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Biomedical subjects

S Melamed

Publications and source records attributed to S Melamed.

At least 73 records · Page 4Linked to original sources
PubMed1993

Cataract and intraocular lens implantation after remote trabeculectomy for Sturge-Weber syndrome.

A 6-year-old patient with Sturge-Weber syndrome and secondary glaucoma had trabeculectomy and subsequent reconstruction of a shallow anterior chamber. Six months later, a dense fibrin clot and anterior capsule cataract developed, requiring surgery. Using the anterior chamber maintainer technique, extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed. Twelve months later visual acuity was 20/30, intraocular pressure was 14 mg Hg, and the anterior chamber was deep and quiet.

Cataract↗
PubMed1993

Internal sclerostomy using laser ablation of dyed sclera in glaucoma patients: a pilot study.

Twelve eyes of 12 patients with refractory glaucoma were treated with internal sclerostomy using laser ablation of dyed sclera. The technique involves iontophoretic impregnation of the sclera at the limbal region with 1% methylene blue and subsequent delivery of a pulsed dye laser beam to the stained area through a goniolens. The red wavelength of 664 nm generated by the laser is maximally absorbed by the stained sclera and creates a through and through sclerostomy. Successful complete sclerostomy was achieved in seven eyes (58.3%) but there was some reduction of intraocular pressure (IOP) in all cases. Mean prelaser IOP (of all 12 eyes) was 36.6 mm Hg and 1 hour after therapy it was reduced to 20.0 mm Hg. At the end of the follow-up period (mean 16 months) the mean IOP was 23.7 mm Hg; five eyes (41%) maintained their IOP below 22 mm Hg, and the average number of medications per eye came down from 3.25 to 2.25 per eye. Transient corneal burns with Descemet's membrane folds adjacent to the laser impact zone were detected in eight eyes (67%). No major complications like IOP spike, hyphaema, iridodialysis, or retinal detachment have been detected. Clear cornea and dark blue scleral staining are essential for the mechanical success of this procedure. Gonioscopic laser internal sclerostomy of methylene blue dyed sclera is technically feasible and the preliminary results of IOP control in refractory glaucoma are promising. Modifications of the iontophoresis process and laser parameters are currently under investigation in order to improve these results.

Adult↗
PubMed1992

The effect of intracamerally injected ethacrynic acid on intraocular pressure in patients with glaucoma.

We studied the effect of ethacrynic acid on intraocular pressure in eyes with advanced open-angle glaucoma. Five to 15 microliters of ethacrynic acid (3.3 to 9.8 micrograms) was injected intracamerally after retrobulbar anesthesia was achieved in five eyes of five patients with advanced glaucoma. Intraocular pressure before treatment ranged from 26 to 46 mm Hg with maximal medical treatment. A reduction in intraocular pressure from 9 to 31 mm Hg was observed in all patients three to 24 hours after treatment, and this effect lasted for three days, with a gradual return of intraocular pressure to pretreatment values one week after treatment. No acute corneal or anterior chamber side effects were observed and results of corneal endothelial cells counts were essentially unchanged two months after treatment. We suggest that ethacrynic acid may represent a new class of antiglaucoma medication. Intracameral administration of ethacrynic acid or a derivative might be contemplated in the future at the time of other ocular surgical procedures to treat short-term intraocular pressure increase.

Adult↗
PubMed1992

Gonioscopic ab interno laser sclerostomy. A pilot study in glaucoma patients.

