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Biomedical subjects

J L Jay

Publications and source records attributed to J L Jay.

At least 55 records · Page 3Linked to original sources
PubMed1988

Early trabeculectomy versus conventional management in primary open angle glaucoma.

The results of a randomised, prospective, multicentre trial of the management of primary open angle glaucoma are presented at up to five years' follow up. Previously undiagnosed cases were selected with intraocular pressure of 26 mmHg or more on two occasions together with field loss characteristic of glaucoma. Analysis was performed on one eye selected at random from each of 99 patients. Conventional medical treatment followed in unsuccessful cases by trabeculectomy (group A) was compared with trabeculectomy at diagnosis followed when necessary by supplementary medical therapy (group B). The life expectancy of these glaucoma patients was found to be similar to that for the local population matched for age and sex. In group A after four years trabeculectomy had been performed in 53% of eyes because medical management had failed to control the disease. The rate of operation was lower in those patients with intraocular pressure less than 31 mmHg and mild relative field loss (17% at three years) than in those with intraocular pressure greater than 30 mmHg and dense scotomas (75% at three years). Early surgery provided much more stable control with fewer changes in treatment than in group A. The group mean intraocular pressure after trabeculectomy was 15.0 mmHg irrespective of the time of operation, and this was significantly lower than the intraocular pressure in those cases thought to be controlled on medical therapy alone at the end of the first year (20.8 mmHg). Early operation provided significantly better protection of visual field, and the extra loss of visual field with delayed operation occurred in the preoperative period. Changes in visual fields were not related to the use of miotics. There was no significant difference in the final visual acuity in the two groups, but six cases in group A lost central fixation because of progressive loss of visual field, and there were no such cases in group B. Cataract occurred in approximately 10% of cases in both groups, but in group A this happened with only half the number of operations and at a shorter postoperative follow-up than in group B. It appears that in cases of primary open angle glaucoma of this severity the risk of delaying operation are significantly greater than those of performing trabeculectomy as the primary treatment.

Aged↗
PubMed1988

Comparative evaluation of oculokinetic perimetry and conventional perimetry in glaucoma.

Oculokinetic perimetry is a new method of visual field assessment in which the patient moves the eye around a central static target to look sequentially at an array of numbers. When fixation on a number is accompanied by disappearance of the central target, that number is deleted from a recording chart. Inversion of the recording chart gives a plot of the central visual field. In this study we have shown that in 64 eyes of 37 patients, with unequivocal field loss attending a glaucoma clinic, the test is efficient and reliable when compared with conventional static (Dicon 3000) and kinetic (Tübingen Oculus) field tests. The results were identical in 88% of eyes tested and approximately comparable in another 6%. Quantitative equivalent targets for the different methods are described. Oculokinetic perimetry was carried out by a previously untrained person, and it is suggested that this new method merits further study as a screening device for glaucoma in the community.

Adult↗
PubMed1987

The organisation of the glaucoma clinic.

The diagnosis and accurate assessment of progress of patients with glaucoma is more complex and time consuming than for most other ophthalmic disorders. Glaucoma patients in an overcrowded general clinic are therefore seldom given time for adequate visual field examination and all too often silent deterioration goes unnoticed until irreversible loss of central vision occurs. The introduction of a clinic specifically for glaucoma patients provides the opportunity for detailed assessment so that effective modern treatment can be applied and unnecessary blindness avoided. This paper describes the simple and practical plan for the organisation of a glaucoma clinic which has worked well for many years in the Tennent Institute of Ophthalmology.

Documentation↗
PubMed1987

Cutaneous and ocular side-effects of oral photochemotherapy: results of an 8-year follow-up study.

To determine the long-term cutaneous side-effects of oral photochemotherapy (PUVA), we examined 95 patients, 59 with psoriasis and 36 with mycosis fungoides (MF). These comprised 80% and 69% respectively of the patients with these disorders treated with PUVA in our department from 1977 to 1985. Two psoriatic patients had squamous carcinomas, both of whom had received high cumulative UVA doses and also methotrexate concurrently with PUVA. Six patients with MF had actinic keratoses. The mean age of these patients (69 years) was significantly greater than the mean age of the patients without actinic keratoses (54 years), but there was no significant difference in their cumulative UVA doses. No patients developed basal cell carcinomas or malignant melanoma. 'PUVA lentigines' were found in 46% of the patients. They were most frequent in patients currently being treated and in those who had received high cumulative UVA doses, but persisted for up to 7 years after discontinuing therapy. Seventy-one patients had yearly ophthalmological examinations, or a single examination at least 3 months after commencing PUVA. This examination included retinal function tests to detect any subclinical visual impairment. Five of these patients had cataract prior to PUVA therapy, and were significantly older (mean age 71 years) than those without cataract (mean age 53 years). Three patients (mean age 61 years) developed new lens opacities whilst receiving PUVA. However, none of these patients was considered to have cataract as none had impairment of visual acuity due to lens opacity. No patients without lens opacity developed evidence of subclinical visual impairment.

Actins↗
PubMed1987

Effect of age on visual acuity after cataract extraction.

