Biomedical subjects

A Ophir

Publications and source records attributed to A Ophir.

At least 19 recordsLinked to original sources

PubMed2006

Protection of the conjunctival flap from contact with mitomycin C during tunnel-trabeculectomy.

AIM: The mid-term appearance of the filtering bleb and surgical outcome following tunnel-trabeculectomy, in which protective measures were carried out to avoid contact between the mitomycin C (MMC) and the conjunctival flap, are presented. METHODS: In a retrospective study the records of 20 consecutive patients who had undergone tunnel-trabeculectomy >/=24 months earlier, using fornix-based conjunctival flap and MMC (0.4 mg/ml) application were evaluated. Inclusion criteria were patients in whom: (I) the MMC-socked sponge was applied without contact with the conjunctival flap; (II) during MMC washout, a second Weck cell sponge was held anterior to the conjunctival flap, to protect the flap from mitomycin contact during its back-flow. Excluded were five patients who either did not complete 24 months of follow-up (n=4) or underwent an intraocular surgery during that period (n=1). RESULTS: After 24-32 (26.9+/-2.2) months, the filtering bleb was completely vascularized and thick in 13/15 patients (86.7%), mostly vascularized with some para-limbal thick cysts in one and avascular and cystic in another. Mean intraocular pressure (IOP) dropped from a preoperative level of 25.3+/-7.0 mmHg with 3.5+/-0.9 hypotensive medications to 13.9+/-2.9 mmHg with 0.9+/-1.1 medications (P<0.0001, Wilcoxon test). Of the five excluded patients, the IOP ranged between 10 and 16 mmHg with 0-1 medications at the last examination, 1-15 months postoperatively. CONCLUSION: In this pilot study, an intraoperative protection of the conjunctival flap from mitomycin contact was mostly associated with a vascularized and thick filtering bleb after mid-term follow-up. Further controlled prospective studies are required to confirm these observations.

Adult↗

PubMed2005

Diabetic vitreopapillary traction and macular oedema.

PURPOSE: To describe an association between optic disc traction and diabetic macular oedema (DME) unresponsive to laser treatment. METHODS: A retrospective review of all patients with DME who attended our clinic between September 2001 and November 2003 was undertaken. The patients had undergone ophthalmic history and examination, fluorescein angiography, and optical coherence tomography (OCT) of the macular area and optic nerve head (ONH). A total of 10 nonvitrectomized eyes that were found to have an elevation of the ONH secondary to vitreopapillary traction were included in the analysis. Eyes with additional traction at the posterior pole were excluded. RESULTS: Out of the 10 eyes (seven patients, aged 47-79 years) with vitreo-papillary traction, nine had previously undergone argon laser photocoagulation(s) for DME. In seven eyes (seven patients), OCT verified the vitreopapillary traction as the sole traction, whereas in the fellow eyes of three patients vitreomacular traction was evident as well. In the seven eyes with only vitreopapillary traction, OCT demonstrated parapapillary serous retinal detachment in two eyes and a diffuse DME in all eyes (mean foveal thickness, 396+/-144 microm). Maximal thickness of the papillo-macular bundle site was adjoining the elevated ONH in three eyes, and was maximal at the central macula in the other four eyes. Ultrasonography (n=5) revealed an incomplete detachment of the posterior hyaloid in each, adherent only at the ONH. CONCLUSIONS: Diffuse DME unresponsive to laser treatment may be associated with vitreopapillary traction. Further studies should indicate whether these two phenomena could suggest a cause and effect in such eyes.

Aged↗

PubMed2001

Mini-trabeculectomy in eyes with high risk of scarring: midterm follow-up.

