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Biomedical subjects

R N Shaffer

Publications and source records attributed to R N Shaffer.

At least 19 recordsLinked to original sources
PubMed1992

Trabeculodialysis for inflammatory glaucoma: a review of 25 cases.

We reviewed the results following trabeculodialysis in 25 eyes of 22 patients with secondary glaucoma due to chronic anterior uveitis. After 1 year, intraocular pressure (IOP) was uncontrolled (greater than 21 mm Hg) in 11 eyes (44%). Trabeculodialysis controlled IOP (less than 21 mm Hg) in 14 eyes (56%), with an average follow up of 52 months (range, 12 to 151 months). Sixteen eyes (64%) were aphakic, but did no worse than the phakic eyes. One eye developed a subchoroidal hemorrhage 3 days postoperatively which required drainage. No other serious complications were encountered. Trabeculodialysis is a safe procedure which can achieve pressure control in these difficult eyes.

Aphakia↗
PubMed1990

Analysis of surgical and medical management of glaucoma in Sturge-Weber syndrome.

Management of glaucoma associated with Sturge-Weber syndrome (SWS) is difficult. The authors reviewed 36 eyes of 30 SWS patients with either early or late-onset glaucoma with a mean follow-up of 122 months (range, 24-253 months). Intervals between required surgical or medical interventions were analyzed. Intervention was attributed to elevated intraocular pressure (IOP) in 55% of cases and disc change in 45%. Median stable postoperative interval with goniotomy was 12 months; with trabeculotomy, 21 months; with trabeculectomy, 34 months; with argon laser trabeculoplasty, 25 months; and with medications, 57 months. Survival analysis shows statistically significant differences between goniotomy and medications. Intraoperative choroidal expansions developed in 24% of cases receiving a trabeculectomy, and none developed with either goniotomy or trabeculotomy.

Adolescent↗
PubMed1986

Long-term analysis of pigmentary dispersion syndrome and pigmentary glaucoma.

A retrospective, longitudinal study of 129 eyes in 65 patients with pigmentary dispersion syndrome and either ocular hypertension of glaucoma was undertaken. The mean follow-up period was 17 years (range, 5-35 years). Visual acuity, intraocular pressure (IOP), visual field loss, pigment grade, Krukenberg spindle, iris transillumination, medications, and surgeries were analyzed for each patient at 5-year intervals from 1960 through 1983. Disc and field changes developed in 35% of patients with pigment dispersion syndrome and ocular hypertension during the study period. The long-term prognosis of the medical and surgical management of pigmentary glaucoma is discussed.

Adult↗
PubMed1984

Anatomical classification of the developmental glaucomas.

With the use of observations in 250 cases of childhood glaucoma, defects were classified anatomically according to the three major anterior chamber structures affected: the trabecular meshwork, the iris, and the cornea. The classification should do much to facilitate communication in the area of the developmental glaucomas and provide standardization of terminology to allow collaborative study of these rare diseases.

Adolescent↗
PubMed1983

Complications of laser trabeculoplasty.

Laser trabeculoplasty (LTP) is a relatively new procedure requiring evaluation for long-term effectiveness and associated complications. The authors review some 300 LTPs and identify complications. Among the most serious are transient or persistent rise in intraocular pressure, iritis, and progression of visual field loss. The authors recommend LTP as an alternative to glaucoma surgery in selected patients not controlled by medications.

Glaucoma↗
PubMed1983

Montgomery lecture. Goniotomy in the treatment of isolated trabeculodysgenesis (primary congenital [infantile] developmental glaucoma).

The Hoskins' gonioscopic classification of developmental glaucoma is useful in choice of therapy and in prognosis. It is based on the alterations occurring in the iris, the cornea and the trabecular meshwork. The various syndromes are described by the various combinations of iridodysgenesis, trabeculodysgenesis and corneodysgenesis. This paper is concerned with the response to goniotomy in infants with isolated trabeculodysgenesis (Primary congenital or infantile glaucoma). Such cases with signs and symptoms presenting in the first to the twenty-fourth month of life are excellent candidates for goniotomy and have a good prognosis. Those with signs and symptoms at birth or after 24 months should have at least one goniotomy before resorting to trabeculotomy or trabeculectomy. The long-term prognosis of eyes successfully treated by goniotomy is good. However of 50 cases followed for 15 to 25 years with pressures ranging between 10 and 20 mm Hg without medication, 7 (14 per cent) developed complications after 15 years. Three had increases in intraocular pressure; two had retinal detachments and two had mild corneal oedema from endothelial dystrophy. Forty-six per cent had some degree of deprivation amblyopia. Few of these cases are as yet in their thirties. The truly long-term prognosis is as yet unknown. It is of great importance that these patients have periodic eye examinations throughout their life.

