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Biomedical subjects

J Ram

Publications and source records attributed to J Ram.

At least 37 records · Page 2Linked to original sources
PubMed1999

Update on fixation of rigid and foldable posterior chamber intraocular lenses. Part I: Elimination of fixation-induced decentration to achieve precise optical correction and visual rehabilitation.

PURPOSE: Realizing that precise posterior chamber intraocular lens (PC-IOL) centration is needed to consistently achieve good optical results and visual rehabilitation after modern cataract surgery, the authors assessed the status and success rate of lens haptic fixation and its correlation with lens optic centration-decentration in a large series of eyes with PC-IOLs obtained postmortem. DESIGN: Prospective analysis of pseudophakic eyes obtained postmortem. PARTICIPANTS: A total of 3493 human eyes obtained postmortem, the largest database of such specimens available to date. METHODS: Miyake-Apple posterior photographic technique. MAIN OUTCOME MEASURES: The amount of decentration of rigid PC-IOLs and small-incision foldable PC-IOLs was analyzed, and the results were correlated with the type of fixation that had been achieved in each case. RESULTS: Determination of mean values revealed that capsular bag fixation was achieved in 52.05% of eyes, asymmetric bag-sulcus fixation in 34.21 % of eyes, and sulcus-sulcus fixation in 13.74% of eyes. Asymmetrically fixed lenses consistently showed significant decentration. During the past 5 years (1993-98), the overall rate of in-the-bag fixation increased to 59.2%; by 1998 it had increased to 64%. Most significantly, success in achieving bag-bag fixation of foldable IOLs implanted in association with modern capsular surgery with small incisions has surged to 90% over the past 4 years. CONCLUSIONS: The authors found a direct correlation of decentration in eyes with asymmetric fixation, and the results underscore the need for careful in-the-bag haptic placement. Although few surgeons today would dispute the goal to implanting haptics in the capsular bag, these findings show that the overall success rate over the years has, while improving, remained surprisingly low. The overall success rate of about 60% seen with all lens designs is probably as good as can be expected with classic large-incision extracapsular techniques. However, and most important and encouraging, the success rate of haptic fixation in cases with foldable lenses has improved dramatically during the past 4 years (up to the 90% range). This coincides with the present emphasis on modern capsular surgery and small-incision techniques used to insert these lenses.

Acrylic Resins↗
PubMed1999

Update on fixation of rigid and foldable posterior chamber intraocular lenses. Part II: Choosing the correct haptic fixation and intraocular lens design to help eradicate posterior capsule opacification.

PURPOSE: Posterior capsule opacification (PCO) is one of the most common complications of cataract surgery, and there is an urgent need to reduce its incidence. Its main treatment, neodymium:YAG (Nd:YAG) laser posterior capsulotomy, may be associated with significant morbidity and is expensive. In this study, the authors ascertain the effect of posterior chamber intraocular lens (PC-IOL) fixation and various IOL designs (rigid polymethyl methacrylate [PMMA] optic and small-incision foldable designs) on the pathogenesis of PCO. DESIGN: Prospective analysis of pseudophakic eyes obtained postmortem. PARTICIPANTS: A total of 3493 eyes with PC-IOLs obtained postmortem and received between 1984 and 1998. METHODS: Miyake-Apple posterior photographic technique. MAIN OUTCOME MEASURES: Peripheral Soemmering's ring, central PCO in the visual axis, and eyes that have had Nd:YAG laser posterior capsulotomy were analyzed and scored, and these findings were correlated with the type of fixation and IOL design. RESULTS: The degree of formation of peripheral Soemmering's ring was not influenced by IOL fixation. The acrylic design revealed relatively low Soemmering's ring scores. In contrast, central PCO and Nd:YAG laser capsulotomy scores were consistently influenced by fixation. The scores were significantly lower in eyes with in-the-bag fixation. The bag-bag fixated acrylic-PMMA design and the three modern silicone IOL designs analyzed in this study had less central PCO and lower posterior capsulotomy scores than did the PMMA IOLs. CONCLUSIONS: The formation of peripheral PCO (the Soemmering's ring), the precursor of clinically significant, vision-threatening PCO, is not significantly influenced by the haptic fixation pattern. It is much more dependent on the quality and thoroughness of surgical cortical cleanup. Reduction of Soemmering's ring is an important goal because the retained regenerative cortical cells within this lesion are the cells of origin of PCO. The acrylic IOL design was associated with a lessor amount of peripheral Soemmering's ring as compared with all other designs. In sharp contrast to peripheral PCO, fixation of the IOL was a highly significant factor affecting the formation and quantity of central PCO-the clinically significant opacity behind the IOL optic, measured in this series either by scoring an intact retro-optical membrane or by documenting the presence of a Nd:YAG laser posterior capsulotomy orifice. The quantity of central PCO was consistently much lower in eyes with in-the-bag fixated IOLs compared with lenses with one or both haptics out of the bag. This is best explained by the fact that secure in-the-bag fixation positions the IOL optic in the best possible position to create a barrier effect. The lowest PCO rates were generally noted with the acrylic and modern silicone IOL designs.

