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Biomedical subjects

J M Liebmann

Publications and source records attributed to J M Liebmann.

At least 109 records · Page 6Linked to original sources
PubMed1994

High-resolution ultrasound biomicroscopy of the anterior segment in patients with dense corneal scars.

Preoperative evaluation and surgical planning for penetrating keratoplasty in patients with dense corneal scars is often difficult because of poor visualization of the anterior segment. We performed ultrasound biomicroscopy (50-megahertz frequency, 50-micron resolution) on five eyes of five patients with dense corneal opacities of different etiologies to evaluate the anatomic relationships of the iris, lens, angle, and ciliary body. Corneal thickness, the presence or absence of iridocorneal adhesions, peripheral anterior synechiae, and cyclitic membranes, intraocular lens position, and relationships among intraocular structures could be evaluated in vivo. Ultrasound biomicroscopy is the optimal method of obtaining reliable, high-resolution images delineating anatomic relationships and pathology in the anterior segment. This information aids in surgical planning for penetrating keratoplasty and anterior segment reconstruction.

Adult↗
PubMed1994

A new lens for argon laser suture lysis.

Argon laser suture lysis is a valuable adjunct for regulating intraocular pressure and establishing a filtration bleb in the early postoperative period after trabeculectomy. We have developed a lens that provides excellent compression of the conjunctiva, an improved view of scleral flap sutures, and effortless retraction of the upper lid.

Argon↗
PubMed1993

Prevalence of pigment dispersion syndrome in a population undergoing glaucoma screening.

The prevalence of pigment dispersion syndrome is thought to be relatively uncommon. Extrapolation of prevalences from glaucoma practices would suggest about 25,000 to 220,000 persons in the United States, an order of magnitude spread. By performing two population screenings that included slit-lamp examination, we detected pigment dispersion syndrome in 18 of 934 individuals. Sixteen of these were white, so that the prevalence of pigment dispersion syndrome in this group was 2.45%. We suggest that many more persons than previously believed may be at risk to develop pigment dispersion.

Adult↗
PubMed1993

Histopathology of argon laser peripheral iridoplasty.

We report the light and electron microscopic findings from two eyes treated with argon laser peripheral iridoplasty (ALPI) for bilateral angle-closure glaucoma. The patient, a 45-year-old man, died from complications of acquired immunodeficiency syndrome 16 days following ALPI. Ocular pathologic findings included contraction furrow formation and proliferation of fibroblast-like cells, accompanied by collagen deposition on the iris surface, denaturation of stromal collagen, and coagulative necrosis of blood vessels within the anterior two thirds of the iris stroma. These findings suggest that heat shrinkage of collagen may be responsible for the short-term response to ALPI, and that contraction of the fibroblastic membrane may be responsible for its long-term effects. Additionally, the presence of coagulative necrosis of iris blood vessels suggests that overt treatment may result in iris necrosis. To our knowledge this is the first report of the histopathology of ALPI.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Initial 5-fluorouracil trabeculectomy in young patients.

The effectiveness of initial trabeculectomy with adjunctive 5-fluorouracil (5-FU) for uncomplicated glaucoma in patients age 40 years or younger at the time of surgery was evaluated retrospectively in a consecutive series of 20 eyes of 20 patients. Fifteen patients had juvenile primary open-angle glaucoma, 4 had pigmentary glaucoma, and 1 had glaucoma associated with angle recession. Mean patient age was 26.8 +/- 9.7 years (range, 13 to 40 years) at the time of surgery. The mean total 5-FU dose administered was 27.8 +/- 8.8 mg (range, 15 to 45 mg). The intraocular pressure (IOP) decreased from 34.4 +/- 11.5 mmHg preoperatively to 10.5 +/- 4.0 mmHg postoperatively after a mean follow-up of 31.1 +/- 17.3 months (range, 11.5 to 70 months). Nineteen eyes (95%) had a postoperative IOP of 20 mmHg or less without pressure-lowering medications. One patient required additional medical therapy to control the IOP. Complications included bleb-related endophthalmitis (2 eyes) and hypotony maculopathy (1 eye).

Adolescent↗
PubMed1992

Sub-Tenon's anesthesia for trabeculectomy.

Sub-Tenon's anesthesia for anterior segment surgery avoids the risks associated with retrobulbar and peribulbar injections. Localized injections over the appropriate rectus muscles ensure patient comfort as well as optimal exposure of the surgical field in eyes undergoing trabeculectomy. We have used this technique without significant complications in approximately 400 procedures.

