure glaucoma versus high pressure glaucoma.

In a total group of 130 patients with Normal Pressure Glaucoma (NPG) twenty-six were classified as Focal Ischaemic NPG (FINPG). This subgroup has a typical defect at the disc with a comparable visual field defect in the corresponding half of the visual field. Visual field defects are more often seen in the upper than the lower half of the visual field. The defects in the upper half are on the average larger (stage 1.6) than those in the lower half (stage 0.9). Abnormalities of the chamber angle were observed in 12% of these patients, the same percentage as in the normal population. Hypertension and/or cardiovascular disorders were found significantly more frequently in FINPG patients (65.4%) than in a control group of High Pressure Glaucoma (HPG) patients (22.2%). Of the local vascular risk factors, papillary haemorrhages (46%) and choroidal sclerosis (30%) were seen significantly more frequently in FINPG than in HPG (11% and 0% respectively). The total amount of peripapillary atrophy (PPA) in FINPG and HPG is the same, but the distribution is clearly different: in FINPG there is more PPA on the side of the papillary defect. Wide veins were observed in a high percentage of cases in both groups. FINPGs were found to be more frequently progressive (38.5%) than had been thought at first. Recognition of subgroups in NPG, and of risk factors, has already made it possible to make a better prognosis in some types of NPG.

Adult↗
PubMed1979

Four year follow-up of a glaucoma operation. Prospective study of the double flap Scheie.

This paper presents the four-year follow-up results of a prospective study on the results of the Double Flap Scheie. The study was started in 1971 and the pre- and post-operative evaluation was carried out according to carefully selected criteria. Admitted were only open angle glaucoma patients. Diurnal IOP-curves, static perimetry, evaluation of lens and optic disc in mydriasis were included in the complete pre- and post-operative examination. In the Douible Flap Scheie a conjunctival and scleral flap are made followed by a cornea-scleral cauterization and incision after which a peripheral iridectomy is made. 51 eyes of 48 patients were operated. After 4 years 42 eyes of 37 patients could still be examined. The mean IOP was reduced from 33.0 to 17.3 mm without additional therapy. This is a mean percentage reduction of 48.5%. 75% of the mean IOP was under 21 mm; with additional therapie 91% was under 21 mm. Diurnal variation decreased from 7 to 4 mm. 48% of the eyes showed a decreased visual acuity of which 38% was caused by cataract. 52% showed visual field deterioration of which one third was attributed to cataract. In 24% the visual field deterioration was considered clinically important. There was no clear relation between IOP level and visual field deterioration.

Aged↗
PubMed1978

Metoprolol eye drops in the treatment of glaucoma. A double-blind single-dose trial of a beta1-adrenergic blocking drug.

A double-blind single-dose trial was performed on 13 patients with primary open-angle glaucoma. Metoprolol 1%, 2%, and 4% produced a median fall in IOP of 5.6, 5.4, and 6.8 mm Hg, respectively, in the treated eye. The differences in effect between the 1%, 2%, and 4% solutions were not statistically significant. There was no significant fall in IOP in the untreated eyes. There were no significant changes in blood pressure, pulse rate, or pupillary diameter. We could not detect any local objective or subjective side effects during the single-dose study. The clinical usefulness of metoprolol may be limited due to local toxic reactions after treatment with multiple doses. Furthermore, there is the problem of tachyphylaxis that could limit extended treatment with topical beta-adrenergic blocking drugs.

Adult↗
PubMed1977

Atenolol 4% eye drops and glaucoma. A double-blind short-term clinical trial of a new beta1-adrenergic blocking agent.

We studied the effect of a single dose of atenolol 4% eye drops on 21 patients with primary open-angle glaucoma during a double-blind clinical trial. We monitored intraocular pressure (IOP), blood pressure, and pulse rate. At three and six h after medication, the average reduction of IOP was 7.3 and 4.1 mm Hg, respectively, compared to the baseline readings without medication. The reduction of IOP at four h after medication was 6.3 mm Hg compared to the pretreatment value. This corresponds to an average change from the pretreatment value of 22%. Blood pressure and pulse rate did not change significantly. We observed no subjective or objective ocular side effects. The duration of the effect of a single dose of atenolol 4% eye drops is approximately six h. Atenolol 4% eye drops may become a useful agent in the medical treatment of glaucoma if a long-term effect and no ocular side effects (especially a local anesthetic effect) can be proven.

Adult↗
PubMed1977

A double-blind short-term trial of guanethidine 3% and adrenaline 0.5% combined in one eye drop.

A double-blind short-term trial was done to test the effect of guanethidine 3% - adrenaline 0.5% (G-A) in a combined eye drop in 18 patients with open-angle glaucoma and one patient with narrow-angle glaucoma. In 9 of the 19 patients we expected an IOP lowering agent. There was one false-negative result. The mean fall in IOP due to G-A was 10.1 mm Hg (range 3 to 23) and 8.7 mm Hg (range-1 to 26) 6 and 8 h after application respectively. There was no effect on IOP in the 9 eyes that received the placebo.

Clinical Trials as Topic↗
PubMed1977

Rapid deterioration of visual fields during bromocriptine-induced pregnancy in a patient with a pituitary adenoma.

A 28-year-old woman with an amenorrhoea-galactorrhoea syndrome was suspected of a microadenoma of the pituitary. She was treated with bromocriptine. In the subsequent pregnancy she developed rapid deterioration of the visual fields (ODS). A large temporal defect in the right eye and a moderate temporal defect in the left eye appeared in the 28th week of pregnancy, threatening the visual acuity of both eyes. Other examinations showed no evident lesion of the sellar region. An adenoma of the pituitary was removed, and the visual fields returned to normal after operation.

Adenoma↗