Biomedical subjects

M R Moster

Publications and source records attributed to M R Moster.

33 records · Page 2Linked to original sources

PubMed1995

Management of overfiltering and leaking blebs with autologous blood injection.

We describe our experience with intrableb autologous blood injection to manage over-filtering and leaking blebs. Autologous blood was injected into 12 thin cystic filtration blebs of 12 eyes. Indications for blood injection included symptomatic hypotony in five eyes, hypotony associated with bleb leakage in five eyes, and bleb leakage without hypotony in two eyes. Seven eyes (58.3%) were classified as successes and five eyes (41.7%) were classified as failures. The mean (+/- SD) follow-up was 6.8 +/- 2.6 months. Among the eyes classified as successes, a significant increase was noted in intraocular pressure and visual acuity by a mean (+/- SD) of 5.1 +/- 2.9 mm Hg and 5.3 +/- 2.1 lines, respectively. Bleb leakage resolved in four of seven eyes. The most common complication was hyphema formation. Injection of autologous blood into a filtration bleb is an alternative procedure for management of excessive filtration or bleb leakage in selected patients.

Adult↗

PubMed1995

Long term effect of apraclonidine.

AIMS: To evaluate the effect of the chronic use of apraclonidine 0.5% on the intraocular pressure (IOP) of patients with glaucoma; also, to study the side effect profile of this drug when used chronically. METHODS: All patients who had uncontrolled IOP, who were either already on glaucoma medications, or who were intolerant of other glaucoma medications were enrolled. A total of 185 patients were started on apraclonidine 0.5% two to three times a day in one eye. RESULTS: Follow up extended to 35 weeks. The mean difference in IOP between treated and control eyes was 2.1 (SD 5.0) mm Hg. A similar IOP lowering effect was obtained comparing IOP difference from baseline in the treated eye only. CONCLUSION: By the end of the follow up period, 46% of patients were still on the medication. The drug was stopped in 23% of patients because of side effects and in 31% of patients because of failure to lower IOP significantly.

Adolescent↗

PubMed1994

Trabeculectomy is associated with retrobulbar hemodynamic changes. A color Doppler analysis.

PURPOSE: To determine whether color Doppler hemodynamic changes occur in the retrobulbar circulation after trabeculectomy. METHODS: The authors prospectively enrolled 20 patients undergoing trabeculectomy and performed color Doppler imaging of both eyes before surgery and then at approximately 2-, 5-, and 14-week intervals after surgery. The systolic maximum velocity, mean velocity, end-diastolic velocity, and vascular resistance (resistance index) of the central retinal artery, nasal and temporal short posterior ciliary arteries, and ophthalmic arteries were determined. Statistical comparison of the preoperative and postoperative measures were performed on both the operative and nonoperative eye using the paired Student's t test. RESULTS: A statistically significant increase was observed in the mean and end-diastolic velocity and a significant decrease in the vascular resistance of the central retinal artery and both short posterior ciliary arteries at nearly all postoperative intervals (25 of 27 preoperative and postoperative comparisons; P < 0.05) The ophthalmic artery, while showing an increased velocity at all intervals, only attained a statistically significant increase in one of three postoperative intervals for mean velocity and two of three intervals for end-diastolic velocity (P < 0.05). There were no notable changes in resistance. The nonoperative eye did not show a statistically significant change in velocity or in resistance in the central retinal artery or either nasal or temporal short posterior ciliary artery at any interval (0 of 27 preoperative and postoperative comparisons for mean velocity, end-diastolic velocity, and resistance index.) CONCLUSION: Sustained increases in mean velocity and end-diastolic velocity and decreases in resistance index were observed in the central retinal artery and the short posterior arteries with clinically attainable reductions in intraocular pressure after trabeculectomy in patients with chronic glaucoma. These findings are consistent with, but not diagnostic of, increased blood flow through these vessels.

Adult↗

PubMed1993

Effects of topical mitomycin C on primary trabeculectomies and combined procedures.