Glaucoma↗
PubMed1982

Prognosis of goniotomy in primary infantile glaucoma (trabeculodysgenesis).

In developmental glaucoma with trabeculodysgenesis (primary infantile glaucoma), goniotomy is a safe and highly successful operation and should be used in preference to trabeculotomy. Prognosis varies markedly with the age of onset of signs and symptoms. When present at birth or after the age of two years, the success rate is only about 30%. Between the ages of 1 and 24 months, success following one or two goniotomies is 94%. Eyes with successful goniotomies have now been followed for over 25 years with maintenance of pressure control without medication in most cases. The major complication has been amblyopia due to breaks in Descemet's membrane in the visual axis and to marked astigmatism and anisometropia. After 15 years, two cases developed an endothelial dystrophy and three had an IOP elevation. Obviously, periodic examination of such eyes will be necessary for life.

Adolescent↗
PubMed1981

Timolol and pediatric glaucomas.

Thirty-eight eyes were treated by adding timolol to the medical regimen. After a suitable trial, attempts were made to reduce other glaucoma medications. Fifteen eyes with infantile glaucoma treated surgically at birth, experienced elevated intraocular pressure later in life. Another 15 eyes had glaucoma associated with congenital anomalies such as aniridia, Sturge-Weber syndrome, and mesodermal malformations. The group with infantile glaucoma demonstrated an average drop in pressure of 24% and 22% after one and three months, respectively. Six of the 15 eyes were controlled at 22 mm Hg or less. In the other group, intraocular pressure fell 30% after one month and 12% after three months. Five of the 15 eyes were controlled. Adverse effects occurred in five patients, timolol therapy was discontinued in two (7%). The IOP was not controlled in any of the eyes with timolol alone.

Adolescent↗
PubMed1980

Biostatistical analysis of the collaborative glaucoma study. I. Summary report of the risk factors for glaucomatous visual-field defects.

A prospective collaborative study was conducted in five centers during a 13-year period to identify factors that influence the development of visual-field defects (GVFDs) of open angle glaucoma. In 5,000 subjects, GVFDs developed in only 1.7% of eyes. Statistical analysis of 26 factors at first examination identified five that were significantly related to the development of GVFDs--outflow facility, age, applanation pressure, cup-disc ratio, and pressure change after water drinking. Their absolute initial value, and not its change with time, was the important predictor. Multivariate analysis showed their collective predictive power to be undesirably poor, indicating that other factors must play an important role in the development of GVFDs. Mortality-table analysis indicated that during a period of five years, 98.54% of eyes with initial pressure less than 20 mm Hg continued to be free from GVFDs as compared with 93.34% of those with pressure of 20 mm Hg or greater.

Aged↗
PubMed1979

Adverse effects experienced by patients taking timolol.

Adverse effects involving one or more organ systems occurred in 38 of 165 patients with various types of glaucoma when timolol was added to their glaucoma therapy. It was necessary to discontinue timolol because of these side effects in 15 (9%) of the patients. Double-masked studies will be necessary to clarify the relationship of these adverse effects to the use of timolol.

Aged↗
PubMed1978

Ciliary block (malignant) glaucoma.

A review of the history, recognition, mechanisms, and therapy of ciliary block glaucoma has been given. Cycloplegic therapy is stressed in the susceptible eye.

Choroid↗
PubMed1977

Revision of filtration surgery.

Forty-one procedures were performed to revise malfunctioning filtering blebs in 37 eyes. Thirty-two procedures were undertaken on underfiltering blebs, seven on overfiltering blebs, and two on normally functioning but otherwise unsatisfactory blebs. Revision procedures were successful in 24 of 32 underfiltering blebs, four of seven overfiltering blebs, and one of two normally functioning but unsatisfactory blebs.

Adult↗