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Biomedical subjects

P Palmberg

Publications and source records attributed to P Palmberg.

14 recordsLinked to original sources
PubMed1997

Delayed-onset endophthalmitis associated with conjunctival filtering blebs.

OBJECTIVE: The purpose of the study is to evaluate the causative organisms, treatment methods, and visual acuity outcomes of patients treated for delayed-onset endophthalmitis associated with conjunctival filtering blebs. METHODS: The medical records of 32 patients with conjunctival filtering bleb-associated endophthalmitis treated at the Bascom Palmer Eye Institute between 1989 and 1995 were reviewed retrospectively. Bleb-associated endophthalmitis was diagnosed at 1 month or more after surgery in all patients. Patients with bleb infections only but without, signs of intraocular infection were excluded from this series. RESULTS: Previous antimetabolite therapy was used in 20 patients, including mitomycin C in 14 and 5-fluorouracil in 6. Streptococcal species were the most frequently cultured organisms occurring in 15 (47%) of 32 eyes. Of the 32 patients, 30 received intraocular antibiotics. The initial treatment included a pars plana vitrectomy in 18 patients and a vitreous tap without vitrectomy in 12 patients. Two of three patients who presented with no light perception vision were treated by evisceration. Overall, 15 (47%) of 32 patients achieved a final visual acuity of 20/400 or better. Of those patients with Streptococcal species cultured from the eye, 6 (40%) of 15 had a visual acuity of 20/400 or better compared to 9 (52%) of 17 in patients with non-Streptococcal species. CONCLUSIONS: Delayed-onset endophthalmitis associated with conjunctival filtering blebs is a current and future concern, especially with increasing use of mitomycin C. The Streptococcal species are a common causative organism. Despite current treatment of these patients, the visual acuity outcomes generally are worse than in patients with acute-onset endophthalmitis after cataract surgery.

Adult↗
PubMed1996

Pars plana vitrectomy in the management of phakic and pseudophakic malignant glaucoma.

OBJECTIVE: To determine the indications for and outcome of pars plana vitrectomy in the management of phakic and pseudophakic malignant glaucoma. DESIGN: Retrospective review. SETTING: Tertiary referral ophthalmic hospital. PATIENTS: Twenty-two patients (24 eyes) who underwent pars plana vitrectomy in the management of malignant glaucoma. RESULTS: Fourteen eyes were phakic and 10 were pseudophakic at the initial vitrectomy. The primary indication for vitrectomy was failure of other therapies. In phakic eyes, the initial vitrectomy was successful in terminating malignant glaucoma without further surgery in 7 (100%) of 7 eyes that underwent lensectomy and in 5 (71%) of 7 eyes that not did not undergo lensectomy. The primary indication for lensectomy was corneal edema caused by lens-corneal touch. In pseudophakic eyes, the initial vitrectomy was successful in 9 (90%) of 10 eyes. Removal of the intraocular lens was performed in 1 eye. Perioperative complications included transient serous choroidal detachment in 2 eyes, transient exudative retinal detachment in 1 eye, and suprachoroidal hemorrhage in 1 eye. CONCLUSIONS: Pars plana vitrectomy is effective in treating phakic and pseudophakic malignant glaucoma. Success is contingent on establishing a pathway for aqueous flow into the anterior chamber, which usually is accompanied by intraoperative deepening of the anterior chamber. In phakic eyes, lensectomy may be considered for marked corneal edema, for dense cataract, or when the anterior chamber will not deepen during vitrectomy.

Adult↗
PubMed1988

Internal sclerectomy with an automated trephine for advanced glaucoma.

An automated trephine (trabecuphine) was used to perform an internal sclerectomy in seven glaucoma patients who were aphakic or had undergone previous filtering surgery that had failed or both. A patent fistula was achieved intraoperatively in all seven eyes. Postoperatively, six patients received subconjunctival injection of 5-fluorouracil (5-FI) once daily for an average of 8 days. Five of seven patients have retained a functional bleb and a controlled intraocular pressure (IOP) after surgery (follow-up, 4-24 months). The only intraoperative complication was hemorrhage from the sclerectomy site in a patient with aniridia that resulted in a 20% hyphema. The hyphema cleared quickly, and the bleb has remained functional with a pressure of 12 mmHg for 9 months. The trabecuphine makes it possible to perform a glaucoma filtering operation safely from within the anterior chamber. This technique minimizes conjunctival trauma in the filtration area. The absence of a conjunctival incision overlying the fistula simplifies the adjunctive use of antimetabolites such as 5-FU.

Choroid↗
PubMed1986

Comparability of ophthalmic diagnoses by clinical and Reading Center examiners in the Visual Acuity Impairment Survey Pilot Study.

Technologic advances in ophthalmic equipment offer the possibility of replacing direct clinical examinations with Reading Center evaluations of data recorded in epidemiologic studies. Clinical and Reading Center examiners made independent ophthalmic diagnoses of 133 right and 132 left eyes of 138 adults in the Visual Acuity Impairment Survey Pilot Study, carried out in three US cities, Boston, Detroit, and Minneapolis, in August 1981-December 1982. The Reading Center diagnosed eye conditions using only photographic and visual field data collected at the time of the clinical examination. In the comparisons of clinical and Reading Center evaluations reported here, only eyes judged by the examiners to have pathology severe enough to reduce visual acuity to 6/9 or worse were classified as having pathology. (No visual acuity criterion was required for the diagnosis of glaucoma or diabetic retinopathy.) There was agreement in diagnostic assessments between clinical and Reading Center examiners in about 80% of eyes. The kappa statistic, which adjusts for chance agreement, was in the fair to good range: 0.60 for 133 right eyes and 0.62 for 132 left eyes. When the Reading Center examiners were provided with additional information on medical history, refractive error and best corrected visual acuity, the agreement between clinical and Reading Center assessments among the subset of eyes with 6/9 or worse vision again was in the fair to good range, with kappas of 0.61 for 45 right eyes and 0.68 for 48 left eyes. Inter-observer agreement between Reading Center examiners in diagnosing pathology was in the good to excellent range. Use of Reading Centers in future epidemiologic studies should be considered, but elimination of the clinical examinations is not recommended until modifications in the protocol described here have been made and shown to improve levels of agreement between clinical and Reading Center examiners.

