Medically uncontrolled glaucoma in the aphakic eye.
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Aphakia, Postcataract↗
Biomedical subjects
J Herschler
Publications and source records attributed to J Herschler.
Modified goniotomy for inflammatory glaucoma. Histologic evidence for the mechanism of pressure reduction.
A modified goniotomy (trabeculodialysis) was performed on both eyes of a 33-year-old woman who had glaucoma secondary to sarcoid uveitis. One month after trabeculodialysis, a cataract extraction was performed on one eye and a histologic specimen was obtained from the area of the filtration angle that was previously incised. Successful control of intraocular pressure has been maintained in both eyes for 18 months following trabeculodialysis. By light and electron microscopic examination, there was a nonhealed incision between the anterior chamber and Schlemm's canal. Trabeculodialysis, it is concluded, works by providing direct communication between the anterior chamber and Schlemm's canal, and might be effective in all trabecular obstructive glaucoma of short duration before secondary changes occur in the outer drainage channels.
Acetazolamide↗
Baring of the circumlinear vessel. An early sign of optic nerve damage.
Baring of the circumlinear vessel is reported as an early sign of optic nerve damage. Evidence is presented to show that this finding is not present in the normal population and, unlike previously described signs of glaucomatous cupping, can be observed at a stage of glaucoma prior to the development of visual field loss. Analysis of a series of stereoscopic photographs from selected high-risk ocular hypertensive patients disclosed a 54% incidence of baring of the circumlinear vessel. Although initially thought to be pathognomonic for glaucomatous cupping, baring of the circumlinear vessel is seen rarely in acquired cupping from optic atrophy secondary to other causes.
Adolescent↗
Nonglaucomatous excavation of the optic disc.
In order to test the hypothesis that glaucomatous and nonglaucomatous optic disc cupping can be distinguished ophthalmoscopically, three ophthalmologists experienced in assessing optic dics were asked to view fundus stereophotographs as "unknowns". Of 29 eyes with nonglaucomatous optic atrophy, 13 (44%) were misdiagnosed as showing glaucoma by at least one observer. Of four optic disc features specifically analyzed, neuroretinal rim pallor proved to be 94% specific for nonglaucomatous atrophy, while focal or diffuse obliteration of the neuroretinal rim was 87% specific for glaucoma. These two signs are the most useful in making the distinction. Thinning of the rim was more common in glaucoma than in nonglaucomatous atrophy, but was only 47% specific for glaucoma. Laminar dots were present in both types of excavation.
Diagnosis, Differential↗
The effect of aqueous humor on the growth of subconjunctival fibroblasts in tissue culture and its implications for glaucoma surgery.
We used aqueous humor from cataract patients and glaucoma patients as a medium for tissue culture of subconjunctival fibroblasts. The aqueous humor from cataract patients consistently inhibited the growth of their own subconjunctival fibroblasts, whereas that of some of the glaucoma patients did not. We found a significant correlation between the success of the filtering operation and the ability of that patient's aqueous humor to inhibit the growth of fibroblasts in tissue culture.
Aqueous Humor↗
Aqueous humor changes after experimental filtering surgery.
We studied aqueous humor of rhesus and owl monkeys for its effect on the growth of subconjunctival fibroblasts in tissue culture. Aqueous humor samples obtained before glaucoma surgery inhibited the initiation of growth of fibroblasts. However, postoperative aqueous humor samples supported growth of fibroblasts. The change in aqueous humor physiology lasted for up to two months after glaucoma surgery. Our study indicated that possibly material added to the postoperative aqueous humor inactivates an inhibitor normally present in primary aqueous humor. An alternative explanation would be that primary aqueous humor, in contrast to secondary aqueous humor, lacks sufficient nutrient material to support fibroblast growth in tissue culture.
Animals↗
Histopathology in the iris-nevus (Cogan-Reese) syndrome.
A 23-year-old-woman had iris-nevus (Cogan-Reese) syndrome characterized by unilateral glaucoma with peripheral anterior synechiae, multiple iris nodules, and ectopic Descemet's membrane. A surgical specimen excised from the involved eye was examined by light and electron microscopy. A cuticular membrane covered both the anterior and posterior surfaces of the iris in this specimen. On the anterior surface of the iris, many projections of apparently normal iris stroma pierced or were surrounded by this membrane. On the posterior surface of the iris, this membrane was associated with a monolayer of cuboidal cells.
Adult↗
Laser shrinkage of the ciliary processes. A treatment for malignant (ciliary block) glaucoma.
Based on the observation of the unusual relationship between the ciliary processes and lens equator in patients with "malignant" glaucoma, a hypothetical cause for the shallowing of the anterior chamber has evolved. Using the concept of a relative block of forward aqueous flow at the lens equator as the inciting element in malignant glaucoma, the clinical response to treatment can be explained. In five of six cases where maximal medical therapy failed to relieve the malignant process, laser shrinkage of several ciliary processes was successful in reversing the posterior secretion of aqueous and restoring the anterior chamber.
