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Biomedical subjects

N H Joseph

Publications and source records attributed to N H Joseph.

12 recordsLinked to original sources
PubMed1987

Surgery for refractory glaucoma. Results and complications with a modified Schocket technique.

A consecutive series of 55 eyes of 50 patients who received silicone tube implant surgery is reviewed. Seven patients had neovascular glaucoma and 43 had refractory nonneovascular glaucoma, for which previous surgery was unsuccessful. A minimum follow-up of one year (mean, 18 months) was achieved for 30 eyes of 30 patients. For these eyes, the success rate (as defined by an intraocular pressure of 25 mm Hg or less, with or without medication) was 80%. Visual acuity was maintained or improved in 67% of eyes. The complications encountered in the overall study of 55 eyes are discussed, and six main causes of failure are identified. These include exposure of the silicone tube from erosion of the overlying conjunctiva; blockage of the proximal orifice of the tube; corneal decompensation secondary to tube touch; extrascleral tube compression proximal to the gutter; blockage of the distal orifice of the tube beneath the gutter; and insufficient aqueous absorption from the encapsulated area surrounding the 360 degrees encircling gutter. Revision surgery was required in 21 eyes (38%). Two alternative methods for insertion of the silicone tube (a "cyclodialysis approach" and a "trabeculectomy approach") are described, and their complications are compared. The incidences of tube exposure, choroidal detachment, and flat anterior chambers were far higher in the trabeculectomy group. The cyclodialysis group had an increased incidence of hyphema and corneal endothelial touch by the tube.

Adolescent↗
PubMed1987

Use of one-piece valved tube and variable surface area explant for glaucoma drainage surgery.

The results of glaucoma surgery on 37 eyes of 36 patients after the use of a one-piece valved silicone explant are described. With a follow-up of 6 to 24 months, intraocular pressures (IOPs) averaging 8.0 to 17.3 mmHg were recorded. The maximum number of eyes receiving antiglaucoma medicines at any of the follow-up visits was six. These results were compared with the authors' previous results with the two-piece tube and gutter explant (ACTSEB). It was found that lower IOPs were obtained with fewer complications from overdrainage in the immediate postoperative period. This difference was attributed to the valve reducing but not preventing overdrainage and less chance of "fibrosis" blocking the tube/plate interface.

Adult↗
PubMed1987

Lack of beneficial effect of intensive topical steroids and beta irradiation of eyes undergoing repeat trabeculectomy.

Sixteen eyes (14 patients) that had previous failed trabeculectomy underwent a further trabeculectomy. In the postoperative period they were treated with intensive topical steroids (hourly) for several months. At the end of one year the overall results of surgery were not improved using this regime when compared with a previously reported series of similar patients who were treated with less steroid. It appeared that the addition of more intensive topical steroid usage was no more successful than steroids given in a four-time-a-day program. Additionally, some eyes were treated with beta irradiation, which did not appear to influence the results. Eyes that had a limbus-based conjunctival flap at reoperation had a more favorable outcome than those having fornix-based flaps.

Administration, Topical↗
PubMed1986

A one-piece drainage system for glaucoma surgery.

A one-piece system for aqueous humour drainage consists of a tube, with a pressure gradient limiting valve, physically continuous with and not able to be divided by scar tissue from a large surface area silicone object. Results in the first 19 consecutive eyes operated on at Moorfields Eye Hospital using this device show average intraocular pressures below 18 mmHg at one, 2, 3, 6 and 9 months post-operation. Further study of this device seems appropriate.

Adolescent↗
PubMed1985

An animal model of filtration surgery.

An animal model for glaucoma fistulising surgery is described. The model is designed to fail after a few weeks. It is suggested that the model may be used to investigate the effects of topical or systemic agents on the results of glaucoma surgery. The preliminary results of intraocular pressure and facility of outflow in the control group of rabbits are presented.

Animals↗
PubMed1976

Use of vidarabine in epidemic keratoconjunctivitis due to adenovirus types 3, 7, 8, and 19.

Adenovirus types 3,7,8, and 19 were isolated during an outbreak of epidemic keratoconjunctivitis. There was no clinically recognizable difference in the severity of the disease produced by each adenovirus type. Twenty-nine patients with positive viral cultures were given either 3.3% vidarabine ointment or polyvinyl alcohol eyedrops within five days of the onset od disease, and were observed for at least 14 days. An observer unaware of which medication was prescribed found subepithelial corneal infiltrates in 81% of vidarabine-treated patients and in 63% of control subjects. Vidarabine was ineffective in preventing subepithelial corneal infiltrates in keratoconjunctivitis caused by adenovirus.

