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Biomedical subjects

J Hetherington

Publications and source records attributed to J Hetherington.

At least 37 records · Page 2Linked to original sources
PubMed1990

Analysis of surgical and medical management of glaucoma in Sturge-Weber syndrome.

Management of glaucoma associated with Sturge-Weber syndrome (SWS) is difficult. The authors reviewed 36 eyes of 30 SWS patients with either early or late-onset glaucoma with a mean follow-up of 122 months (range, 24-253 months). Intervals between required surgical or medical interventions were analyzed. Intervention was attributed to elevated intraocular pressure (IOP) in 55% of cases and disc change in 45%. Median stable postoperative interval with goniotomy was 12 months; with trabeculotomy, 21 months; with trabeculectomy, 34 months; with argon laser trabeculoplasty, 25 months; and with medications, 57 months. Survival analysis shows statistically significant differences between goniotomy and medications. Intraoperative choroidal expansions developed in 24% of cases receiving a trabeculectomy, and none developed with either goniotomy or trabeculotomy.

Adolescent↗
PubMed1989

CSF in neonatal unit.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed1989

Low intraocular pressure and postural changes in intraocular pressure in patients with Hansen's disease.

We found intraocular pressures of less than 7 mm Hg in 11 of 72 patients (15%) with early Hansen's disease. Furthermore, significant postural changes in intraocular pressure (greater than 30%) occurred in 43 of 72 patients (60%). This loss of intraocular pressure homeostasis, which results from reduced aqueous humor production or increased uveoscleral outflow with reduced local adrenergic control in the ciliary body-iris-trabecular meshwork region, suggests that early autonomic neuropathy of the eye may occur in Hansen's disease. The only predictive value for significant postural change in intraocular pressure was the presence of immunologically unstable disease.

Homeostasis↗
PubMed1989

Retrospective and prospective identification of unpublished controlled trials: lessons from a survey of obstetricians and pediatricians.

Investigations in which statistically significant differences between treatment groups have not been observed are less likely than others to be reported in scientific journals. In clinical research, this selective suppression of "negative" results may lead to the adoption of ineffective or hazardous treatments. In an attempt to obtain information about unpublished trials in perinatal medicine, letters were sent to 42,000 obstetricians and pediatricians in 18 countries. As a result, we were notified of 395 unpublished randomized trials. Only 18 of the trials had been completed more than 2 years before the survey, a period during which at least 2300 reports of perinatal trials had been published. Of the 395 unpublished trials, 125 had ceased recruitment within the 2 years prior to the survey, 193 were actively recruiting at the time of the survey, and 59 were about to begin recruitment. It was concluded that publication bias will not be addressed successfully by attempts to obtain information about unpublished trials retrospectively. However, since the response rate to our request for details about ongoing and planned trials was good, prospective registration of trials at inception appears to be a feasible approach to reducing publication bias and its adverse consequences. An additional merit of prospective registration of clinical trials is that it should reduce unnecessary duplication (as opposed to necessary replication) in research and promote more effective collaboration.

Clinical Trials as Topic↗
PubMed1988

Surgical results in iridocorneal endothelial syndrome.

The charts of 83 patients with iridocorneal endothelial (ICE) syndrome were retrospectively reviewed. Forty-two eyes of 42 patients had had filtering surgery, 37 of whom had had a trabeculectomy to reduce uncontrolled intraocular pressure. Twenty-four of these trabeculectomy patients required a second surgery, and 8 required a third surgery. The results are presented using a survival analysis. The success rates at one year of follow-up for the first, second, and third trabeculectomies were 64%, 79%, and 63%, respectively. Patients subclassified as having Chandler's syndrome, essential iris atrophy, and Cogan-Reese syndrome responded with approximately the same success rates within the first two years following their first surgery. The success rates for repeated surgeries are comparable with those of initial surgery in patients with primary open angle glaucoma. On the basis of this study, further surgery is recommended despite initial failure in this group of difficult patients.

Endothelium, Corneal↗
PubMed1988

Capsular glaucoma: management philosophy.