Acrylic Resins↗
PubMed1999

Visual results and postoperative complications of capsular bag and ciliary sulcus fixation of posterior chamber intraocular lenses in children with traumatic cataracts.

PURPOSE: To evaluate the visual results and postoperative complications of capsular bag and ciliary sulcus fixation of posterior chamber intraocular lenses (IOLs) for traumatic cataracts in children. SETTING: Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS: Twenty children (20 eyes) with traumatic cataracts had extracapsular cataract extraction (ECCE) and posterior chamber IOL implantation. They were randomly divided into 2 groups. Capsular bag fixation was performed in 10 children (Group A) and ciliary sulcus fixation in the other 10 (Group B). Traumatic cataracts associated with large corneal lacerations (10.0 mm or more), hyphema, angle recession, or posterior segment involvement were excluded. The best corrected visual acuity (BCVA) as well as early and delayed postoperative complications were prospectively evaluated in both groups. RESULTS: The BCVA was 6/12 or better in 9 eyes (90%) in Group A and 8 eyes (80%) in Group B at the end of the mean follow-up (24.6 months +/- 10.6 [SD]). Amblyopia (1 eye in Group A) and corneal scar and commotio retinae (1 eye each in Group B) accounted for a visual acuity of worse than 6/12. The residual refractive error did not exceed 3.50 diopters in either group. The incidences of fibrinous anterior uveitis and pupillary capture were significantly higher in Group B (P < .05, Fisher exact test). CONCLUSION: Capsular bag fixation of posterior chamber IOLs provided visual results similar to those with ciliary sulcus fixation but was associated with fewer postoperative complications, particularly uveitis and pupillary capture. This represents another important reason to attempt in-the-bag fixation in cases of traumatic cataract.

Cataract↗
PubMed1998

Cataract surgery in patients with dry eyes.

PURPOSE: To evaluate the potential causes of postoperative complications and the visual outcome after surgery for age-related cataract in dry eyes. SETTING: Tertiary-care multidisciplinary referral medical institution. METHODS: The records of 15 patients (21 eyes) with age-related cataract, a Schirmer value of 5.0 mm or less in 5 minutes, and a tear-film breakup time of 5 seconds or less having complications after cataract surgery were reviewed. Patients were assigned to 1 of 2 groups: dry eye with probable secondary Sjögren's syndrome (Group 1); dry eye without connective tissue disorders (Group 2). The surgical procedure, preoperative and postoperative medications, postoperative complications, and final visual outcome were analyzed. RESULTS: Ten eyes (8 patients) in Group 1 and 11 (7 patients) in Group 2 had cataract surgery. In Group 1, postoperative endophthalmitis developed in 3 eyes and peripheral keratolysis in 4; 5 eyes attained a visual acuity between 6/60 and 6/18 2 years after surgery. In Group 2, filamentary keratitis developed in 6 eyes and peripheral keratolysis in 2 eyes; 6 eyes achieved a visual acuity of 6/12 or better 2 year after surgery. A significant decrease in visual acuity occurred between 3 months and 2 years postoperatively in both Group 1 (P = .010) and Group 2 (P = .0005). CONCLUSION: Cataract surgery in dry eyes had fewer complications and better visual outcome in patients who did not have connective tissue disease than in those who did.