Adenoviridae Infections↗
PubMed1975

Trabeculectomy: a re-evaluation after three years and a comparison with Scheie's procedure.

Seventy-one patients with glaucoma needing surgical correction had either a peripheral iridectomy with a thermal sclerostomy or a trabeculectomy utilizing a modification of Watson's technique in which the scleral flap was closed tightly with sutures. Results of surgery were analyzed at intervals up to and including three years following the surgical procedure. The success of the operations was judged both in terms of the effect on intraocular pressure as well as on the visual ability of the eye. Since the surgeon's aim is to lower intraocular pressure to a particular level, not simply to an arbitrary level that facilitates statistical analysis, the control of the disease was graded in terms of how completely the operative procedure fulfilled the goal set by the surgeon at the time the decision to operate was made. While this method of grading success introduces a subjective element, a more valid assessment of the true value of the surgery may be obtained. The results suggest that the Scheie procedure lowers pressure to a lower level and for a longer duration than does the trabeculectomy (mean intraocular pressure three years postoperatively was 12.3 mm Hg in cases of primary glaucoma treated with a Scheie procedure and 16 mm Hg in those with trabeculectomy with a sutured scleral flap). In this study the long-term visual result was apparently no different with the Scheie procedure and trabeculectomy. Trabeculectomy causes fewer flat anterior changes than the Scheie procedure. The degree of pressure lowering in trabeculectomy is directly related to the amount of postoperative filtration. The relative indications for trabeculectomy include: (1) malignant glaucoma in the other eye; (2) chronic angle closure glaucoma where an iridectomy is considered insufficient; (3) "high pressure glaucoma" where pressure below 20 mm Hg is not essential; (4) low inflow glaucoma in which persistent flat anterior chambers may be expected following routine filtration surgery; and (5) cases where endophthalmitis is a real concern, as in the very young, those remote from medical care and those with poor personal hygiene. Trabeculectomy gives such poor results in secondary glaucoma that the procedure is probably relatively contraindicated. Trabeculectomy is a valuable operation, but not the final solution to glaucoma surgery. It should be chosen with full recognition of its specific advantages and disadvantages.

Administration, Topical↗
PubMedDate not supplied

Trabeculectomy: a reevaluation after three years and a comparison with Scheie's procedure.

Seventy-one patients with glaucoma needing surgical correction had either a peripheral iridectomy with a thermal sclerostomy or a trabeculectomy utilizing a modification of Watson's technique in which the scleral flap was closed tightly with sutures. Results of surgery were analyzed at intervals up to an including three years following the surgical procedure. The success of the operations was judged both in terms of the effect on intraocular pressure as well as on the visual ability of the eye. Since the surgeon's aim is to lower intraocular pressure to a particular level, not simply to an arbitrary level that facilitates statistical analysis, the control of the disease was graded in terms of how completely the operative procedure fulfilled the goal set by the surgeon at the time the decision to operate was made. While this method of grading success introduces a subjective element, a more valid assessment of the true value of the surgery may be obtained. The results suggest that the Scheie procedure lowers pressure to a lower level and for a longer duration than does the trabeculectomy (mean intraocular pressure three years postoperatively was 12.3 mm Hg in patients with primary glaucoma treated with a Scheie procedure and 16.6 mm Hg in those with trabeculectomy with a sutured scleral flap). In this study the long-term visual result was apparently no different with the Scheie procedure and trabeculectomy. Trabeculectomy causes fewer flat anterior chambers than the Scheie procedure. The degree of pressure lowering in trabeculectomy is directly related to the amount of postoperative filtration. The relative indications for trabeculectomy include: (1) malignant glaucoma in the other eye, (2) chronic angle-closure glaucoma where an iridectomy is considered insufficient, (3) "high pressure glaucoma" where pressure below 20 mm Hg is not essential, (4) low inflow glaucoma in which persistent flat anterior chambers may be expected following routine filtration surgery, and (5) patients where endophthalmitis is a real concern, as in the young, those remote from medical care and those with poor personal hygiene. Trabeculectomy gives such poor results in secondary glaucoma that the procedure is probably relatively contraindicated. Trabeculectomy is a valuable operation, but not the final solution to glaucoma surgery. It should be chosen with full recognition of its specific advantages and disadvantages.

Adolescent↗