This paper attempts to evaluate exfoliative glaucoma management. Exfoliative glaucoma is generally considered to be more severe than chronic open angle glaucoma. Pressures are generally higher and more resistant to the pressure lowering effect of various medications. Laser trabeculoplasty is generally more effective in exfoliative glaucoma in the first year but successful in only 50% of eyes at two years follow-up. Filtration surgery is far more effective in exfoliative glaucoma than it is in chronic open angle glaucoma.

Anterior Eye Segment↗
PubMed1987

Minor physical anomalies and learning disability: what is the prenatal component?

The authors performed a case-control study of 60 school children who were examined for a constellation of anomalies suggestive of fetal alcohol exposure. Nonretarded learning disabled children were 7.25 times (95%, confidence interval, 1.05 to 50.0) more likely than controls to have signs consistent with alcohol exposure in fetal life. These data suggest an expanded spectrum of fetal alcohol effects. Early recognition of minor physical anomalies could result in prompt evaluation and treatment of these children.

Alcohol Drinking↗
PubMed1986

The Oxford Database of Perinatal Trials: developing a register of published reports of controlled trials.

A database of perinatal trials is currently being established to provide a resource for reviews of the safety and efficacy of interventions used in perinatal care and to foster cooperative and coordinated research efforts in the perinatal field. The database will ultimately comprise four main elements: a register of published reports of trials; a register of unpublished trials; a register of ongoing and planned trials; and data derived from pooled overviews (meta-analyses) of trials. This article describes the development of the first of these four elements.

Clinical Trials as Topic↗
PubMed1986

Pathogenesis of Chandler's syndrome, essential iris atrophy and the Cogan-Reese syndrome. I. Alterations of the corneal endothelium.

Eight keratoplasty and 14 trabeculectomy specimens from Chandler's syndrome, Essential Iris Atrophy, and the Cogan-Reese syndrome were studied by electron microscopic and morphometric methods. The corneal endothelium in these conditions undergoes the most varied and complex alterations of any of the endotheliopathies so far studied. The size, shape, and density are altered, and the apical surface shows a myriad of abnormalities including alterations of the intercellular borders and junctions, and formation of numerous microvilli, filopodia, and "blebs." Whereas many cells have features indicative of metabolic activity, and others may have undergone division, still others appear to have been injured as they are disrupted and necrotic. There is also evidence for the presence of a low-grade, long-standing chronic inflammation and an associated loss of contact inhibition with formation of multiple endothelial layers. These changes do not encompass the entire endothelium, as some regions remain relatively unaffected, and each specimen presents a unique morphology. The endothelium is most affected in cases of Essential Iris Atrophy. Some changes may be related to such processes as cell migration and reparative activities. However, the presence of cell necrosis (apoptosis) and chronic inflammation (endotheliitis) may be more specifically related to the ICE syndrome endotheliopathy. The slit lamp and specular microscopy findings characteristic of this disease are correlated with the described histologic abnormalities.

Adolescent↗
PubMed1986

Pathogenesis of Chandler's syndrome, essential iris atrophy and the Cogan-Reese syndrome. II. Estimated age at disease onset.

The presence of a layer of abnormal material in Descemet's membrane in eight keratoplasty specimens served as a marker to determine whether Chandler's syndrome, Essential Iris Atrophy, and the Cogan-Reese syndrome are congenital or acquired conditions. In all eight cases of the ICE syndrome, a pattern of membrane deposition was observed, which typifies acquired disorders: a completely normal prenatal layer and both normal and abnormal portions of the postnatal layer. The thickness of the membrane deposited before the onset of abnormal secretion was used to estimate a time span for possible ages at which abnormal secretion began. The estimated age intervals for all diseased specimens had their lower limits in the postnatal period. Thus, these results led us to the conclusion that abnormal Descemet's membrane first appeared in postnatal life, years before clinical recognition of disease. The possibility of a viral etiology for this unilateral endotheliopathy resulting in an altered Descemet's membrane is discussed.

Adult↗
PubMed1985

Clinical experience with timolol in childhood glaucoma.

We studied 67 patients (100 eyes) with childhood glaucoma who were treated with timolol maleate. Thirty of these patients (40 eyes) did not require additional surgery or medications after being treated with timolol (follow-up, from six to 60 months). Thirty-one eyes (78%) in this group had a pressure drop; 18 eyes (45%) had a pressure drop of greater than 10 mm Hg. We conclude that timolol is effective in the treatment of pediatric glaucoma, although there is a need to be aware of its potential complications.