The charts were reviewed of all patients who underwent primary trabeculectomies (group 1) or combined procedures (phacoemulsification + intraocular lens implantation + trabeculectomy--group 2) and received intraoperative mitomycin C (0.4 mg/ml) between 1991 and 1992 at Wills Eye Hospital. A total of 54 eyes of 54 patients were included: 39 in group 1 and 15 in group 2. Intraocular pressure was controlled successfully in 97.4% of eyes in group 1 (mean follow up 6.7 months), and in 93.3% in group 2 (mean follow up 6.8 months). Main complications included choroidal detachment (n = 15), shallow anterior chamber (n = 9), cataract formation (n = 8), and hypotony maculopathy (n = 3). The use of mitomycin C in primary trabeculectomies and combined procedures is associated with high success rates. However, it may be associated with unacceptable risks of vision threatening complications related to excessive filtration.

Administration, Topical↗

PubMed1993

The influence of primary open-angle glaucoma upon the retrobulbar circulation: baseline, postoperative and reproducibility analysis.

CDI is showing continued promise as a reliable, reproducible method to assess the hemodynamics of a variety of ophthalmic diseases in which vascular perfusion abnormalities are suspect. Moreover, some patients with advanced POAG appears to have abnormalities of the vasculature of the retrobulbar circulation that is corrected by trabeculectomy. Continued CDI clinical correlations with longitudinal studies are now required to elucidate the significance of this technology and these results for individual patients.

Adult↗

PubMed1993

Hypotony maculopathy following the use of topical mitomycin C in glaucoma filtration surgery.

Intraoperative mitomycin C has been shown to be highly effective in increasing the success rate of glaucoma filtration surgery. Between October 1991 and June 1992, 169 eyes of 156 patients underwent filtration procedures with intraoperative mitomycin C. In the postoperative period, five eyes (2.9%) developed hypotony maculopathy, characterized by disc edema, vascular tortuosity, and chorioretinal folds in the macular area. Cryotherapy was applied to three eyes, and was effective in reversing the hypotony in two of them. However, the visual prognosis was poor: after a mean follow up of 5.3 months (range, 3.5 to 8 months), visual acuity returned to preoperative levels in one case. Hypotony maculopathy may develop after glaucoma filtration surgery with intraoperative mitomycin C. We suggest restricting the indication of its adjunctive use to eyes with poor surgical prognosis or those in which a very low intraocular pressure is desired. The use of extra sutures (which can be sectioned by laser) or releasable sutures to prevent excessive filtration in the postoperative period also is advisable.

Administration, Topical↗

PubMed1990

The chamber-retaining suture revisited.

In 1977, C. William Simcoe developed the anterior chamber-retaining suture as a means of preventing intraocular lens-cornea touch during intraocular lens manipulation, penetrating keratoplasty, and following filtration surgery. Though seldom remembered today, Simcoe's innovation safely and effectively insures corneal well-being following increasingly complex modern filtration and shunt procedures. The use of a combination of double-armed 9-0 nylon suture and anterior chamber-bridging straight needles simplifies placement.

Anterior Chamber↗

PubMed1989

Risk factors for the development of Tenon's capsule cysts after trabeculectomy.

Tenon's capsule cysts (TCCs) are a complication of glaucoma filtering surgery. They are frequently associated with substantial elevations in intraocular pressure (IOP) beginning 2 to 8 weeks postoperatively. To determine the incidence and possible risk factors for the development of TCCs, case records of all patients who received trabeculectomy over a 4-year period at the Wills Eye Hospital were reviewed. The incidence of TCCs was 28% in those who underwent trabeculectomy. Characteristics of patients after trabeculectomy in whom TCCs developed were compared with patients after trabeculectomy in whom TCCs did not develop. Both univariate and multivariate techniques were used to assess the association of characteristics associated with the development of TCCs. Factors associated with increased risk (P less than 0.05) were: history of prior TCCs, argon laser trabeculoplasty, male gender, and the use of preoperative sympathomimetics. The use of a compression shell was associated with decreased risk (P less than 0.05).

