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Biomedical subjects

L F Cashwell

Publications and source records attributed to L F Cashwell.

16 recordsLinked to original sources
PubMed1999

Axial length decrease accompanying successful glaucoma filtration surgery.

OBJECTIVE: To evaluate change in axial length measurement after successful glaucoma filtering surgery. DESIGN: Retrospective consecutive case series. PARTICIPANTS: Sixty-two patients with phakia who underwent primary trabeculectomy. INTERVENTION: The A-scan biometry of ocular axial length before and after trabeculectomy. MAIN OUTCOME MEASURES: Changes in ocular axial length measurement after successful trabeculectomy were analyzed. RESULTS: The mean decrease in axial length measurement was 0.423 mm (range, -2.8 to +0.5 mm). Regression analysis yielded a statistically significant association between decrease in axial length measurement and age (P = 0.0001) and post-trabeculectomy intraocular pressure decrease greater than 30 mmHg (P = 0.01). Analysis of variance revealed a significant association between decrease in axial length measurement and use of antimetabolite (P = 0.005). Pseudophakic axial length measurements increased an average of 0.275 mm compared to the axial length after trabeculectomy and before cataract surgery. CONCLUSIONS: Axial length measurement decreased in 32 of 62 eyes after successful initial trabeculectomy. A decrease in axial length measurement may have an influence on intraocular lens calculations. Therefore, the authors recommend that an axial length measurement be obtained on phakic eyes before an initial trabeculectomy to reduce the risk of an inaccurate intraocular lens power calculation based on post-trabeculectomy axial length measurements.

Adult↗
PubMed1996

Long-term effect of cataract extraction on the function of an established filtering bleb.

BACKGROUND AND OBJECTIVE: For patients with advanced glaucoma, care must be taken in the management of cataract to prevent loss of long-term intraocular pressure (IOP) control. The authors evaluated the effect of extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PC IOL) implantation via the inferotemporal limbal approach on the function of an established glaucoma filtering bleb. PATIENTS AND METHODS: Twenty-three eyes of 21 patients with a minimum of 48 months of follow-up (range 48 to 97 months) were retrospectively evaluated. IOP, bleb status, visual field, and visual acuity were compared before and after operation. RESULTS: Average IOP increased from 8.7 mm Hg preoperatively to 12.2 mm Hg at last follow-up. Six blebs (26.1%) decreased in size, 11 (47.8%) did not change, 4 (17.4%) increased in size, and 2 (8.7%) were lost and required refiltration. At last follow-up, 23 eyes had an IOP of less than 20 mm Hg and did not show progression of glaucoma damage by optic disc or visual field evaluation. Six eyes required resumption of medical therapy and 2 eyes required refiltration for adequate control. CONCLUSION: ECCE with PC IOL implantation via the inferotemporal limbal approach in the presence of an established filtering bleb is effective in the long-term management of the glaucomatous eye with cataract.

Aged↗
PubMed1995

Central visual field changes associated with acquired pits of the optic nerve.

BACKGROUND: With the increased use of a hand-held indirect lens and slit-lamp biomicroscopy for stereoscopic viewing of the optic nerve, the authors believe that an acquired pit of the optic nerve is more common than was recognized previously. This increased recognition has led to the awareness that the central visual field was affected frequently in the presence of such an acquired pit. METHODS: The authors retrieved the charts of a series of 97 patients who had an acquired pit of the optic nerve during an 18-month period and retrospectively reviewed the automated visual fields associated with these pits using the Humphrey Visual Field Analyzer Programs 30-2 and 10-2 and looked for involvement of the central visual field. RESULTS: In 81.7% of the acquired pits of the optic nerves, one of the central-most test points (3 degrees from fixation) in the appropriate hemifield on the 30-2 format was depressed severely by Statpac II (P < 0.5). The authors therefore restudied as many patients as possible using the 10-2 format to determine the extent of central visual field involvement in the presence of an acquired optic nerve pit. Among these patients, the 10-2 format demonstrated that the approach of the defect to fixation varied, but was frequently inside 3 degrees, reaching between 1 degrees and 3 degrees from fixation in 96.7% of the eyes with depression of at least one central point on the 30-2 format. It was more likely that an acquired pit located at the inferior pole of the optic nerve would produce a visual field defect within 3 degrees of fixation than such a pit at the superior pole (P = 0.03). CONCLUSION: The authors showed that the presence of an acquired pit in an optic nerve damaged by glaucoma frequently is associated with a threat to fixation.

Adult↗
PubMed1992

Malignant glaucoma after laser iridotomy.

Malignant glaucoma was initially reported as developing after surgery for glaucoma. Subsequently, associations with trauma, inflammation, and the use of miotic agents, as well as spontaneous occurrence have been noted. Laser iridotomy has been assumed to avoid the risk of subsequent malignant glaucoma in eyes with angle-closure glaucoma by avoiding surgical incision of the eye. However, the authors report six cases of malignant glaucoma after laser iridotomy. In all but two cases, medical therapy for the malignant glaucoma resulted in deepening of the anterior chamber and normalization of the intraocular pressure. Malignant glaucoma recurred in five of the patients, and two patients had malignant glaucoma in the fellow eye.

Adult↗
PubMed1989

Idiopathic true exfoliation of the lens capsule.

The ophthalmic literature of the past half century contains relatively few reports of true exfoliation of the lens capsule, reflecting a reduction in the occupation-related occurrence of "glassblower's cataract." The authors report 11 eyes (7 patients) with a diaphanous membrane arising from the anterior lens capsule, which they have identified by slit-lamp biomicroscopy. None of the seven patients had had extended exposure to an infrared-emitting heat source or ocular trauma; one patient with bilateral true exfoliation of the lens capsule had a history of unilateral herpes simplex keratitis. The average age of these patients at the time of diagnosis was 85.4 years. Identification of these 11 eyes by two ophthalmologists during a 6-year period suggests that idiopathic true exfoliation of the lens capsule has been underdetected, under-reported, or both.

