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Biomedical subjects

R H Stewart

Publications and source records attributed to R H Stewart.

At least 55 records · Page 3Linked to original sources
PubMed1981

D-penicillamine and the ocular myasthenic syndrome.

D-penicillamine is a potent drug used to treat rheumatoid arthritis, Wilson's disease and cystinuria. D-penicillamine has recently been found to cause myasthenia gravis in certain susceptible patients. We present a typical case of one patient who developed myasthenia while taking D-penicillamine. The withdrawal of D-penicillamine and the institution of short-term anticholinesterase therapy resulted in the resolution of this disease. The literature is reviewed and attention is focused on the point that all patients who developed myasthenia while undergoing D-penicillamine therapy had ocular symptoms.

Arthritis, Rheumatoid↗
PubMed1980

Outpatient trabeculectomy.

Eighty trabeculectomies were performed for medically uncontrolled adult phakic primary open angle glaucoma during the past two years. Forty-eight of these trabeculectomies were performed as outpatients and thirty-two of these trabeculectomies were performed as inpatients. We compared the complication rates of inpatients and outpatients during the first two weeks post-op. The results of this study demonstrate that early ambulation and moderate activity did not adversely influence the rate of early postoperative complications following trabeculectomy.

Ambulatory Surgical Procedures↗
PubMed1980

A method of managing flat anterior chamber following trabeculectomy.

A method of injecting an air bubble into a flat anterior chamber (iridocorneal apposition) following trabeculectomy is described. Nine of nine cases have been successfully treated. One case required a second injection of air into the anterior chamber 24 hours after the first air injection. No complications have been noted.

Air↗
PubMed1979

Intraocular pressure response to topically administered fluorometholone.

Certain corticosteroids, including fluorometholone, have been reported to have a low propensity for elevating intraocular pressure. Our clinical impression was that the incidence of IOP increase with fluorometholone may be higher than reported. This study was to determine the incidence and degree of IOP response to 0.1% fluorometholone suspension in 43 patients demonstrated to be responsive to 0.1% dexamethasone sodium phosphate solution. Twenty-six patients (60.5%) had IOP increases of 5 mm Hg or more while receiving fluorometholone, and three patients (7%) demonstrated pressure rises greater than 15 mm Hg. Fluorometholone can significantly raise IOP in a significant number of corticosteroid responders.

Administration, Topical↗
PubMed1979

Trabeculectomy and modifications of trabeculectomy.

Seventy-four trabeculectomies have been reviewed and discussed. Intraocular pressure 20 mm Hg or lower was achieved in 74.2% at the end of six months and in 66% one year postoperatively. The influence of age and sex on postoperative maintainance of intraocular pressure has also been discussed. There was not a statistical difference in results when the sex of the patients were compared. Patients under age forty did poorly in this series as compared to patients over age forty-one. Tenonectomy and cautery to the posterior edges of the scleral flap have been beneficial. The insertion of a gel film or silastic implant under the posterior edge of the scleral flap has been studied but in too few patients to draw any valid conclusions. In general, our results have been satisfactory with very few operative or postoperative complications.

Adult↗
PubMed1979

Complications of 10-0 nylon sutures.

Three cases are presented which document the finding that 10-0 monofilament nylon suture may cut through corneal tissue after a coup or contrecoup injury to a recently operated eye. The authors speculate that a larger gauge suture does not have the tendency to cut through recently operated corneal tissue as easily as 10-0 monifilament nylon. The authors recommend the use of a larger gauge suture in closing corneal incisions in persons whom the surgeon feels are at a greater postoperative traumatic risk.

Aged↗
PubMed1978

Evaluation of dexamethasone acetate as a topical ophthalmic formulation.

Penetration of an ophthalmic suspension of 0.1% dexamethasone acetate into the rabbit cornea and aqueous humor was unaffected by the status of the corneal epithelium or by the presence or absence of intraocular inflammation. However, the total quantity of this corticosteroid that could be measured in the cornea or aqueous humor was significantly less than that produced by either dexamethason alcohol or dexamethasone sodium phosphate. Despite this, dexamethasone acetate was the most effective of the three dexamethasone derivatives in suppressing inflammation in the cornea, which indicates that following topical administration to the eye it is the most potent of the dexamethasone derivatives studied. This greater therapeutic effect does not seem to be accompanied by a greater propensity to increase intraocular pressure. Comparison of the intraocular pressureincreasing effect in known corticosteroid responders of dexamethasone acetate with that of dexamethasone sodium phosphate, the least effective of the dexamethasone products studied, demonstrated no difference between the two drugs. These data support the conclusion that dexamethasone acetate is superior to the commercially available dexamethasone derivatives for use as a topical ocular anti-inflammatory agent.

Animals↗
PubMed1978

Introduction of the ocusert ocular system to an ophthalmic practice.

This study, on a sample of 81 patients, was primarily shortterm. The objectives were to determine what type of patient would be successful on the Ocusert; to see if we had similar pressure control with the Ocusert as with drops; and to see if the advantages were obvious to our patients. We found that 56% of our patients could wear the unit successfully (after 3 months of study). The major reasons for discontinuing the Ocusert were discomfort and retention, but age was also a significant factor to success. We found the most critical period of adjustment was the first 2 weeks. It was found that 46% of the group stayed in the smae pressure range, 30% moved to a lower pressure range, and 24% moved to a higher category of intraocular pressure.

Adult↗
PubMed1976

Combined cataract extraction and thermal sclerostomy versus combined cataract extraction and trabeculectomy.

We performed either a combined cataract extraction and trabeculectomy or a combined cataract extraction and thermal sclerostomy on 43 eyes. All eyes had chronic open angle glaucoma or chronic angle closure glaucoma, or a combination of the two. In our cataract/trabeculectomy group, 74% had improvement in visual acuity, 91% had normalized intraocular pressure without anti-glaucoma medications, 31% had transient postoperative hyphemas. In our cataract/thermal sclerostomy group, 61% had improvement in visual acuity, 61% had normalization of intraocular pressures without antiglaucoma medications, 17% had transient postoperative hyphemas. We could not correlate any of the complications of surgery with poor intraocular pressure results in either groups. The mechanism for the higher success rate with a combined cataract extraction and trabeculectomy as compared with a combined cataract extraction and thermal sclerostomy was not obvious after analyzing these patients.

Cataract Extraction↗
PubMed1975

Trabeculectomy.

The more important surgical steps in a trabeculectomy are the creation of a lamellar-scleral flap, the excision of a block of limbal tissue without damaging underlying structures, the creation of a basal peripheral iridectomy, and, finally, the closing of the scleral flap to maintain fluid within the anterior chamber. Careful attention to certain modifications of these steps can prevent the most common operative complications that occur with this procedure. One method is described in this paper.

Anterior Chamber↗