PURPOSE: To report on the surgical outcome after at least 1 year of follow-up of mini-trabeculectomy (without scleral radial incisions), which took place in eyes at high risk of postoperative filtering bleb scarring. METHODS: In a prospective, institutional study, mini-trabeculectomy was performed on 26 eyes of 26 consecutive patients aged 40 years and older who had undergone a previous intraocular surgery or had had a post-traumatic recessed anterior chamber angle. The surgical procedure, a modification of the standard trabeculectomy, involved a 3-mm fornix-based conjunctival flap, sclerostomy at 1 mm from the limbus, and a sclerocorneal tunnel without radial incisions. During surgery, 0.4 mg per ml of mitomycin C was applied in the scleral pocket of each eye for 3 minutes. Of the 26 eyes, each of two eyes underwent an intraocular intervention during the first postoperative year and therefore was evaluated only for surgical complications. Another eye underwent inferior mini-trabeculectomy, and three other eyes did not complete 12 months of follow-up. Twenty eyes have completed 12 months or more of follow-up and were included in the midterm calculations of intraocular pressure control. RESULTS: Mean preoperative intraocular pressure (n = 20) was 32.2 +/- 9.5 mm Hg with 3.3 +/- 0.9 hypotensive medications. After 12 to 37 months (mean, 22.1 +/- 6.6) of follow-up, intraocular pressure was 20 mm Hg or less in 18 of 20 eyes (90%) and the mean intraocular pressure was 17.4 +/- 2.9 mm Hg (range, 12 to 23) with 1.1 +/- 1.2 hypotensive medications (range, 0 to 4). At that time, the filtering bleb was low and fleshy in appearance in 15 eyes (75%). Postoperative complications of the 22 eyes included early postoperative aqueous leakage in one eye (4.5%); cataract extraction took place in one eye and vitrectomy was performed in another eye, 7 and 3 months postoperatively, respectively. The four eyes that were excluded from the study had controlled intraocular pressure at the last examination. CONCLUSION: Mini-trabeculectomy in eyes with high risk of scarring was found efficacious and relatively safe. The relatively small peritomy, the tunnel approach, and the avoidance of radial incisions seem to offer important advantages over the standard trabeculectomy.

Aged↗

PubMed2001

Mini-trabeculectomy as initial surgery for medically uncontrolled glaucoma.

PURPOSE: To report on the surgical outcome after at least 12 months of follow-up of mini-trabeculectomy (without radial incisions) as an initial surgery. METHODS: In a prospective, institutional study, mini-trabeculectomy was performed as the initial surgical therapy on 41 eyes with medically uncontrolled glaucoma of 41 consecutive patients aged 40 years or older. Mini-trabeculectomy consists of a 3-mm fornix-based conjunctival flap, sclerostomy at 1 mm from the limbus, and a sclerocorneal tunnel without radial incisions. Of the 41 eyes, four eyes did not complete 12 months of follow-up. Of the remaining 37 eyes, one eye underwent cataract extraction 5 months postoperatively and was evaluated only for surgical complications. Thirty-six patients with a mean age of 70.3 +/- 7.4 standard deviation years (range, 54 to 87) completed 12 months or more of follow-up. RESULTS: In the 36 eyes, mean preoperative intraocular pressure was 30.2 +/- 9.3 mm Hg (range, 19 to 54) with 3.0 +/- 1.2 hypotensive medications (range, 1 to 4). After postoperative mean follow-up of 25.0 +/- 9.2 months (range, 12 to 43), intraocular pressure was at or below the planned target intraocular pressure in 35 eyes (97.2%; P <.0001) and mean intraocular pressure was 16.0 +/- 2.8 mm Hg (range, 11 to 21) with 0.8 +/- 1.0 medications (range, 0 to 3). Postoperative complications in the 37 eyes included early postoperative aqueous leakage with moderately shallow or deep anterior chamber in two eyes (5.4%) and rapid cataract progression in one eye (2.7%). The four eyes that were excluded from the study had intraocular pressures of 10 to 16 mm Hg with 0 to 1 hypotensive medications, 3 to 9 months after surgery, respectively. CONCLUSIONS: Mini-trabeculectomy, which may offer clinical and technical advantages over the standard trabeculectomy, was generally efficacious and relatively safe, based on outcome observed at a mean of 25 months follow-up. A controlled study is required to confirm these observations.

