Biomedical subjects

M Blumenthal

Publications and source records attributed to M Blumenthal.

At least 55 records · Page 3Linked to original sources

PubMed1995

Myopic keratomileusis in situ combined with VISX 20/20 photorefractive keratectomy.

We present the results of myopic keratomileusis in situ combined with photorefractive keratectomy (PRK) in five eyes with high myopia and low astigmatism. Follow-up ranged from 10 to 12 months. A hinge was used to perform subtotal lamellar keratectomy and the spherical component of myopia was corrected by three-zone PRK. The mean preoperative spheroequivalent was -21.00 diopters (D) and the postoperative spheroequivalent was -1.50 D. In four eyes the best corrected visual acuity was unchanged or improved; in one eye it decreased because of epithelial ingrowth in the lamellar interface. Persistent oblique longitudinal folds were noted in the corneal disc in one eye, and induced cylinder was found postoperatively in one eye.

Adult↗

PubMed1995

Management of Descemet's membrane detachment.

Detachment of Descemet's membrane is a rare but serious complication of cataract surgery. Most surgeons attempt to reposition the membrane by injecting air, slow-reabsorbing gases, or viscoelastic substances into the anterior chamber. We describe five cases of subtotal detachment without rolled scroll. These cases recovered spontaneously after two to three months. We believe that conservative treatment in such cases is indicated and has a good chance of favorable outcome.

Aged↗

PubMed1995

Fosinopril attenuates clinical deterioration and improves exercise tolerance in patients with heart failure. Fosinopril Efficacy/Safety Trial (FEST) Study Group.

This study was a 12-week, double-blind, placebo-controlled, multinational trial of fosinopril in 308 patients with mild to moderately severe heart failure (New York Heart Association [NYHA] functional class IIS 17%, IIM 48%, and III 35%; mean ejection fraction [+/-SD] 26.5% [+/-6.9%]; bicycle exercise duration 1 to 11 min). An initial dose of 10 mg once daily was titrated as tolerated to 40 mg once daily. Patients all received diuretic therapy; digoxin was optional. The primary endpoint was maximal bicycle exercise time; a secondary endpoint was occurrence of the following prospectively defined, ordered clinical events indicative of worsening heart failure: death, study discontinuation, hospitalization, emergency room visits, and need for supplemental diuretic. At study endpoint (last value obtained for each patient), bicycle exercise time increased more with fosinopril (38.1 s) than with placebo (23.5 s) (P = 0.101 by ANCOVA and 0.010 by prospectively defined dropout-adjusted endpoint analysis). More patients remained free of clinical events indicative of worsening heart failure when treated with fosinopril (89%) than with placebo (75%), and the worst events of fosinopril-treated patients tended to be less severe than those of placebo patients (P = 0.001). Analysis of the occurrence of individual clinical events showed that the need for supplemental diuretic was markedly reduced with fosinopril (8% vs 20%, of patients, P = 0.002), as were hospitalizations (3% vs 12% of patients, P = 0.002) and study discontinuations (2% vs 12% of patients, P < 0.001) for worsening heart failure; the two groups had similar incidences of death (3% of patients in the fosinopril group vs 2% in the placebo group, P = 0.723). In addition, symptoms of dyspnoea (P = 0.017), fatigue (P = 0.019), and NYHA functional class (P = 0.008) improved with fosinopril relative to placebo. In conclusion, fosinopril, at an initial dose of 10 mg once daily, subsequently titrated as tolerated to 40 mg once daily, increased exercise tolerance and reduced the frequency of clinical events indicative of worsening heart failure.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed1995

Surgical consequences in coexisting cataract and glaucoma.

Of the three classical approaches to surgery for coexisting cataract and glaucoma, last year's publications dealt with the surgical consequences of combined cataract and glaucoma operations only. When used in combined cataract and glaucoma surgery, a small-incision extracapsular cataract extraction (ECCE) with phacoemulsification (PHACO) was found to be only slightly superior to the standard manual ECCE in terms of postoperative intraocular pressure (IOP) control. Injections of 5-fluorouracil postoperatively did not improve IOP control in PHACO-ECCE-trabeculectomy or manual ECCE-trabeculectomy. A preliminary uncontrolled report suggests, however, that intraoperative mitomycin C application in PHACO-ECCE-trabeculectomy may result in excellent postoperative IOP control without antiglaucomatous medications, and with no significant mitomycin C-related complications. Controlled studies on mitomycin C application in small-incision cataract and glaucoma surgery are needed to assess its long-term effect on IOP and astigmatism.

Cataract↗

PubMed1994

[Secondary glaucoma after congenital cataract surgery].