Anterior Chamber↗
Hypotony due to inadvertent cyclodialysis after intraocular lens implantation.
Six patients had hypotony from inadvertent cyclodialysis after intraocular lens implantation. Factors that may have contributed to the formation or persistence of the cyclodialysis are scleral cataract incision, prolonged postoperative course of corticosteroid treatment, intraocular lens weight, iridectomy, and maneuvers related to insertion and fixation of the intraocular lens. Closure of these cyclodialysis clefts may be a lengthy process involving various treatment modalities. Fortunately, cyclodialysis with hypotony, although increased in incidence with intraocular lens surgery over routine extraction, occurs rarely.
Aged↗
A modified filtering operation for neovascular glaucoma.
Thirteen patients with useful vision but suffering from uncontrollable neovascular glaucoma due to total angle closure were treated with modified filtering operations. Ten (77%) of the cases were controlled more than one year postoperatively. Most patients whose pressures were controlled maintained their preoperative visual acuities. These visual results appear to be better than those reported with cyclocryotherapy, where vision is usually lost despite satisfactory pressure control.
Adolescent↗
Glaucoma and the intraocular lens.
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Aged↗
Intraocular extension of squamous cell carcinoma of the conjunctiva.
The present case report illustrates the clinical and pathologic features of intraocular invasion by squamous cell carcinoma of the conjunctiva. Cytologic study of aqueous humor aspirate is a useful technique for confirming the diagnosis of this unusual route of tumor extension.
Aged↗
Increased intraocular pressure induced by repository corticosteroids.
Twelve patients (14 eyes) had intraocular pressure elevations induced by repository coritcosteroids. The duration and severity of the resulting pressure elevations were directly related to the decreasing solubility of the agent employed. Ten patitens had received intensive topical corticosteroids before injection, resulting in no intraocular pressure elevations during that period. Two patients who developed marked intraocular pressure elevations after repository corticosteroid injection did not manifest a positive response on subsequent topical corticosteroid testing.
Adrenal Cortex Hormones↗
Intractable intraocular hypertension induced by repository triamcinolone acetonide.
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Adult↗
Aqueous humor as a modulator of growth in fibroblast cultures.
Samples of aqueous humor from rabbits and humans were examined for growth effects on subconfluent monolayer fibroblast cultures from ocular and extraocular tissues. At a concentration of 20% aqueous by medium volume, both homologous and heterologous aqueous stimulated DNA synthesis in fibroblasts from both species. The stimulation was independent of medium serum. When fibroblasts were exposed to 0 to 100% aqueous in serum-free medium or 0 to 98% aqueous in 2% serum-supplemented medium, no concentration of aqueous was observed in which DNA synthesis was inhibited. However, higher concentrations of aqueous led to increasing cell loss resulting in an apparent net inhibition of culture growth. Net growth effects of aqueous humor were, therefore, dependent upon aqueous concentration and were apparently due to the combined effects of stimulation of proliferation and reduction in cell survival.
Animals↗
Congenital glaucoma associated with cutis marmorata telangiectatica congenita: two case reports.
Two cases of cutis marmorata telangiectatica congenita are described in association with nevus flammeus and congenital glaucoma. Approximately 65 cases have been reported and the association with nevus flammeus and congenital glaucoma has only been reported in one of those cases. Unlike the glaucoma associated with nevus flammeus of Sturge-Weber, this type of congenital glaucoma appears to be associated with an abnormal filtration angle rather than an increased episcleral venous pressure.
Child, Preschool↗
Trabecular damage due to blunt anterior segment injury and its relationship to traumatic glaucoma.
Gonioscopy, performed within 48 hours of traumatic hyphema, revealed not only angle recession but also a high incidence of damage to the trabecular meshwork and the Schlemm canal. These trabecular lesions tend to scar and become much more difficult to recognize over the ensuing weeks. Large tears into the ciliary body (angle recession) also had a tendency to "close." Using a specially calibrated BB gun hyphema was induced in rhesus monkeys. Trabecular tears were recognized by gonioscopic and histologic examination. Impaired outflow facility developed between 10 and 30 days after injury in the one surviving animal studied to date. In patients developing open-angle glaucoma years after trauma, evidence of past trabecular injury was seen by gonioscopy in addition to the obvious ciliary body tears (angle recession). The "normal" fellow eye had early glaucoma, ocular hypertension, or "high normal" intraocular pressure. The evidence presented supports the hypothesis that traumatic glaucoma is the result of trabecular meshwork injury from the original trauma and the rapid scarring that results, in combination with an underlying predisposition for the development of primary open-angle glaucoma and the passage of time.
Adolescent↗