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Biomedical subjects

S Melamed

Publications and source records attributed to S Melamed.

At least 91 records · Page 5Linked to original sources
PubMed1991

Anterior capsule adherence to iris leading to pseudophakic pupillary block.

We present a rare case of anterior capsule adherence to the iris following extracapsular cataract extraction with posterior chamber intraocular lens implantation and leading to pseudophakic pupillary block. There were no synechiae at the pupillary margins associated with the capsule/iris adherence, but aqueous was entrapped behind the iris and intraocular pressure rose. Laser iridotomy was temporarily beneficial, but it had to be repeated several times.

Aged↗
PubMed1991

Risk factors associated with late infection of filtering blebs and endophthalmitis.

Late infection of filtering blebs and endophthalmitis are hazardous complications of glaucoma filtering surgery frequently associated with bleb failure and loss of functional vision. To determine possible risk factors for the development of these complications, characteristics of nine eyes of nine patients after filtering surgery in whom late endophthalmitis developed were compared with those in patients who had received a comparable operation at the same time in whom endophthalmitis did not develop. An average of 7.7 +/- 6.2 years (range, 6 months to 18 years) elapsed between the time of the filtering procedure and the initial appearance of endophthalmitis. Factors associated with increased risk were: increased axial length, thin and leaky bleb, conjunctivitis, upper respiratory infection, and the winter season.

Adolescent↗
PubMed1990

Adjunctive use of delayed and adjustable low-dose 5-fluorouracil in refractory glaucoma.

We used delayed 5-mg subconjunctival injections of 5-fluorouracil as an adjunct to filtering surgery in ten eyes with refractory glaucoma. The first 5-fluorouracil injection was made three to 15 days postoperatively and was used only when clinical signs suggested an impending bleb failure. These signs included flattening and localization of bleb, increased vascularity, early subconjunctival scarring, loss of microcystic conjunctival changes, and increased intraocular pressure. After a follow-up of ten to 17 months (mean, 13.7 months), an intraocular pressure of less than 21 mm Hg was attained in five eyes without medication and in four eyes with medication. The treatment failed in one eye. The average dose of 5-fluorouracil was 28 +/- 12 mg per eye. There were no conjunctival wound leaks. Six eyes developed transient corneal epithelial defects. The modified administration of 5-fluorouracil can result in fewer conjunctival wound leaks. Its use can be limited to those patients who show evidence of impending bleb failure.

Adolescent↗
PubMed1990

Tight scleral flap trabeculectomy with postoperative laser suture lysis.

Thirty eyes of 30 patients underwent tight scleral flap trabeculectomy. Of these eyes, 22 underwent laser lysis of the scleral flap sutures, whereas eight eyes did not require such treatment because of low intraocular pressure and active filtering blebs. In the 22 eyes treated, preoperative intraocular pressure was 32.6 +/- 8.3 mm Hg, whereas postoperative and pre-laser intraocular pressure was 29.3 +/- 7.4 mm Hg. Immediately after laser suture lysis, intraocular pressure dropped by 22.7 +/- 9.4 mm Hg (P less than .01) to 6.6 +/- 7.0 mm Hg, with elevation of the conjunctival bleb in all eyes treated. After a mean follow-up of 14.4 months, intraocular pressure was controlled (less than or equal to 18 mm Hg) in 20 of the 22 eyes treated (91%). The only major complication was a single case of anterior chamber flattening with intraocular lens touching the corneal endothelium. Combination of tight scleral flap trabeculectomy with subsequent postoperative laser suture lysis is a safe and effective method for low-level intraocular pressure control. This technique seems to combine the advantages of full-thickness filtration and trabeculectomy by achieving relatively low intraocular pressures while minimizing complications caused by excessive aqueous runoff.

Evaluation Studies as Topic↗
PubMed1990

Glaucoma in siblings with Morquio syndrome.

Two cases of association between the Morquio Syndrome and glaucoma in one family are described. Possible role of Mucopolysaccharides acting in the anterior chamber angle is discussed.

Adult↗
PubMed1990

Retinal detachment adherent to posterior chamber IOL after Molteno implant surgery.