In a retrospective study, the incidence of secondary glaucoma after congenital cataract extraction was evaluated. Causes of this type of secondary glaucoma include peripheral anterior adhesions which obstruct the anterior chamber angle and prevent normal outflow of aqueous humor, pupillary block, intraocular hemorrhage, and chronic uveitis, among others. During the past 12 years 41 children (57 eyes) were operated for congenital cataract. Secondary glaucoma was found in a 1-month-old boy and a 1-month-old girl (5.3%; 3 eyes). Follow-up in most patients was less than 5 years. A similar incidence of secondary glaucoma has been reported by others. In spite of the low incidence of this complication, secondary glaucoma should be excluded during routine follow-up of these children.

Cataract↗

PubMed1994

[Cataract surgery in Israel, 1984-1991].

A review of cataract surgery and intraocular lens implantation in Israel between 1984-1991 is presented. During these 7 years the number of cataract operations increased by 50%, with a significant increase in operations in private hospitals. The proportion of intraocular lens implantations increased from 47% to 93%, predominantly posterior chamber implantations. A rapid transition from intracapsular to extracapsular extraction was documented.

Cataract Extraction↗

PubMed1994

Using an anterior chamber maintainer to control intraocular pressure during phacoemulsification.

We describe a phacoemulsification technique that uses an anterior chamber maintainer (ACM) to control intraocular pressure. Continuous irrigation through the ACM maintains pressurized intraocular conditions throughout surgery and when the automated system is not activated. Intraocular pressure is stabilized at predetermined levels with minor fluctuations. Viscoelastics can be used in conjunction with the ACM.

Anterior Chamber↗

PubMed1994

Manual ECCE, the present state of the art.

BACKGROUND: Manual ECCE has proved to be safe surgery compatible with small incision, no stitches, possible topical anesthesia, very cost effective and quick rehabilitation. The technique has a learning curve and needs experience. "Mini-nuc" stands for mini nucleus. This surgery can be achieved only if performed under positive intraocular pressure (IOP). METHODS: A BSS bottle is connected to the eye by an anterior chamber maintainer (ACM). The height of the BSS bottle controls the IOP during the surgery. Controlled IOP is a principle suggested for all kinds of cataract surgery. It creates continuous flow which washes out of the eye cortex debris, blood, pigment, etc. The BSS contains antibiotics and adrenalin, it creates low turbulence due to the small amount of BSS used per case, 30-50 cc. A round capsulorhexis is essential. A special way of hydrodissection creates a very small hard core nucleus delivered to the anterior chamber and is extracted out through a sclero-corneal tunnel using a glide introduced under the nucleus to guide the nucleus out. RESULTS: Positive IOP during all stages of surgery creates the best operative conditions for controlled surgery throughout all manipulations. This technique is a very cost effective system and at the same time provides a high quality procedure.

Anterior Chamber↗

PubMed1994

Hydroexpression of subluxated lenses using a glide.

During the past 8 years, 15 patients (20 eyes) underwent a variety of operations to remove a subluxated lens. In six of these eyes, a new technique, featuring an anterior chamber maintainer and a plastic glide, was used for intracapsular cataract extraction (ICCE). The results achieved in these eyes were compared with those in 8 eyes in which cryo extraction was used, in 1 in which pars plana lensectomy was used, in 4 in which aspiration of lens material and peeling of the capsule was used, and in 1 in which a viscoelastic material and spatula were used. Using the glide, the lens is extracted through a scleral tunnel incision or a limbal opening. The length of the opening is somewhat smaller than the diameter of the lens and is significantly smaller than that used in traditional ICCE. The visual outcomes achieved with these various techniques were essentially identical. The proposed technique is simple and relatively safe for these complicated cases.

Adult↗

PubMed1994

Proximity-sensor dimmer device as an aid in the reduction of operating microscope-induced retinal phototoxicity.

The length of exposure to the light source of the operating microscope is a major factor determining retinal phototoxicity. In our experience, for about 20% of the time during cataract surgery, the surgeon is not looking through the oculars. To take advantage of these times, we designed a device, a proximity switch consisting of an infrared sensor mounted between the oculars in the operating microscope. When the surgeon's forehead approaches the microscope to look through the oculars, the sensor increases the illumination; when the surgeon moves away, it is automatically reduced. The resulting decreased overall exposure to light may reduce retinal phototoxicity.

Cataract Extraction↗

PubMed1993

Optic nerve compression by carotid arteries in low-tension glaucoma.

Low-tension glaucoma (LTG) is manifested by glaucomatous optic nerve damage and visual field loss despite normal intraocular pressure (IOP). We describe 62 patients with classical signs of LTG. Computed tomography (CT) was performed in all patients. In 56 of the patients (90.3%), pathology of the intracavernous carotid arteries adjacent to the intracranial opening of the optic canal could be demonstrated. In 28 patients (45.2%) a clear asymmetry of the optic nerve cupping was found and could be correlated with the severity of the carotid artery pathology. A control group of 24 age-matched patients included five (20.8%) with intracavernous carotid artery calcification and only one (4.2%) with intracavernous ectasia. We suggest that calcification, dilatation and ectasia of the carotid artery into the optic canal may play an important role in the pathogenesis of many cases of LTG. The close proximity of the carotid artery to the optic nerve at this location may result in compressive neuropathy with subsequent glaucomatous damage of the optic nerve head.