PURPOSE: The purpose of this study is to evaluate the safety and efficacy of gonioscopic ab interno laser sclerostomy (GLS) in patients with glaucoma. METHODS: The technique of GLS involves iontophoresis of methylene blue dye (1%) at the limbus to focally dye the sclera and to provide subsequent delivery of 10-microsecond pulsed laser energy to the dyed area through a goniolens. The laser emits at 660 nm, a wavelength that is maximally absorbed by the methylene blue dye. Patients were evaluated for fistula formation, intraocular pressure (IOP) reduction, and adverse sequelae. Thirty-eight treatments were performed in 35 eyes. RESULTS: Successful complete sclerostomies were achieved in 21 eyes (55%), which was associated with an acute mean reduction in IOP of 23 mmHg. Mean preoperative IOP for all patients was 35 mmHg, and 1 hour after treatment it was reduced to 18.5 mmHg. In 4 of the 38 treatments, there was no acute IOP reduction, and these eyes were judged as failures. The mean follow-up time was 8.2 months with a maximum follow-up of 15 months. By 9 months, 50% of patients had an IOP of 22 mmHg or lower. The number of antiglaucoma medications decreased from 3.1 to 1.7 for all eyes over the 15-month follow-up period. Hyphemas (13%) were the only major complication, and these resolved spontaneously. In only one case did the IOP increase after the procedure. CONCLUSION: The results of this trial indicate that GLS is technically feasible, and preliminary results of IOP control are promising.

Adult↗
PubMed1992

The Gulf War and its impact on burnout and well-being of working civilians.

Burnout signifies the chronic depletion of coping resources following prolonged exposure to emotionally charged demands. It is manifested by symptoms of emotional, physical and cognitive exhaustion, and is usually studied in relation to occupational stressors. We hypothesized that the major life crisis engendered by missile attacks would give rise to burnout or exacerbate preexisting burnout symptoms. We also hypothesized that individuals suffering from prewar burnout would appraise the war as being more threatening and would be more vulnerable to upper respiratory infections (URI). Wartime and pre-war (baseline) levels of burnout and related symptomatology (cognitive weariness, listlessness, tension and somatic complaints) were compared among 162 Israeli civilians who carried on with their employment duties throughout the Gulf War. We found that the war impacted primarily on younger individuals (age < 45). All the pre-war levels of the above measures increased significantly (except for a marginal increase in tension). The impact of the war was mediated by threat appraisal, as indicated by worry and apprehension. Worry was positively associated with pre-war burnout, and negatively with age and education. Pre-war burnout was associated positively with wartime URIs. It was concluded that the war accelerated the depletion of coping resources and that burnout may be affected by factors other than occupational stress.

Adaptation, Psychological↗
PubMed1992

Burnout and risk factors for cardiovascular diseases.

The burnout syndrome denotes a constellation of physical fatigue, emotional exhaustion, and cognitive weariness resulting from chronic stress. Although it overlaps considerably with chronic fatigue as defined in internal medicine, its links with physical illness have not been systematically investigated. This exploratory study, conducted among 104 male workers free from cardiovascular disease (CVD), tested the association between burnout and two of its common concomitants--tension and listlessness--and cardiovascular risk factors. After ruling out five possible confounders (age, relative weight, smoking, alcohol use, and sports activity), the authors found that scores on burnout plus tension (tense-burnout) were associated with somatic complaints, cholesterol, glucose, triglycerides, uric acid, and, marginally, with ECG abnormalities. Workers scoring high on tense-burnout also had a significantly higher low density lipoprotein (LDL) level. Conversely, scores on burnout plus listlessness were significantly associated with glucose and negatively with diastolic blood pressure. The findings warrant further study of burnout as a predictor of cardiovascular morbidity and mortality.

Adaptation, Psychological↗
PubMed1992

Personal determinants of leisure-time exercise activities.

This study investigated the importance of personal determinants such as self-efficacy, beliefs about the contribution of exercise, health locus of control, and dispositional optimism for leisure-time exercise in a working population. The main predictors of such exercise were beliefs and self-efficacy with the generalization of the latter to eat correctly. Beliefs and efficacy expectations were highly correlated. Neither health locus of control nor dispositional optimism was related to leisure-time exercise; however, optimism was related to the positive belief that exercise contributes to health. Ramifications of the findings were carefully described.

Adolescent↗
PubMed1992

The effect of continuous strenuous exercise on intraocular pressure.