A patient with refractory glaucoma 1 year after cataract extraction and trabeculectomy had Molteno implant surgery. Three days after surgery a kissing choroidal effusion and retinal detachment adherent to the posterior chamber IOL were detected. Repeated choroidal taps were unsuccessful. Removal of the Molteno implant, vitrectomy, and silicone oil injection were required to reattach the retina.

Cataract Extraction↗
PubMed1990

[Aqueous drainage implants in glaucoma].

The use of implants to drain aqueous from the anterior chamber to a posterior collecting reservoir is an important additional option in the treatment of advanced refractory glaucoma. In the past decade, many problems and complications associated with drainage implants have been solved by modifications in implant design and surgical technique. These include: entry of the tube into an equatorial collecting device, increased surface area of the collecting reservoir, use of a needle track to insert the tube into the anterior chamber, suturing a donor scleral patch to cover the tube, intracameral injection of hyaluronic acid (Healon), ligation of the tube with a temporary suture, and antifibrotic medical therapy. The adoption of some or all of these modifications in recent years has clearly resulted in fewer complications and better long-term control of intraocular pressure.

Anterior Chamber↗
PubMed1989

Patterns of aqueous humor outflow in glaucomatous and nonglaucomatous human eyes. A tracer study using cationized ferritin.

We used cationized ferritin, which binds to negatively charged membrane surfaces, as a tracer to delineate the aqueous humor outflow pathway by perfusing it into the anterior chamber of 14 normal human eyes and five with primary open angle glaucoma. In the normal human eyes, diffuse labeling with cationized ferritin was evident throughout the outflow pathway, while in the glaucomatous eyes distinctly different staining patterns were noted. A decorating pattern similar to that seen in normal eyes was observed, as well as apparent areas of underperfusion, suggestive of possible segmental changes in aqueous outflow. These findings may support the hypothesis that primary open angle glaucoma is a segmental disease of the outflow system due to possible regional increases in resistance to aqueous outflow.

Adult↗
PubMed1989

A comparison of the ocular hypotensive efficacy of once-daily and twice-daily levobunolol treatment.

The authors compared the ocular hypotensive efficacy of two different treatment regimens of levobunolol 0.5% in a double-masked, randomized, controlled clinical trial. Seventy-one patients with open-angle glaucoma or ocular hypertension received levobunolol 0.5% as their sole glaucoma medication either on a once-daily or twice-daily treatment regimen for 3 months. Approximately 81% of the patients in the once-daily treatment group and 88% of subjects in the twice-daily treatment group successfully completed the 3-month study period. The overall mean decrease in intraocular pressure (IOP) was 4.5 mmHg in the once-daily group and 5.6 mmHg in the twice-daily group. These differences were not statistically different. For both treatment groups, effects on mean heart rate and blood pressure were minimal. The authors' data from this population suggest that once-daily treatment with levobunolol is an effective glaucoma regimen.

Blood Pressure↗
PubMed1989

Glaucoma in patients with ocular cicatricial pemphigoid.

This retrospective review of 111 patients with ocular cicatricial pemphigoid (CP) identifies 29 patients (26%) with glaucoma. Twenty-seven of these patients had a history of glaucoma for a mean of 11.3 years before the diagnosis of CP was made. Most had advanced glaucoma, with a long history of medication use, optic nerve damage, and visual field loss. Patients with CP and glaucoma were more likely to manifest continued high-grade conjunctival inflammation than those with CP alone despite treatment for CP (P less than 0.05). Possible mechanisms including genetic susceptibility to both diseases, drug-induced conjunctival cicatrization, and CP-induced alterations in aqueous outflow are discussed. Physicians who care for patients with CP should remain mindful of the possible coexistence or development of glaucoma in this group of patients. Patients with glaucoma and chronic conjunctivitis of uncertain etiology should be referred for evaluation by physicians experienced in the detection and management of CP.

Age Factors↗
PubMed1989

Ergonomic stress levels, personal characteristics, accident occurrence and sickness absence among factory workers.