The best Snellen visual acuity in the three months after cataract extraction was found to decline with the age of the patient. The relationship was identical in 111 patients who had extracapsular extraction and a Pearce tripod posterior chamber intraocular lens and in 50 patients who had intracapsular extraction with spectacle correction. Vision after operation varied from a mean value of 6/5 at 50 years to 6/12 at 90 years, a decline of 1 line per 13.4 years. In the intracapsular group, over a mean follow-up period of 14 years, the rate of fall in acuity with increasing age after operation was found to be statistically similar to that of the early postoperative acuity plotted against age for both types of operation. This suggests that the rate of decline with age is unchanged after a prolonged period of aphakia with presumed increased exposure to ultraviolet and blue light. The data were found to be similar to the decline in the neurosensory elements of vision with age measured experimentally in 20 phakic subjects by laser interferometry. This method of assessment of contrast sensitivity threshold effectively bypasses changes in the optical media. The findings indicate that the previously recognised drop in visual acuity with age is not related to changes in the aging crystalline lens and support the view that there is a decline in the neurosensory elements of vision. It is important to recognise this deterioration so that results of surgery or other treatment are adjusted to allow for the age of the patients.

Adult↗
PubMed1986

Retinal changes in malignant hypertension.

To assess the diagnostic and prognostic importance of papilloedema in malignant hypertension a two part study was undertaken. Four observers reviewed 56 photographs of fundi from patients with grade 3 or 4 hypertensive retinopathy. Complete agreement on the presence or absence of haemorrhages was recorded in 52 cases and on exudates in 53 cases. Opinion on papilloedema, however, was divided, all four observers agreeing in only 34 cases. In the second part of the study survival in 139 consecutive hypertensive patients with bilateral retinal haemorrhages and exudates was examined by life tables. Ten year survival was 46% in patients with bilateral haemorrhages and exudates alone (n = 43) and 48% when papilloedema was also present (n = 96). Multivariate analysis confirmed that papilloedema was not related to survival. These results suggest that papilloedema is an unreliable physical sign and does not adversely influence prognosis in hypertensive patients who already have bilateral retinal haemorrhages and exudates when effective treatment is available. Papilloedema should no longer be regarded as a necessary feature of malignant hypertension.

Actuarial Analysis↗
PubMed1985

A complicated case of ciliary body melanoma and glaucoma.

This clinicopathological case report describes the bilateral ocular pathology in an elderly man suffering from primary open angle glaucoma, aphakia and a ciliary body melanoma which was treated by cryotherapy to preserve vision in the better eye. Liver metastases were detected 18 months after the tumour was recognised. At autopsy, melanoma metastases were found within a renal cell carcinoma which had also metastasised to the lungs. Other abnormalities included aphakic maculopathy, senile macular degeneration, asteroid hyalosis and patchy hyalinisation of the retinal vasculature, which in one eye was the source of preretinal neovascularisation derived from intramural neovascularisation.

Aged↗
PubMed1985

Extracapsular lens extraction and posterior chamber intraocular lens insertion combined with trabeculectomy.

Trabeculectomy for primary glaucoma was successfully combined with extracapsular lens extraction and insertion of a Pearce tripod posterior chamber lens in seven eyes of five patients. The results were similar to those expected from each component of the operation when performed alone, and all eyes achieved visual acuity of 6/9 or better with control of intraocular pressure below 22 mmHg without supplementary medical treatment. The incidence of mild anterior uveitis (three out of seven eyes) and hyphaema (two out of seven eyes) was greater than usual with this type of cataract extraction but no more than expected after trabeculectomy. Mydriatic drops may be used to treat postoperative iritis without danger to the stability of this pattern of implant. In addition the anterior chamber cannot become shallow, as the rigid legs of this lens extend behind the iris beyond the periphery of the cornea and prevent forward movement of the implant even if there is excessively free drainage of aqueous after the operation.

Aged↗
PubMed1985

Self-inflicted corneal injuries in children with congenital corneal anaesthesia.

Severe corneal ulceration related to self-inflicted injury in the presence of congenital corneal anaesthesia is described in four boys under 2 1/2 years of age. The ulcers had failed to heal until it was recognised that the children were scratching their own eyes. The application of arm splints allowed rapid healing. Although corneal ulceration is a recognised complication of congenital corneal anaesthesia, this preventable cause of the ulceration has not previously been recognised. In two cases there were isolated recurrences which healed quickly with the reapplication of splints. All four children had good vision initially, and, although there were no overt gross development abnormalities, two had neurological signs on detailed investigation suggesting cerebellar or brain stem malformation and one had unilateral anophthalmos, talipes equinovarus, and patent ductus arteriosus. All the children showed normal intellectual development. Whether the eye scratching behaviour was the primary cause of the ulceration or merely an aggravating factor, the identification of this abnormal behaviour is important in any child with idiopathic corneal ulceration, as even in the presence of congenital corneal anaesthesia the eyes heal quickly with effective splinting of the elbows. It is therefore important to test sensation of the cornea and face and to consider the possibility of self-inflicted injury in children with refractory corneal ulceration, as in our cases there were no other consistent diagnostic features.