Adult↗
PubMed1998

Evaluation of in situ fracture versus phaco chop techniques.

PURPOSE: To quantify and compare the phaco time required using in situ nucleofracture and phaco chop techniques. SETTING: Center for Research on Ocular Therapeutics and Biodevices and Miyake Laboratory, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Thirty human eyes obtained postmortem were randomly divided into 2 groups of 15 eyes each. In situ nucleofracture or phaco chop was performed in each group. The phaco time required for each technique was determined. RESULTS: The mean phaco time was 0.91 minutes +/- 0.37 (SD) for the phaco chop and 1.56 +/- 0.89 minutes for the in situ fracture technique (P < .015). CONCLUSIONS: The phaco chop technique reduced phaco time and total phaco power consumed during phacoemulsification without imposing a risk of intraoperative complications.

Aged↗
PubMed1998

Management of presumed intraocular tuberculosis: possible role of the polymerase chain reaction.

PURPOSE: A highly selective technique of polymerase chain reaction (PCR) was performed for detection of Mycobacterium tuberculosis from aqueous samples of 45 patients to evaluate its role in initiating antituberculosis treatment in patients with presumed intraocular tuberculosis. METHODS: Forty-five patients were divided into three groups. Group I included 17 patients of presumed intraocular tuberculosis, group II 13 disease controls and group III had 15 normal controls. Patients with positive PCR were offered antituberculosis chemotherapy and followed up for a minimum of 18 months. RESULTS: Ten patients in group I, 3 in group II and none in group III were positive for Mycobacterium tuberculosis by PCR. Ten patients with positive PCR for Mycobacterium tuberculosis (8 in group I and 2 in group II) were treated with antituberculosis chemotherapy and all showed resolution of inflammation without any recurrence over 18 months of follow-up. Two PCR positive patients treated with steroids alone, however, did not show complete resolution and had recurrent attacks. CONCLUSION: These results suggest that antituberculosis treatment in PCR positive patients leads to resolution of inflammation and elimination of recurrences, most likely by eliminating Mycobacterium tuberculosis from the intraocular tissues.

Adolescent↗
PubMed1998

Comparison between adjustable and non-adjustable hang-back muscle recession for concomitant exotropia.

We compared the results of strabismus surgery using adjustable and non-adjustable hang-back muscle recessions in 38 patients having concomitant exotropia. The two groups were matched for age of the patient, type of concomitant exotropia, amount of deviation, and type and amount of muscle surgery. At 6 months follow-up, 18 of the 19 patients (95%) in the adjustable hang-back recession group and 17 of the 19 patients (90%) in the non-adjustable hang-back recession group had ocular alignment within 10 prism diopters (PD) of orthophoria. At the most recent follow-up (mean 3.4 years), 12 of the 13 patients (92%) in adjustable hang-back recession group and 12 of the 14 patients (86%) in non-adjustable hang-back recession group had ocular alignment within 10 PD of orthophoria. There was no statistically significant difference in success rates between the two groups at 6 months postoperatively and at the most recent follow-up. This preliminary study suggests that non-adjustable hang-back muscle recession can be considered for routine concomitant exotropia.

Adolescent↗
PubMed1997

Clinical review 91: Female sex hormones and cardiovascular disease in women.

Cardiovascular disease is the leading cause of mortality in women, a fact that is underappreciated by women and physicians. Clinical and experimental data underscore the cardioprotective effects of female sex hormones, particularly estrogen. Indeed, the loss of female sex hormones after menopause contributes to the striking increase in the incidence of cardiovascular morbidity and mortality after menopause. Estrogen replacement therapy improved lipoprotein profiles in the postmenopausal women, but this accounts for less than half of the cardioprotective effects of estrogen replacement therapy. Addition of progestins to estrogen therapy in women appears not to significantly attenuate the cardioprotective effects of estrogen replacement therapy despite experimental data suggesting otherwise. This review addresses potential mechanisms, other than influences on lipoproteins, by which estrogen and progesterone exert their cardiovascular protective effects. Particular emphasis is directed to genomic and nongenomic effects of estrogen and progesterone that are exerted directly on cardiovascular tissue.