Eye Diseases↗
PubMed1985

Cellular sensitivity to glucocorticoids in patients with POAG. Steroid receptors and responses in cultured skin fibroblasts.

The question of a generalized hypersensitivity to corticosteroids in primary open-angle glaucoma (POAG) was investigated using cultured skin fibroblasts from patients with POAG and age-matched controls. Nuclear binding of (3H)-dexamethasone was performed to evaluate possible changes in the glucocorticoid receptors. Cortisol effects on (3H)-thymidine uptake into the cells were investigated as a measure of the cellular sensitivity to corticosteroids. When POAG and control groups were compared, no significant differences (P less than 0.05) were found for either the number or affinity of glucocorticoid receptors (POAG: Kd = 6.1 +/- 1.0 nM, Rt = 94 +/- 13 sites/cell X 10(3); control: Kd = 5.5 +/- 1.6 nM, Rt = 124 +/- 20 X 10(3) sites/cell) or for cortisol effects on thymidine uptake (POAG: C50 = 83 +/- 38 nM; control: C50 = 80 +/- 34 nM). Use of epidermal growth factor (EGF) resulted in an increased steroid sensitivity in some cell lines, but again no differences between POAG and control groups were detected. These results suggest that a generalized cellular hypersensitivity to glucocorticoids is not intrinsic to POAG. It is possible that environmental alterations and/or endogenous factors may influence the steroid responses observed in these patients.

Adult↗
PubMed1981

The natural history of retinopathy in insulin-dependent juvenile-onset diabetes.

We determined the cross-sectional natural history of retinopathy by prospective study of 461 insulin-dependent juvenile-onset diabetics. In so doing, we compared the sensitivity of ophthalmoscopy, photography, and fluorescein angiography in detecting retinopathy. Photography was far more reliable than ophthalmoscopy in detecting early retinopathy and equivalent to angiography. Retinopathy was not present at diagnosis of diabetes. After a lag period, the prevalence of retinopathy rose in sigmoidal fashion, reaching 50% at just over seven years duration, and asymptotically approaching 90% at 17--50 years. Proliferative retinopathy was first seen at 13 years duration, and its prevalence rose to 26% at 26--50 years. From the natural history we computed the dimensions of a proposed clinical trial to test the effect of tight metabolic control in prevention of retinopathy.

Diabetes Mellitus, Type 1↗
PubMed1978

Histocompatibility antigens and primary open-angle glaucoma. A reassessment.

Histocompatibility (HLA) antigen typing was performed on 306 patients who had been studied and classified carefully. Black individuals with primary open-angle glaucoma (POAG) had no significant differences in HLA antigen prevalences from black control subjects. In one white population with POAG, a significant decrease in HLA-A1, a significant increase in HLA-Aw31, and a significant increase in the antigen combination HLA-B7 and HLA-Bw22 were noted. However, these differences were not confirmed in a second white population with POAG. We concluded that associations between the A and B loci of the HLA antigen system and POAG were not as impressive as has been previously reported.

Black People↗
PubMed1977

The ocular anti-inflammatory action of imidazole.

Imidazole administered intraperitoneally to albino rabbits at a dose of 250 mg. per kilogram inhibited the rise of aqueous humor protein concentration by approximately 50 per cent 30 minutes after paracentesis. Systemic imidazole administered daily to albino rabbits injected with intravitreal Shigella endotoxin decreased the conjunctival and iris hyperemia and reduced the anterior chamber cell and flare and the haziness of the optical media. Systemically administered imidazole had no effect on the aqueous humor concentrations of c-AMP or c-GMP in the rabbit. In vitro studies of rabbit ciliary body-iris phosphodiesterase activity indicated no effect of imidazole at a concentration of 10(-3) molar.

Adenosine Monophosphate↗
PubMedDate not supplied

The effect of puberty on the development of early diabetic microvascular disease in insulin-dependent diabetes.

We studied the prevalence of early diabetic retinopathy and nephropathy in 21 prepubertal and 55 late-pubertal subjects with insulin-dependent diabetes (IDD). All subjects had IDD of 5-7 years duration at the time of evaluation. The prevalence of early diabetic retinopathy was significantly greater in the late-pubertal subjects than prepubertal subjects (33% vs. 9.5%, P = 0.05), despite similar glycosylated hemoglobin values between the two groups (11.7 +/- 2.7% vs. 10.1 +/- 1.6%) at the time of evaluation. Nephropathy was infrequent in late-pubertal subjects (9%), and absent in the prepubertal subjects. We hypothesize that puberty plays an important role in the development of microvascular complications of IDD, and that increases in growth factors, sex hormones and deterioration in glycemic control at the time of puberty may each enhance the development of diabetic microvascular disease.

Adolescent↗