Aged↗
PubMed1989

The spectrum of cavitary optic disc anomalies in a family.

The current classification of cavitary optic disc anomalies including the morphologically related entities--optic nerve pit, morning glory disc anomaly, coloboma of the optic nerve, and retinochoroidal coloboma involving the optic nerve--is inexact and confusing. Traditionally, these disc abnormalities have been regarded as distinct morphologic anomalies. Thirty-five members of a five-generation kindred with autosomal dominantly inherited optic disc anomalies were examined. Observed abnormalities in this pedigree comprised a spectrum of morphologic variants ranging from large anomalous discs to typical pits and colobomas. The findings in this family suggest a variable expression of a single autosomal dominant defect rather than the chance occurrence of three separate, distinct, but morphologically similar entities occurring in a single pedigree.

Chromosome Aberrations↗
PubMed1988

Exfoliation syndrome. Prevalence in a southeastern United States population.

A prospective study of 2121 patients in the southeastern United States having no evidence of glaucoma, suspected of having primary open angle glaucoma, having primary open angle glaucoma, or having open angle glaucoma with exfoliation syndrome revealed an overall prevalence of exfoliation syndrome of 1.6% and a prevalence in the glaucoma subpopulation of 6.0%. All but one of the 33 patients with exfoliation syndrome were at least 60 years of age, and the prevalence of exfoliation syndrome in the subgroup of 1000 patients in this age group was 3.2%. Among the patients in this age group who did not have open angle glaucoma, 1.6% had exfoliation syndrome, and this prevalence was significantly less than those reported in studies from other geographic areas.

Adult↗
PubMed1988

Optic nerve coloboma associated with renal disease.

Optic nerve colobomas can occur as sporadic abnormalities, may be inherited as an autosomal dominant defect, occur as part of syndromes, and are rarely associated with cardiac malformations and midline encephaloceles. Karcher [1979] described a father and son with the "morning glory" optic disc anomaly and renal disease as a new association. We report on two brothers with optic nerve colobomas associated with renal disease. The ophthalmologic findings and renal histopathology are presented. This second familial occurrence suggests that the association of optic nerve coloboma and renal disease is a newly recognized syndrome.

Child↗
PubMed1988

Panretinal photocoagulation in the management of neovascular glaucoma.

We report a retrospective evaluation of the role of panretinal photocoagulation in the primary treatment of neovascular glaucoma. Thirty-six eyes (32 patients) received aggressive argon laser panretinal photocoagulation beginning as soon as feasible after diagnosis of the developing neovascular glaucoma. Thirty eyes were stabilized by photocoagulation, though 25 required long-term glaucoma medications. Six eyes required additional procedures. Vision deteriorated in 21 of the 36 eyes (nine eyes finally having "no light perception") during the 32.8-month follow-up. Intraocular pressure averaged 39.0 mm Hg before photocoagulation and 21.2 mm Hg at study's end. All 36 eyes were retained and remain comfortable. We conclude that panretinal photocoagulation plays an important role in the management of neovascular glaucoma.

Aged↗
PubMed1988

Exfoliation syndrome in the southeastern United States. I. Prevalence in open-angle glaucoma and non-glaucoma populations.

A prospective study of 2,121 patients, 30 years of age or older, examined in two clinics in the southeastern United States with dilated slit-lamp biomicroscopy, revealed the exfoliation syndrome in 1.6% of the total population and in 6.0% of an open-angle glaucoma subpopulation. All but one of the 33 patients with exfoliation syndrome were over age 60 years, and the prevalence of exfoliation syndrome in the subgroup over age 60 was 3.2%. Among the patients over age 60 who did not have open-angle glaucoma, 1.6% had exfoliation syndrome. By chi square analysis, the prevalence of the exfoliation syndrome in the over age 60 population without glaucoma was found to be significantly less (P = 0.00009) than reported in studies from other geographic areas.

Age Factors↗
PubMed1986

Glaucoma management in pseudophakia.

The ever-increasing number of cataract extractions followed by insertion of intraocular lenses has resulted in the emergence of a new group of patients with severe glaucoma. A series of 41 patients (45 eyes) referred for evaluation and management of uncontrolled glaucoma in pseudophakia is presented. Glaucoma had preexisted in 23 eyes. Sixteen different mechanisms were responsible for the postoperative glaucoma. Among the 41 patients were three with acquired pigmentary glaucoma. The case report of one of those three demonstrates that nonfixation of an Anis posterior chamber intraocular lens was the means by which iris pigment was dislodged. In all cases medical therapy was instituted or intensified, but resulted in acceptable glaucoma control in only 14 eyes. Laser procedures were used in 24 eyes, and laser therapy followed by medical therapy resulted in control in 19 eyes. The remaining 12 eyes underwent 31 surgical procedures, including three enucleations.

Aged↗
PubMed1985

Laser iridotomy for management of angle-closure glaucoma.

In this series, laser iridotomies were produced in 112 eyes, with a minimum of six months' follow-up. Despite the need to reopen some laser-produced iridotomies, it has proved to be safe and effective therapy. When the cornea is clear, laser iridotomy is an alternative to surgical iridectomy and can be used on outpatients without the risks of intraocular surgery. This alternative is especially beneficial to patients with combined-mechanism glaucoma and to patients in whom incisional surgery is contraindicated. There appears to be a definable curve of increased proficiency in producing patent laser iridotomies as the surgeon's experience increases.

Adolescent↗