Blood Vessels↗
PubMed1997

Trabeculectomy with mitomycin-C for postkeratoplasty glaucoma: a preliminary study.

BACKGROUND AND OBJECTIVE: To evaluate the safety and efficacy of trabeculectomy with mitomycin-C in the management of postkeratoplasty glaucoma. PATIENTS AND METHODS: Included in this study were 16 eyes of 16 patients who underwent trabeculectomy with mitomycin-C for medically uncontrolled postkeratoplasty glaucoma, each having at least 6 months of follow-up. RESULTS: The mean pretrabeculectomy intraocular pressure (IOP) with maximal medical therapy was 34.6 mm Hg (range 24-45 mm Hg). The mean IOP following trabeculectomy with mitomycin-C was 14.2 mm Hg (range 8-36 mm Hg) by the end of a mean follow-up of 14.2 months (range 8-32 months). Fourteen eyes (87.5%) had complete success, 1 eye (6.25%) had qualified success, and 1 eye (6.25%) had failure. All the patents had the same or better visual acuity, compared with the preoperative value. None of the patients had postoperative complications, such as shallow anterior chamber, epithelial defect, or hypotony. CONCLUSIONS: Trabeculectomy with mitomycin-C is a safe and effective modality in the management of medically uncontrolled postkeratoplasty glaucoma.

Administration, Topical↗
PubMed1997

Topical ketorolac 0.5% solution for the treatment of vernal keratoconjunctivitis.

The efficacy of topical ketorolac 0.5% in treatment of vernal keratoconjunctivitis (VKC) was evaluated in a randomised double-blind prospective trial in 21 patients. Ketorolac treated eyes showed 50.7% reduction in main symptoms of itching compared to 33.3% relief in placebo treated eyes after 2 weeks of treatment (p < 0.01). Photophobia, ropy discharge, and conjunctival injection also lessened by 39.9%, 31.6%, and 39.1%, respectively, in ketorolac treated eyes compared to 23.8%, 17.3%, and 20.3% in placebo group. Transient stinging sensation was observed in 3 (14.3%) patients on ketorolac therapy. This study shows efficacy of ketorolac 0.5% solution in controlling symptoms in VKC.

Administration, Topical↗
PubMed1995

Postoperative complications of intraocular lens implantation in patients with Fuchs' heterochromic cyclitis.

We studied 29 eyes of 24 patients with Fuchs' heterochromic cyclitis who had extracapsular cataract extraction and posterior chamber intraocular lens implantation. Follow-up ranged from one to four years (mean two years). Intraoperative complications included mild hyphema (n = 4). Early postoperative complications included uveitis (n = 9), glaucoma (n = 7), pigment deposits on the lens surface (n = 8), vitreous opacities (n = 8), and cystoid macular edema (n = 1). Late postoperative complications included posterior capsule opacification (n = 6), recurrent uveitis (n = 4), and persistent glaucoma (n = 3). Best corrected visual acuity of 20/40 or better was achieved in 24 eyes (82.8%).

Adolescent↗
PubMed1994

Systemic diseases in age related cataract patients.

Age related cataract is the most common cause of blindness in the world. Most of these patients are elderly and are likely to have various associated systemic diseases. Higher mortality has been reported in patients undergoing cataract surgery. In order to determine the prevalence of associated systemic disease, we carried out a large eye camp based study in 6103 age related cataract patients. Seventeen percent of our patients had systemic problems. Pulmonary disease was seen in 4.3%, cardiovascular disease and hypertension in 4.1%, diabetes mellitus in 3.8%, skin disorder in 1.4%, orodental disease requiring tooth extraction in 3%, and other diseases were seen in 0.4% of the cases. Seventy eight patients (1.27%) had significant systemic complications post-operatively, 46% of whom required hospitalization in a tertiary care center. Thus, all patients undergoing cataract surgery should be evaluated for associated systemic diseases to prevent morbidity and mortality in the preoperative, operative and postoperative period.

Adult↗