The effect of a continuous 110-km march with a 20-kg backpack load on intraocular pressure (IOP), plasma osmolarity, blood lactate, pH, and other related laboratory parameters was studied in 22 healthy young volunteers. Intraocular pressure decreased significantly at all marching intervals and returned to baseline level 3 hr after the completion of marching. The maximal average reduction during marching was 4.1 mmHg, 26.5% below the baseline level. The IOP decreased again 48 hr after the march and returned to baseline level 48 hr later. There were two peaks of increased plasma osmolarity (one during the march and the other 48 hr after the march). There was no correlation between IOP changes and levels of pH, blood lactate, serum proteins, and electrolytes or hematologic parameters. These findings suggest that IOP reduction is related inversely to plasma osmolarity during and after strenuous exercise.

Adult↗
PubMed1992

Nd:YAG laser trabeculopuncture in angle-recession glaucoma.

Nd:YAG laser trabeculopuncture (YLT) was performed in 12 eyes of 12 patients with angle-recession glaucoma. Confluent, 1-clock-hour trabeculotomy was attempted in all eyes. The calculated average laser energy was 181 +/- 86 mJ. Where possible, the midtrabecular meshwork was treated, preferably at the superior half. After a mean follow up of 12.0 +/- 5.6 months, intraocular pressure (IOP) was controlled (less than or equal to 19 mm Hg) in five eyes (41.7%). YLT was associated with blood reflux during or after treatment in all successfully treated eyes. In eyes that failed, blood reflux could be detected in only two of seven eyes (28.6%). YLT failed to control IOP in all five eyes that had angle-recession for 360 degrees. Following YLT, IOP rose in two eyes (16.6%), minimal hyphema occurred in one eye, and temporary flare and cells developed in the anterior chamber in all eyes. Six eyes (50%) required glaucoma surgery (four had trabeculectomy and two had Molteno implant surgery). We recommend YLT only for selected cases of uncontrolled angle-recession glaucoma in which at least part of the trabecular meshwork by gonioscopy appears to maintain its anatomical structure, permitting penetration into Schlemm's canal.

Adolescent↗
PubMed1992

The protective effect of early intraoperative injection of viscoelastic material in trabeculectomy.

In a prospective study, we evaluated the effect of intracameral injection of sodium hyaluronate (HA) in trabeculectomy on short- and long-term results, including the effect on the corneal endothelium. Twenty-two patients were randomly assigned into two groups: group A, consisting of 11 patients, underwent standard trabeculectomy; in group B (11 patients), additionally, HA was injected into the anterior chamber immediately following paracentesis in an attempt to minimize shallowing of the chamber after the subsequent trabeculectomy. Both groups had comparable age distributions, preoperative intraocular pressures (IOPs), preoperative endothelial cell counts, postoperative IOPs after 3 months, and glaucoma medication indices. The reduction in the number of endothelial cells after 1 month was significantly greater in group A than in group B (16.1% vs 6.7%). Also, significantly more shallow anterior chambers occurred in group A (three eyes vs one eye). However, 1 day postoperatively, the average IOP was 16.4 mm Hg in group A, as compared with 25 mm Hg in group B. Thus, although HA, injected early in trabeculectomy, appeared to protect against corneal endothelial loss and flat anterior chamber, it also seemed to be associated with early IOP spikes.

Aged↗
PubMed1991

Identification, prevention, and treatment of silicone oil pupillary block after an inferior iridectomy.

We treated two patients in whom silicone oil pupillary block developed despite a patent inferior iridectomy. The clinical characteristics of this complication were a deep anterior chamber, specular reflexes from the iris surface, identification by biomicroscopy of aqueous trapped inferiorly in the vitreous cavity, and no convection currents in the anterior chamber. This complication may be prevented by early face-down positioning of the patient after the operation, and the avoidance of large, centrally located, inferior iridectomies. We recommend that the iridectomy be placed peripherally no larger than 2 mm and propose a new technique for breaking the silicone oil block, which was clearly successful in one of the patients.

Anterior Chamber↗
PubMed1991

Postoperative complications after Molteno implant surgery.