Aged↗

PubMed1993

Glare disability.

Explore the source record for details and available documents.

Cataract Extraction↗

PubMed1993

The gliding nucleus.

The lens glide is a disposable sterile plastic piece designed to achieve smooth, easy, safe expression of the nucleus in planned extracapsular cataract extraction. The advantages of the technique include prevention of iris prolapse or iris trauma, controlled nucleus extraction without sudden nucleus expulsion, direction of the nucleus toward the external opening, and prevention of malengagement of the nucleus to the anterior chamber angle or vitreous cavity. Using the glide facilitates extraction of a nucleus through a small limbal or scleral incision. Combining the glide with other modern surgical techniques, such as scleral tunnel small incision, capsulorhexis, and hydrodissection, results in a no-stitch low astigmatic wound and stable intraocular lens fixation in the capsular bag.

Cataract Extraction↗

PubMed1993

Cataract and intraocular lens implantation after remote trabeculectomy for Sturge-Weber syndrome.

A 6-year-old patient with Sturge-Weber syndrome and secondary glaucoma had trabeculectomy and subsequent reconstruction of a shallow anterior chamber. Six months later, a dense fibrin clot and anterior capsule cataract developed, requiring surgery. Using the anterior chamber maintainer technique, extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed. Twelve months later visual acuity was 20/30, intraocular pressure was 14 mg Hg, and the anterior chamber was deep and quiet.

Cataract↗

PubMed1993

Long-term follow up of accidental parafoveal laser burns.

The findings after 12 years of follow-up evaluation of 2 patients who sustained accidental parafoveal and juxtafoveal Nd:YAG laser injuries are reported. In both cases, the fovea was not destroyed by the initial insult and early scar formation. Both cases demonstrated, after more than a decade, minimal visual deficit without significant late complications. In spite of early decrease in visual performance, the long-term prognosis for Q-switched Nd:YAG laser retinal lesions in which the fovea was not directly involved in the injury or its repair mechanisms is relatively benign.

Adult↗

PubMed1993

Internal sclerostomy using laser ablation of dyed sclera in glaucoma patients: a pilot study.

Twelve eyes of 12 patients with refractory glaucoma were treated with internal sclerostomy using laser ablation of dyed sclera. The technique involves iontophoretic impregnation of the sclera at the limbal region with 1% methylene blue and subsequent delivery of a pulsed dye laser beam to the stained area through a goniolens. The red wavelength of 664 nm generated by the laser is maximally absorbed by the stained sclera and creates a through and through sclerostomy. Successful complete sclerostomy was achieved in seven eyes (58.3%) but there was some reduction of intraocular pressure (IOP) in all cases. Mean prelaser IOP (of all 12 eyes) was 36.6 mm Hg and 1 hour after therapy it was reduced to 20.0 mm Hg. At the end of the follow-up period (mean 16 months) the mean IOP was 23.7 mm Hg; five eyes (41%) maintained their IOP below 22 mm Hg, and the average number of medications per eye came down from 3.25 to 2.25 per eye. Transient corneal burns with Descemet's membrane folds adjacent to the laser impact zone were detected in eight eyes (67%). No major complications like IOP spike, hyphaema, iridodialysis, or retinal detachment have been detected. Clear cornea and dark blue scleral staining are essential for the mechanical success of this procedure. Gonioscopic laser internal sclerostomy of methylene blue dyed sclera is technically feasible and the preliminary results of IOP control in refractory glaucoma are promising. Modifications of the iontophoresis process and laser parameters are currently under investigation in order to improve these results.

Adult↗

PubMed1993

Suggested mechanism for acute transient myopia after sulfonamide treatment.

This report describes the occurrence of acute transient myopia in a patient treated with sulfonamide. We followed this patient by performing A-scan ultrasonographic ocular measurements documenting the anterior chamber depth, lens thickness, and axial length during the acute and convalescent periods. The outstanding feature in this case was the documented ultrasonographically significant reduction of the anterior chamber depth combined with lens thickening. This could be caused by a forward displacement of the lens as a result of allergic ciliary body edema and rotation. These changes could explain the mechanism of drug-induced transient myopia.

Acute Disease↗

PubMed1993

Orbital pseudotumor presenting as acute glaucoma with choroidal and retinal detachment.

A 68-year-old woman presented with acute visual loss, elevated intraocular pressure (IOP), and a flat anterior chamber combined with retinal and choroidal detachment. The diagnosis of orbital pseudotumor was based on the patient's poor response to conventional therapy and on computerized tomography and ultrasound findings. After treatment with oral corticosteroids, the inflammatory process, elevated IOP, and choroidal and retinal detachment resolved.

Acute Disease↗