Anesthesia, Local↗
PubMed1991

Late bleb-related endophthalmitis after trabeculectomy with adjunctive 5-fluorouracil.

The incidence of late-onset bleb-related endophthalmitis was evaluated retrospectively in 229 consecutive trabeculectomies performed with adjunctive 5-fluorouracil (5-FU) therapy. Mean follow-up was 23.7 +/- 16.3 months (range, 3 to 60 months). Thirteen eyes (5.7%) of 11 patients developed bleb-related endophthalmitis an average of 25.9 +/- 17.4 months (range, 5 to 58 months) after surgery. Infection occurred in 9 of 96 (9.4%) procedures performed from below and in 4 of 133 (3.0%) procedures performed superiorly (P = 0.05, Fisher's exact test). The relative risk of bleb-related endophthalmitis in trabeculectomy from below versus above is 4.0 after adjustment for age and sex (95% confidence interval = 1.1, 14.8). Trabeculectomy with adjunctive 5-FU performed from below carries an increased risk of late bleb-related infection. The incidence of late bleb-related endophthalmitis after 5-FU trabeculectomy appears to be higher than that for trabeculectomy without adjunctive 5-FU injections.

Adolescent↗
PubMed1991

Initial 5-fluorouracil trabeculectomy in uncomplicated glaucoma.

The effectiveness of trabeculectomy with adjunctive low-dose 5-fluorouracil (5-FU) as the initial surgical procedure in uncomplicated glaucoma was evaluated retrospectively in a consecutive series of 52 patients (mean follow-up, 18.6 +/- 11.7 mos) and 74 control subjects. The cumulative 2-year success (intraocular pressure [IOP] less than 21 mmHg) was 100% in the 5-FU group and 78.9% in the control group (P = 0.01, Wilcoxon test). The 5-FU group had a mean postoperative IOP of 12.5 +/- 4.6 mmHg versus 17.4 +/- 5.7 mmHg in the control group at 2-year follow-up (P = 0.015, t test). Antiglaucoma medications were required in 5.8% of patients in the 5-FU group and in 41.9% of controls within 2 years (P less than 0.0001, Fisher's exact test). These results suggest that low-dose 5-FU at the time of initial trabeculectomy leads to a higher success rate, lower IOP, and less need for antiglaucoma medications postoperatively.

Adolescent↗
PubMed1991

Tears of the retinal pigment epithelium: occurrence in association with choroidal effusion.

Two patients developed large tears of the retinal pigment epithelium associated with choroidal effusion. One tear occurred after combined cataract/filtration surgery complicated by postoperative choroidal detachment; the second developed in a patient with idiopathic uveal effusion syndrome. Weakness of the junctions of the pigment epithelial cells secondary to the accumulation of fluid in the subretinal or suprachoroidal space may result in tearing of the retinal pigment epithelium as it is stretched.

Aged↗
PubMed1990

Early intraocular pressure rise after trabeculectomy.

Intraocular pressure (IOP) was measured 4 to 6 hours after surgery and on the first postoperative day in 35 eyes of 35 consecutive patients undergoing initial trabeculectomy. In 27 eyes, the anterior chamber was re-formed at the completion of surgery with balanced salt solution, and in eight eyes it was reformed with hyaluronate sodium. A total of six eyes (17%) had an IOP of 40 mm Hg or greater 4 to 6 hours after surgery. Patients who received hyaluronate to maintain the depth of the anterior chamber had a significantly greater chance of experiencing a marked postoperative IOP rise, both at 4 to 6 hours (P = .005) and on the first postoperative day (P = .0038). There was no correlation between the postoperative IOP rise and the patient's age, sex, glaucoma diagnosis, preoperative IOP, use of 5-fluorouracil, or the number of sutures used to close the scleral flap. Hyaluronate may contribute to an early increase in IOP that could result in further visual field loss in eyes with severe glaucomatous damage. We recommend early monitoring of IOP after trabeculectomy and avoiding the routine use of hyaluronate.

Acetates↗
PubMed1990

Acute angle-closure glaucoma in a patient with acquired immunodeficiency syndrome successfully treated with argon laser peripheral iridoplasty.