We performed Molteno implant surgery in one eye each of 41 patients with uncontrolled glaucoma. Intraocular pressure was controlled (intraocular pressure less than or equal to 18 mm Hg) in 32 eyes (78%). The mean preoperative intraocular pressure was 40 +/- 13.2 mm Hg, whereas the mean postoperative intraocular pressure was 16 +/- 6.6 mm Hg. Patients were followed up for an average of 16 months after the operation. Visual acuity was unchanged in 23 eyes (56%), improved in nine eyes (22%), and poorer in nine eyes (22%). The major complications included shallow anterior chamber and hypotony in six eyes (14.6%), vitreous hemorrhage in two eyes (4.9%), retinal detachment in one eye (2.4%), and malignant glaucoma in two eyes (4.9%). Less grave complications included hyphema in four eyes (9.8%), peripheral choroidal effusion in 15 eyes (36.6%), obstruction of the tube in six eyes (14.6%), recession of the tube into the angle in two eyes (4.9%), erosion of the tube in one eye (2.4%), and Tenon's cyst formation in three eyes (7.3%).

Adolescent↗
PubMed1991

Internal sclerostomy with laser: a new approach to glaucoma surgery.

The creation of a fistula that permits controlled flow of aqueous from the anterior chamber to the subconjunctival space has been and remains the main technical goal of glaucoma filtering surgery. Currently, most complications are secondary to the surgical manipulation of the conjunctiva (mainly leakage from bleb and conjunctival fibrosis) or flattening of the anterior chamber. To overcome this problem, new methods are evolving in which the fistula is created from within the eye, with no conjunctival dissection. The performing of the sclerostomy by means of externally delivered laser energy is a further step in the same direction.

Glaucoma↗
PubMed1991

Trabeculectomy with anterior vitrectomy in aphakic and pseudophakic glaucoma.

In 15 eyes with uncontrolled aphakic/pseudophakic glaucoma, trabeculectomy with anterior vitrectomy was performed. Mean pre-operative intraocular pressure (IOP) was 38.2 +/- 6.7 mmHg and mean post operative IOP was 19.3 +/- 5.2 mmHg after follow-up of 11.2 2 months. The anterior chamber maintainer technique during vitrectomy has been employed. Success rate (IOP less than 21 mmHg with or without glaucoma medication) was 80%. Visual acuity remained unchanged in 4 eyes, improved in 5 eyes and worsened in 6 eyes. Postoperative complications included: two eyes with cystoid macular edema, two eyes with choroidal effusion and prolonged hypotony, one eye with self-absorbing vitreous hemorrhage and one eye with some opacification of the corneal graft. In aphakic/pseudophakic glaucoma where vitreous is filling the anterior chamber--a combined trabeculectomy with anterior vitrectomy is indicated for removal of vitreous from the sclerostomy site with better aqueous flow through the sclerostomy and adequate control of IOP.

Adult↗
PubMed1991

Nd-YAG laser hyaloidotomy for malignant glaucoma following one-piece 7 mm intraocular lens implantation.

Three cases of malignant glaucoma following extracapsular cataract extraction with 7 mm one-piece posterior chamber intraocular lens implantation are presented. Nd-YAG laser hyaloidotomy was successfully performed in all eyes, but was difficult and required several sessions in two eyes. In the third eye, which had a sector iridectomy, laser hyaloidotomy applied over the edge of the lens optic through the iridectomy resulted in brisk deepening of the anterior chamber and reduction of intraocular pressure. We propose that the one-piece 7 mm optic posterior chamber intraocular lens may constitute an obstacle to successful hyaloidotomy, mainly owing to its large size, as it may block aqueous percolation from the vitreous into the anterior chamber. Eyes prone to develop malignant glaucoma after surgery should have a sector or large peripheral iridectomy to facilitate postoperative Nd-YAG laser hyaloidotomy if required.

Aged↗
PubMed1991

Vogt-Koyanagi-Harada syndrome in two siblings.

Two cases of a brother and a sister with characteristic manifestations of Vogt-Koyanagi-Harada syndrome are presented. To the best of our knowledge, this is the first report of a typical appearance of Vogt-Koyanagi-Harada syndrome in two siblings.

Adult↗