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Biomedical subjects

W J Stark

Publications and source records attributed to W J Stark.

At least 163 records · Page 9Linked to original sources
PubMed1984

Posterior chamber intraocular lenses at the Wilmer Institute: a comparative analysis of complications and visual results.

Intraocular lens (IOL) implantation is now accepted as the most effective means of aphakic correction in selected patients undergoing cataract surgery. In terms of final rehabilitation, however, complications such as corneal oedema, retinal detachment, and cystoid macular oedema remain problematic. Results of prospective concurrent trials of IOL implantation performed at the Wilmer Institute are presented, with particular reference to the posterior chamber intraocular lens and with specific emphasis on postoperative complications.

Aged↗
PubMed1984

Removal of closed-loop anterior chamber lens implants.

A simplified method for removing closed-loop anterior chamber intraocular lenses which have become embedded within the ciliary body is described. The procedure is not difficult to perform, requires no special instrumentation, and minimizes the risk of bleeding.

Anterior Chamber↗
PubMed1984

The anterior capsulotomy of extracapsular cataract extraction.

Cataracts are a major cause of blindness, and more than 75% of all cataract operations performed in the United States are associated with an intraocular lens (IOL) implant. Since approximately 63% of all IOL implants are of the posterior chamber type and associated with extracapsular cataract extraction (ECCE), it is important for the ophthalmic surgeon to perfect this operation. We describe herein the important surgical anatomy of the zonular-lens capsular attachments and present the results of a poll of experts as to the important aspects of the anterior capsulotomy of the ECCE.

Adolescent↗
PubMed1984

The FDA report on intraocular lenses.

Clinical studies of intraocular lenses (IOLs) as investigational devices have been regulated in the United States by the Food and Drug Administration (FDA) since 9 February 1978. As of August 1982, data have been collected on more than one million IOLs implanted. During the last 12 months of the study, 409 000 IOLs were implanted. Visual acuity of 20/40 or better at one year after surgery was present in 85% of over 45 000 cases reviewed. Increasing patient age, surgical problems, postoperative complications, and adverse reactions were factors that reduced the visual acuity. The current trend in the USA is for implantation of posterior chamber and anterior chamber IOLs.

Cataract Extraction↗
PubMed1983

Extended-wear soft contact lenses for aphakic correction.

Evaluation of an extended-wear perfilcon A soft contact lens (Permalens) in 299 eyes of 244 patients showed that 266 eyes (89%) were successfully fitted and wore the lenses without important complications (mean follow-up, 23 months; range, four to 48 months). Use of the lens in 33 eyes was discontinued because of transient lens-related problems. "Overcorrected" acuity of 6/12 (20/40) or better (with spectacles plus the contact lens) was achieved in all patients who were without vitreous, retinal, or optic nerve disease. Seventy-six percent of patients could wear the lens for longer than one-month intervals, and 30% removed the lens at four- to six-month intervals. There were no cases of infectious corneal ulcers or scarring or permanent visual loss. Our more limited experience with lidofilcon B lenses (Sauflon PW) (24 eyes) and the silicone lenses (Silsoft) (25 eyes) also showed beneficial results.

Aged↗
PubMed1983

Clinical specular microscopy of corneal endothelial rejection.

Clinical specular microscopy was performed during acute rejection episodes in 20 patients. The following five distinct morphologic changes were noted: (1) "blackout" areas due to deposition of wandering cells on the endothelial layer, (2) intracytoplasmic blackout areas of unknown cause, (3) intracellular "bright" oval bodies related to the cell nucleus, (4) prominent variation in cell size, and (5) a sharp demarcation line of affected endothelial cells in a linear-type rejection. These morphologic changes were severe even in early rejection, and there was frequent persistence after the rejection episode was considered controlled by slit-lamp examination. Although these changes were not pathognomonic for endothelial rejection and could be seen in isolation in idiopathic uveitis and normal corneal transplant endothelium, a constellation of all these changes appeared specific for endothelial rejection.

Adult↗
PubMed1983

Aphakic extended-wear contact lenses after penetrating keratoplasty.

Fifteen aphakic eyes in 15 selected patients who underwent penetrating keratoplasty were successfully fitted with extended-wear contact lenses three to 42 months postoperatively. After an average follow-up of 17 months, there was no graft edema, no microbial corneal ulcers, and no episode of graft rejection. Three eyes developed minor (1 to 2 mm) graft neovascularization; the neovascularization was stable and did not require discontinuation of the contact lenses. Fourteen of the 15 patients had postoperative visual acuities of 20/70 or better; the one patient whose visual acuity was worse than 20/70 had a clear graft but also had senile macular degeneration.

Aged↗
PubMed1983

Neodymium-YAG laser for posterior capsulotomy.