Adult↗

PubMed1989

Neodymium-YAG transscleral cyclophotocoagulation. The role of pigmentation.

Using a rabbit model we investigated the role of pigmentation of the ciliary body in obtaining ciliodestruction by neodymium-YAG transscleral cyclophotocoagulation. There was marked destruction of the ciliary body in pigmented rabbit eyes, but no histologic effect was observed in albino rabbit eyes. These findings suggest that pigmentation of the ciliary body is important for obtaining the desired response from neodymium-YAG transscleral cyclophotocoagulation in rabbit eyes by our technique. Further study is necessary to define the role of pigmentation in human eyes in this treatment modality.

Animals↗

PubMed1988

Surgical therapy of chronic glaucoma in aphakia and pseudophakia.

Most glaucoma surgical procedures are less successful in aphakic or pseudophakic eyes. The authors reviewed 91 consecutive initial glaucoma procedures in aphakic patients from 1979 to 1986 to determine successful outcomes and complications. Success was defined as an intraocular pressure (IOP) of at least 30% below the preoperative value and less than 21 mmHg, less than 2 lines of Snellen acuity loss, and no further surgical intervention. At 9 months, success rates were: trabeculectomy, 4 of 15 patients; cyclodialysis, 3 of 20 patients; neodymium:YAG (Nd:YAG) cyclophotocoagulation, 1 of 8 patients; cyclocryotherapy, 9 of 22 patients; anterior chamber tube shunt (Schocket procedure), 3 of 6 patients; and argon laser trabeculoplasty, 2 of 20 patients. Severe complications included phthisis bulbi in 11% of cyclocryotherapy and severe visual loss in 20% with cyclodialysis and 14% with cyclocryotherapy. Results confirm the difficulty of surgical therapy in these patients.

Aged↗

PubMed1986

Neodymium-YAG laser iridectomies in glaucoma associated with closed or occludable angles.

A review of our first 200 neodymium-YAG laser iridectomies performed over a two-year period in various forms of glaucoma showed patent iridectomies in 180 of 182 eyes (99% success) at the last examination (one to 26 months postoperatively). Both failures had preexisting chronic uveitis. Eighteen eyes were lost to follow-up. Complications included intraocular pressure increased more than 10 mm Hg in 54 eyes (30%), hemorrhage in 36 eyes (20%), iritis in 21 eyes (11.5%), posterior synechiae in 13 eyes (7%), corneal changes in seven eyes (4%), and pupillary distortion in six eyes (3%). With experience, fewer applications are required to penetrate the iris, and retreatment to obtain patency is less likely to be needed.

Glaucoma↗

PubMed1986

Laser iridectomy. A controlled study comparing argon and neodymium: YAG.

Laser peripheral iridectomies were performed on both eyes of 38 patients with acute or chronic primary angle-closure glaucoma or with narrow angles capable of closure. The right eye was treated with the neodymium YAG laser (Nd:YAG) and the left eye with the argon laser. Patients were followed for a minimum of eight months. The mean number of applications to produce iris penetration was six with the Nd:YAG laser and 73 with the argon laser. Visual acuity, postoperative intraocular pressure (IOP), corneal changes, and pigment dispersion were similar in the two groups. Microhyphema was more prevalent in the Nd:YAG iridectomy group. Pupillary distortion, iritis, and late failure of patency were more frequent in the argon laser group. Nd:YAG laser iridectomies require fewer applications and produce less inflammation. This controlled study demonstrates that when properly and carefully performed, the Nd:YAG laser is at least as effective and appears to be as safe as the argon laser for performing peripheral iridectomies.

Adult↗

PubMed1983

B-scan ultrasonic evaluation of a dilated superior ophthalmic vein in orbital and retro-orbital arteriovenous anomalies.

