Biomedical subjects
Publications and source records attributed to R L Kimbrough.
Two patients had nanophthalmos with uveal effusion and angle-closure glaucoma. They were treated with a method based on the use of the laser, not only to perform iridotomy but to shrink the iris stroma, which appears to open the anterior chamber angle even without iridotomy. Additionally, we introduced three factors that may be diagnostic of nanophthalmos.
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.
A cyclodialysis spatula specifically designed for glaucoma surgery is presented which facilitates the performance of the cyclodialysis procedure alone or in combination with cataract extraction and decreases the chance of inadvertent damage to the eye.
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.
The glaucoma shell tamponade technique in filtering surgery for glaucoma is a technique for (1) decreasing the incidence of flat anterior chamber and choroidal separation postoperatively, (2) promoting the development of a low diffuse filtration area, and (3) increasing the possibility of achieving very low resulting postoperative pressure. The glaucoma shell technique is applicable to all types of filtration procedures, including conventional filtering procedures utilizing no scleral flap and those utilizing a scleral flap, such as trabeculectomy. It can be used at surgery or can be applied in the postoperative period to deal with flat or shallow anterior chambers immediately at the time of onset. The shell tamponade technique can be utilized to aid in the management of some cases of leaking bleb in the early postoperative period or in the late postoperative period. The technique for operative and postoperative use of the glaucoma shell tamponade technique and its closely related pressure dressing is a demanding and exacting art. Because the technique increases the possibility of very low resulting tensions, its use should be considered especially for cases in which very low pressures are desired, such as some cases of extremely advanced cupping and field loss and low-tension glaucoma.
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.
A new treatment, goniophotocoagulation, for neovascularization of the anterior chamber angle has been applied with the argon laser to 21 eyes of 20 patients. Three of the eyes had neovascularization related to central retinal vein occlusion. In the other 18 eyes the neovascularization was related to diabetic retinopathy. A specific protocol has been followed since January 1973. The results so far indicate that closure of the angle and progression of the usual chain of pathologic events in neovascular glaucoma were prevented in 10 (77%) of the 13 eyes having an average follow-up of 22 months. We believe that goniophotocoagulation of the angle deserves more extensive, judicious, and carefully monitored clinical use. Our results suggest that this new technique is safe and reasonably effective in preventing progressive neovascularization of the angle, synechial closure, and severe nonvascular glaucoma.