Laser iridectomy relieves pupillary block and is the procedure of choice for angle-closure glaucoma. Since not all cases of angle closure glaucoma are due to this mechanism, iridectomy is not always curative. Argon laser peripheral iridoplasty causes a contraction of peripheral iris away from the trabecular meshwork, and is useful in these circumstances. We successfully treated bilateral acute angle-closure glaucoma in a patient with acquired immunodeficiency syndrome with this procedure.

Acquired Immunodeficiency Syndrome↗
PubMed1989

A modification of the use of the glaucoma tamponade shell.

Filtering surgery may be complicated by excessive filtration or bleb leak in the postoperative period, resulting in a shallow or flat anterior chamber and choroidal detachment. A glaucoma tamponade shell with a raised inner platform increases the resistance to flow through the fistula, deepening the anterior chamber. Some surgeons apply a pressure patch over the shell to increase the tamponading effect and to prevent rotation of the shell. Nevertheless, the shell may still rotate, resulting in less than adequate tamponade. We describe a technique that prevents rotation of the shell.

Bandages↗
PubMedDate not supplied

Ultrasound biomicroscopy dark room provocative testing: a quantitative method for estimating anterior chamber angle width.

PURPOSE: To describe a quantitative method for measuring the iridocorneal angle recess area, and, using this, to evaluate factors associated with appositional angle-closure during dark room provocative testing using ultrasound biomicroscopy (UBM). METHODS: All patients (178 patients, 178 eyes) with clinically narrow angles referred for UBM dark room provocative testing between September 1996 and March 1998 were enrolled in this study. Images of the inferior quadrant of the angle taken under standardized dark and light conditions were analyzed. The angle recess area (ARA) was defined as the triangular area demarcated by the anterior iris surface, corneal endothelium, and a line perpendicular to the corneal endothelium drawn from a point 750 microm anterior to the scleral spur to the iris surface. ARA, and acceleration and gamma-intercept of the linear regression analysis of the ARA were calculated. In the linear regression formula, y = ax + b, the acceleration a describes the rate at which the angle widens from the scleral spur; the y-intercept b describes the distance from the scleral spur to the iris. RESULTS: Under dark conditions, the angles in 99 patients (55.6%) showed evidence of appositional angle-closure during testing. ARA (0.11 +/- 0.04 vs. 0.15 +/- 0.05 mm2, P < .0001, Student t-test), acceleration a (0.22 +/- 0.15 vs. 0.26 +/- 0.17, P = .068), and y-intercept b (66 +/- 46 vs. 92 +/- 47 microm, P = .0003) were smaller in eyes that were occluded. In the eyes that were not occluded, y-intercept b showed no significant difference between light and dark conditions (P = .1, paired t-test), while acceleration a did (P < .0001). In the eyes that were occluded, both decreased significantly under dark conditions (P < .0001). CONCLUSIONS The ARA linear regression formula provides useful quantitative information about angle recess anatomy. The more posterior the iris insertion on the ciliary face, the less likely the provocative test will be positive.

Adult↗
PubMedDate not supplied

Angle recess area decreases with age in normal Japanese.

PURPOSE: To investigate prospectively the relationships between anterior chamber angle configuration and refractive error, axial length, age, and body height in the Japanese. METHODS: We studied 65 eyes of 65 subjects (30 men, 35 women) who were either patients at the Ophthalmology Department of Mie University or volunteers. The 65 subjects underwent a complete eye examination, A-scan biometry, and ultrasound biomicroscopy. Images were exported to an IBM-compatible personal computer in PCX format. The angle recess area (ARA) was measured using a software program of our own design. RESULTS: The ARA decreased with age in all quadrants of all eyes. In older individuals, the angle in the superior quadrant was significantly narrower than in the other quadrants. The ARA correlated directly with anterior chamber depth (P < .001), axial length (P < .001), and body height (P = .003), and inversely with age (P < .001) and refractive error (P = .003) in pairwise analysis. Multivariate analysis revealed a significant association between ARA and anterior chamber depth (P < .001), axial length (P = .016), and younger age (P = .043). CONCLUSIONS: The anterior chamber area narrows with age, especially in the superior quadrant. Narrowing of the angle in Japanese is associated with older age, shorter axial length, and shallower anterior chamber depth. We hypothesize that because of the increasing prevalence of axial myopia in younger Japanese, angle-closure glaucoma could become less common in Japan in the future.

Adult↗