This study was designed to evaluate the association of a single, integrated measure of simultaneous exposure to a number of adverse work and environmental conditions, termed the Ergonomic Stress Level (E-S-L), on workers' accident and sickness absence rates. The factors determining the E-S-L were body motion and posture, physical effort, active hazards and environmental stressors. E-S-L evaluation was based on 'walk-through' hazard inventories, direct observations, measurements and interviews. Workers were assigned to one of four stress levels ranging from low (A) to high (D). Subjects were 729 males, aged 20-67 years, employed in five factories in Israel. A linear relationship between E-S-L AND accident incidence was found, increasing from the lowest to the highest E-S-L. Moreover, workers more sensitive to environmental stressors, as indicated by their reported subjective annoyance, showed higher accident rates across all the ergonomic stress levels, a tendency which was statistically significant at levels C and D. On the other hand, sickness absence was significantly related to the overall subjective stress experienced, as manifested by reported job dissatisfaction and somatic complaints, and not directly to E-S-L. These findings highlight the role of aggregate work stress, coupled with individual sensitivity to environmental stressors, in increasing the risk of accidents.

Absenteeism↗
PubMed1989

Outflow resistance of enucleated human eyes at two different perfusion pressures and different extents of trabeculotomy.

Aqueous outflow resistance of enucleated human eyes was measured at 7 and 25 mm Hg before and after partial and complete (12 clock hours) internal trabeculotomy. Following complete trabeculotomy, 71% of the resistance was eliminated at 25 mm Hg while only 49% was eliminated at 7 mm Hg. In contrast to published findings in eyes with intact trabecular meshwork where the resistance increased with increasing IOP (1), following complete trabeculotomy, the resistance decreased 2% per mm Hg with increasing IOP. Experiments with trabeculotomy limited to part of the circumference showed that a one hour trabeculotomy produced 41% (25 mm Hg) to 60% (7 mm Hg) of the effect of a twelve hour trabeculotomy. The results indicate that a surprisingly high fraction of aqueous outflow resistance resides in the distal aspects of the outflow system at normal IOP, and that this distal resistance drops as IOP is increased.

Aged↗
PubMed1989

Trabecular precipitates and elevated intraocular pressure following argon laser trabeculoplasty.

Two patients with pseudoexfoliation glaucoma underwent argon laser trabeculoplasty for control of intraocular pressure. Within 1 month both patients developed elevated intraocular pressure associated with many large inflammatory precipitates on the trabecular meshwork detected only by gonioscopy. Treatment with topical steroids for 7 to 10 days resolved these precipitates and lowered the intraocular pressure. We believe our patients had severe trabeculitis occurring as a late reaction to argon laser trabeculoplasty. An increase in intraocular pressure following trabeculoplasty warrants careful gonioscopic examination; in fact we recommend routine gonioscopy for all patients after laser treatment.

Aged↗
PubMed1989

Use of neodymium: YAG laser to open an occluded molteno tube.

A patient with refractory glaucoma secondary to trauma and repeat penetrating keratoplasty had Molteno implant surgery to control elevated intraocular pressure. Six weeks after surgery intraocular pressure rose abruptly, and a fibrinous membrane was seen covering and occluding the tip of the Molteno tube. The Q-switched neodymium (Nd):YAG laser was used successfully to open the membrane, with subsequent renewal of aqueous flow and control of intraocular pressure. Bevel-up cutting of the tube tip facilitates Nd:YAG laser opening of such an obstruction. We describe this use of the Nd:YAG laser and recommend bevel-up trimming of implant tubes in aqueous implant surgery.

Adult↗
PubMed1989

Focal scleral thinning after transscleral Nd:YAG cyclophotocoagulation.

Transscleral neodymium (Nd):YAG cyclophotocoagulation, a new cyclodestructive procedure for controlling intraocular pressure in patients with refractory glaucoma, is designed to penetrate the sclera and selectively destroy the ciliary body and processes without damaging the overlying tissue. Complications include conjunctival edema, corneal edema, iritis, gas in the anterior chamber, pain, hyphema, hypopyon, vitreous hemorrhage, and cataract. We present a case in which a patient developed focal areas of scleral thinning 6 weeks after transscleral Nd:YAG cyclophotocoagulation. The possibility of scleral damage or thinning should be kept in mind when performing the procedure.

Adult↗