Adolescent↗
PubMed1984

Anatomical classification of the developmental glaucomas.

With the use of observations in 250 cases of childhood glaucoma, defects were classified anatomically according to the three major anterior chamber structures affected: the trabecular meshwork, the iris, and the cornea. The classification should do much to facilitate communication in the area of the developmental glaucomas and provide standardization of terminology to allow collaborative study of these rare diseases.

Adolescent↗
PubMed1984

Congenital ectropion uveae with glaucoma.

Congenital ectropion uveae (CEU) is a rare, nonprogressive anomaly characterized by the presence of iris pigment epithelium on the anterior surface of the iris stroma, often associated with neurofibromatosis and occasionally with other ocular anomalies. We present eight patients with unilateral CEU. Seven patients had glaucoma in the involved eye, while the eighth was a 10-week-old infant. In the two patients with bilateral glaucoma, the second eye was similar to the first, but without CEU. Three patients had neurofibromatosis, two had facial hemihypertrophy, one had Rieger's anomaly, one had Prader-Willi syndrome, and one had no systemic anomalies. Two had initially been misdiagnosed as having a large pupil in the involved eye and one as having a Horner's syndrome in the uninvolved eye. The finding of CEU in an infant warrants continued observation for the development of glaucoma and disorders of neural crest origin.

Abnormalities, Multiple↗
PubMed1983

Side effects of timolol.

Timolol maleate, a nonselective beta blocker, has been associated with adverse reactions when administered topically or systemically. The current literature pertaining to timolol-related side effects and reports to the National Registry of Drug Induced Ocular Side Effects are reviewed. Knowing what side effects are associated with the systemic administration of timolol is helpful in predicting systemic side effects that may be encountered when timolol is administered topically.

Administration, Topical↗
PubMed1983

Complications of laser trabeculoplasty.

Laser trabeculoplasty (LTP) is a relatively new procedure requiring evaluation for long-term effectiveness and associated complications. The authors review some 300 LTPs and identify complications. Among the most serious are transient or persistent rise in intraocular pressure, iritis, and progression of visual field loss. The authors recommend LTP as an alternative to glaucoma surgery in selected patients not controlled by medications.

Glaucoma↗
PubMed1983

Laser trabeculoplasty and the glaucomas.

A standard 100-spot laser trabeculoplasty was applied to 137 eyes of 109 presurgical patients with a variety of primary, secondary, and postsurgical glaucomas. Average follow-up was 15.3 months. Laser therapy was most successful in eyes without prior surgery (chronic open-angle glaucoma (COAG), pseudoexfoliation, pigmentary dispersion) or with only one prior operation (iridectomy, trabeculectomy, or intracapsular cataract extraction). The mean range for pressure reduction was 6 to 12 mmHg. Failures were frequently seen in eyes with angle recession, uveitis, or more than one operation. Visual field deterioration was seen in 11% of successful COAG eyes. Asymmetric responses in bilaterally treated COAG patients were seen half the time. A drift downward of 5 mmHg or more at six months after laser reversed itself by 12 months in approximately one out of eight eyes from various categories.

Adult↗
PubMed1981

Timolol and pediatric glaucomas.

Thirty-eight eyes were treated by adding timolol to the medical regimen. After a suitable trial, attempts were made to reduce other glaucoma medications. Fifteen eyes with infantile glaucoma treated surgically at birth, experienced elevated intraocular pressure later in life. Another 15 eyes had glaucoma associated with congenital anomalies such as aniridia, Sturge-Weber syndrome, and mesodermal malformations. The group with infantile glaucoma demonstrated an average drop in pressure of 24% and 22% after one and three months, respectively. Six of the 15 eyes were controlled at 22 mm Hg or less. In the other group, intraocular pressure fell 30% after one month and 12% after three months. Five of the 15 eyes were controlled. Adverse effects occurred in five patients, timolol therapy was discontinued in two (7%). The IOP was not controlled in any of the eyes with timolol alone.

Adolescent↗