Child, Preschool↗
PubMed1985

Ischaemic optic neuropathy and retinopathy associated with acute pancreatitis.

A man with previously undiagnosed chronic renal failure developed acute pancreatitis. He had severe abdominal pain and simultaneous loss of vision. Ophthalmoscopy showed pale, swollen optic discs, soft exudates and superficial retinal haemorrhages similar to that of Purtscher's retinopathy. We suggest that the ocular changes may be due to fat microemboli secondary to acute pancreatitis.

Acute Disease↗
PubMed1983

Earlier trabeculectomy.

This is a preliminary report of a collaborative, prospective, randomised trial of management of primary open angle glaucoma where conventional management using medical therapy followed by trabeculectomy only in unsuccessful cases (Group A) was compared with trabeculectomy as the primary form of treatment supplemented where necessary by medical therapy (Group B). Using one eye of each patient 40 eyes were available at one year and 14 eyes at two years after entry to the trial. The two groups were comparable for age, sex, intraocular pressure before treatment, visual acuity, visual fields and other features. Seven of the 22 eyes in Group A (31 per cent) had required operation in the first year and two of the 18 eyes in Group B (11 per cent) had required supplementary medical therapy in the same period. Trabeculectomy was more effective in lowering intraocular pressure than medical treatment. No statistically significant differences in visual function or disc appearances are yet detectable but there is a trend in favour of trabeculectomy as a primary procedure (Group B).

Aged↗
PubMed1982

Colour perception in pseudophakia.

Minor differences in colour perception between pseudophakic, phakic, and spectacle aphakic eyes were identified by the Pickford-Nicholson anomaloscope and the Farnsworth-Munsell 100-hue test. The results suggest that pseudophakic eyes are more sensitive to red and less sensitive to blue than aphakic eyes corrected with spectacles. Spectrophotometer measurements reveal that the Rayner-Pearce posterior chamber intraocular lens used in this study transmits an evenly balanced colour spectrum, whereas an aphakic spectacle lens exhibits significant colour distortion, reducing the red and enhancing the blue transmission. This distortion may possibly be attributed to the increased chromatic aberration in the spectacle lens compared with the intraocular lens.

Aged↗
PubMed1982

Keratoconjunctivitis artefacta.

Six cases of keratoconjunctivitis caused by self-inflicted injury are described. The diagnosis is suggested by the combination of the characteristic sharply delineated lesions localised in the more accessible inferior and nasal quadrants of the bulbar conjunctiva and cornea, together with the unconcerned attitude of the patient and other psychological features. Secondary post-traumatic erosions, infections, and allergies may complicate the clinical appearances, and other functional eye disturbances including corneal anaesthesia may be detected. In all cases the eye condition resolved with a sympathetic but authoritative approach avoiding direct accusation. Avoidance of feelings about bereavement or sexual relationships were directly related to the onset of symptoms in 3 cases. In some patients the psychological mechanism seemed inaccessible and they continued to produce new self-inflicted diseases with considerable physical and psychological morbidity. These more intractable cases need psychiatric investigation but usually resist referral.

Adolescent↗
PubMed1982

Perforating injuries of cornea and sclera.

A highly skilled surgical team should perform the primary repair of penetrating injuries in order to reduce the need for secondary procedures. Detailed enquiry into the circumstances of the injury together with scrupulous preoperative assessment and planning are essential prerequisites for successful repair. Surgical objectives not only include careful reconstruction but also the need to avoid increasing the tissue damage by unnecessary manipulation. Stimulus deprivation amblyopia may be inadvertently produced by injudicious post-operative management in young children. The methods of microsurgical technique in wound closure and anterior chamber reformation are discussed and some of the consequences of imperfect repair are outlined.

Child↗
PubMed1981

Clinical features and diagnosis of adult atopic keratoconjunctivitis and the effect of treatment with sodium cromoglycate.

This study describes 17 cases of atopic keratoconjunctivitis in adults. In 8 cases the clinical appearances were nonspecific and sufficiently different from vernal keratoconjunctivitis to make diagnosis difficult. These atypical cases often showed a fine papillary conjunctival reaction on the upper tarsus, subconjunctival scarring, and in 1 case severe symblepharon. Corneal features included corneal microcysts, peripheral vascularisation, and various patterns of punctate epithelial keratitis. It was therefore important to establish the atopic status of the patient. A personal or family history of other atopic disease was elicited in every case, and the diagnosis was confirmed by the detection of raised serum IgE level. Uncontrolled clinical assessment suggested that 10 out of 15 patients experienced improvement in symptoms with the use of 2% sodium cromoglycate eyedrops 4 times a day. A subsequent double-masked cross-over trial comparing the same treatment with a matched placebo preparation indicated that 6 out of 9 patients preferred sodium cromoglycate while 1 preferred the placebo. Two patients noted no difference. Cases showing nonspecific or atypical clinical features responded to treatment just as frequently as did cases of typical vernal keratoconjunctivitis.

Adolescent↗