All patients between 1977 and 1982 who presented with unilateral exophthalmos were evaluated with contact B-scan ultrasonography. Of these, eight patients were diagnosed as having retro-orbital or orbital arteriovenous anomalies (two carotidcavernous sinus fistulas, four dural arteriovenous malformations, and two orbital arteriovenous malformations). On B-scan ultrasound, all of these patients demonstrated a dilated superior ophthalmic vein. None of the other patients with unilateral proptosis demonstrated this finding. With recent advances in treatment of these conditions, early diagnosis becomes increasingly important. Contact B-scan ultrasonography (which is widely available, convenient, and expedient) can be used for early diagnosis of arteriovenous anomalies in the orbit and cavernous sinus areas. Other ultrasonic techniques such as A-scan, standardized A-scan, or immersion B-scan, are equally reliable in the recognition of a dilated superior orbital vein. In the authors' opinion, however, these are less convenient, more time consuming, and require more expertise for similar results.

Adult↗

PubMedDate not supplied

The outcome of the functioning filter after subsequent cataract extraction.

OBJECTIVE: To evaluate and compare the outcome of functioning filtration surgery followed by cataract surgery with posterior intraocular lens implantation by both phacoemulsification and extracapsular cataract extraction (ECCE) techniques in glaucomatous eyes. PATIENTS AND METHODS: We retrospectively evaluated the clinical course of 77 eyes (68 patients) that after successful trabeculectomy, underwent cataract surgery by either phacoemulsification or ECCE techniques. We determined the frequency of partial and absolute failure following cataract surgery by either phacoemulsification or ECCE in eyes with functioning trabeculectomies. Partial failure of intraocular pressure (IOP), control after cataract extraction was defined as the need for an increased number of antiglaucoma medications or argon laser trabeculoplasty to maintain IOP < or =21mm Hg. Complete failure of IOP control after cataract surgery was defined as an IOP >21 mm Hg on at least two consecutive measurements one or more weeks apart or the performance of additional filtration surgery. Failure rates were calculated using the Kaplan-Meier actuarial method. Failure rates between phacoemulsification and ECCE subgroups were compared using the log rank test. RESULTS: The probability of partial failure by the third postoperative year after cataract surgery was 39.5% in the phacoemulsification subgroup and 37.3% in the ECCE subgroup. This small difference is not statistically significant (P = 0.48). The probability of complete failure by the fourth postoperative year after cataract surgery was 12.0% in the phacoemulsification subgroup and 12.5% in the ECCE subgroup. This difference is also not statistically significant (P = 0.77). At the 6-month follow-up visit, visual acuity of both groups improved one or more lines in 87.0% of patients, and worsened one or more lines in 3.9% of patients. Sixty-one percent achieved visual acuity of 20/40 or better. The most frequent complication was posterior capsular opacification requiring laser capsulotomy that occurred in 31.2% of patients. CONCLUSION: Cataract extraction by either phacoemulsification or ECCE following trabeculectomy surgery may be associated with a partial loss of the previously functioning filter and the need for more antiglaucoma medications to control IOP.

Aged↗

PubMedDate not supplied

Comparison of the 20-MHz ultrasound probe with ultrasound biomicroscopy in glaucoma.

The 20-MHz ultrasound probe was compared with ultrasound biomicroscopy to determine its usefulness in imaging various glaucomatous conditions. Ten patients with glaucoma underwent anterior segment imaging with both the 20-MHz probe, which attaches to the I3 B-scan (Innovative Imaging Inc., Sacramento, CA), and the Ultrasonic BioMicroscope (UBM; Paradigm Medical Industries, Salt Lake City, UT). All pathology was easily demonstrable using the 20-MHz probe, in one case showing a retinal detachment not seen with the UBM. However, anterior findings such as fluid in the suprachoroidal space and sclerostomy sites in postoperative trabeculectomy cases were more difficult to view with the 20-MHz probe. The use of coupling enhanced the quality of the latter images. The 20-MHz ultrasound probe may be a viable aid in diagnosis and follow-up of certain glaucomatous conditions, and the use of a coupling device enhances its images.

Anterior Eye Segment↗