We used the neodymium-YAG laser to perform discission of the posterior capsule in 49 eyes of 47 patients who had undergone previous extracapsular cataract extraction. The visual results were encouraging, with an improvement in visual acuity of one or more Snellen lines in 45 eyes and an improvement of three or more Snellen lines in 33 eyes. The complications included increases in intraocular pressure in 28 eyes. Intraocular pressures between 21 and 40 mm Hg were detected in 21 eyes and exceeded 41 mm Hg in another seven. In 14 of the 16 eyes in which intraocular pressure increased to more than 30 mm Hg, the maximum intraocular pressure was detectable within three hours after treatment. Other complications included damage to the intraocular lens in 12 of 30 eyes with implants and rupture of the anterior hyaloid face with forward displacement of vitreous into the anterior chamber in six of 19 eyes without implants. One of these eyes later developed a rhegmatogenous retinal detachment. A transient laser-induced hemorrhage occurred in one eye.

Aqueous Humor↗
PubMed1983

Trends in cataract surgery and intraocular lenses in the United States.

Cataracts are the second leading cause of blindness in the United States. The rate of cataract surgery has greatly increased in the past several years, in part because of the extensive use of intraocular lenses for aphakic correction. It is estimated that more than 600,000 cataract operations were done in 1982. During a similar period, an estimated 496,000 intraocular lenses were implanted. Thus, more than 70% of all cataract operations in the United States involved intraocular lens implantation. Although iris fixation lenses accounted for 52% of all intraocular lenses implanted in 1978, during the six-month period from July 1982 through January 1983 57% of all implanted intraocular lenses were posterior chamber lenses and 40% were anterior chamber lenses.

Adolescent↗
PubMed1983

Persistent hyperplastic primary vitreous. Surgical treatment.

Instruments designed for pars plana vitrectomy can be used to manage selected complicated congenital cataracts such as those with persistent hyperplastic primary vitreous (PHPV). We have applied closed-eye vitrectomy techniques through a limbal approach in seven eyes with PHPV. A clear pupillary space was achieved in all cases and two eyes achieved useful postoperative vision. The management of children with complicated congenital cataracts, such as with PHPV, is discussed.

Cataract↗
PubMed1983

The FDA report on intraocular lenses.

Clinical studies of intraocular lenses (IOLs) as investigational devices have been regulated in the United States by the Food and Drug Administration (FDA) since February 9, 1978. As of August 1982, data have been collected on more than one million IOLs implanted. During the last 12 months of the study, 409,000 IOLs were implanted. Visual acuity of 20/40 or better at one year after surgery was present in 85% of over 45,000 cases reviewed. Increasing patient age, surgical problems, postoperative complications, and adverse reactions were factors that reduced the visual acuity. The current trend in the USA is for implantation of the posterior chamber and anterior chamber IOLs.

Aged↗
PubMed1983

Ocular copper deposition associated with pulmonary carcinoma, IgG monoclonal gammopathy and hypercupremia. A clinicopathologic correlation.

Hypercupremia with central deposition of copper in Descemet's membrane and lens capsule has been reported previously in lymphoproliferative disorders in two cases. A 60-year-old white man presented with visual acuity loss and was found to have an iridescent brown corneal and lenticular discoloration. Laboratory investigation revealed hypercupremia secondary to a poorly differentiated adenocarcinoma of the lung. Presence of copper in the eye was confirmed by specific atomic absorption spectra and histochemical stains of ocular tissue. This appears to be the first report of a carcinoma with associated hypercupremia presenting initially with ocular copper deposition.

Adenocarcinoma↗
PubMed1983

Management of persistent hyperplastic primary vitreous.

Instruments designed for pars plana vitrectomy can be used to manage selected complicated congenital cataracts such as those with persistent hyperplastic primary vitreous (PHPV). We have applied closed-eye vitrectomy techniques through a limbal approach in seven eyes with PHPV. A clear pupillary space was achieved in all cases and two of the seven eyes achieved useful vision. The management of children with complicated congenital cataracts such as those with PHPV is discussed.

Cataract↗
PubMed1983

Transplantation antigens and keratoplasty.

Allograft rejection is one of the leading causes of corneal graft failure in man when the cornea is heavily vascularised. This paper reports the feasibility and possible benefits of using histocompatibility (HLA) antigen crossmatch testing and HLA-D locus antigen matching for corneal donor selection. Double-masked clinical trials designed to determine the value of these procedures for keratoplasty are discussed.

Adolescent↗
PubMed1983

Update of the intraocular lens. Experience at the Wilmer Institute.

A series of 795 primary intraocular lens (IOL) implantations performed at the Wilmer Institute during the past 6 years by two surgeons were reviewed. Progressive corneal endothelial-cell loss and an increased rate of late-onset corneal edema were detected in the group with the Morcher (European) four-loop iris-clip Binkhorst IOLs. Clinically significant cystoid macular edema was more frequent in eyes with the American four-loop Binkhorst lens, presumably due to chronic iritis caused by contaminants on the IOLs. Our short-term results with the American Shearing-type IOLs implanted at the time of extracapsular cataract extraction are encouraging, with 98% of the cases achieving 20/40 vision or better, excluding those with known macular degeneration or amblyopia. A continued cautious approach to IOL implantation is recommended.

Aged↗