Aged↗

PubMed2001

Halting pterygium recurrence by postoperative 5-fluorouracil.

PURPOSE: To investigate the efficacy of postoperative 5-fluorouracil (5-FU) in halting recurrence of pterygium. METHODS: Early recurrence of pterygium was detected in six eyes of six patients aged 40 to 66 years that, over a 3-year period, had undergone pterygium excision in our institution, using the "bare sclera" technique. Each of the hyperemic fibrovascular tissues was found to override the cornea by 1.5 mm or less in length. Five of these eyes had undergone a primary excision and one, a second operation (with intraoperative mitomycin C). Upon diagnosis, each eye was treated with two to four injections of 5-FU, administered into the dome of the fibrovascular tissue. The dose of 5-FU per injection was 1 to 3 mg (mean, 2.1 +/- 0.8 mg). Of all 126 eyes that underwent pterygium surgery during that 3-year period, pterygium recurred in nine additional eyes but was found to be 2 mm or more in length in each. These eyes were not treated by 5-FU. RESULTS: In five of the six treated eyes, the pterygium became clinically atrophic and the recurrence process was stopped. No renewal of the recurrence process was detected after 12 months or more of follow-up. No major complications were related to the use of 5-FU. CONCLUSION: This pilot study suggests that when early recurrence of pterygium is already evident, 5-FU treatment into the dome of the fibrovascular tissue may be beneficial in halting its progression, by rendering it atrophic. A prospective, randomized, controlled study is required to confirm the efficacy of this approach.

Adult↗

PubMed2001

Spontaneous expulsive suprachoroidal hemorrhage.

PURPOSE: To present a 90-year-old patient with spontaneous expulsive suprachoroidal hemorrhage (SESCH). This unique case suggests a mechanism of SESCH, which is still under debate. METHODS: The patient, who had corneal inflammatory disease and diabetes mellitus, atherosclerosis, and glaucoma, presented with active ocular bleeding and expulsion of intraocular tissues. Almost the entire cornea was absent, except for several small and irregular areas in its periphery. Histopathologic evaluation of the eviscerated contents was performed. RESULTS: Clinicopathologic evaluation revealed acute inflammation of the corneal remains as well as intraocular inflammation. Inflammatory necrosis of choroidal vessels was evident. CONCLUSION: The findings point to the assumption that choroidal bleeding, secondary to vascular inflammatory necrosis, was the initial event in this case of spontaneous expulsive suprachoroidal hemorrhage. Presumedly, the intraocular pressure level was very high owing to continuous bleeding, which could result in a very large, rather than localized, tearing of the peripherally inflamed cornea.

Aged↗

PubMed2000

Noncontact tonometry in perforating corneal injuries.

PURPOSE: To report on one of the possible complications induced by puff noncontact tonometry and to discuss various aspects such as safety, other optional methods, rationality, and the need for tonometry in cases of perforating corneal injuries. PATIENTS AND METHODS: We report a case of traumatic, self-sealed, midperipheral corneal perforation, where puff tonometry was performed upon admission, 30 minutes after the injury. RESULTS: The integrity of the wound was temporarily distorted by the air-jet of the puff tonometer, the wound was opened, and an air-bubble filled the anterior chamber. CONCLUSION: Puff tonometry in patients with self-sealed midperipheral corneal perforation and a negative Seidel test does not seem sufficiently safe during the immediate posttraumatic period.

Adult↗

PubMed1999

Mini-trabeculectomy without radial incisions.

PURPOSE: To describe a new modification of Cairns trabeculectomy. METHODS: Surgical adjustment includes a small, 3-mm, fornix-based conjunctival flap, a circumferential scleral incision at a distance of only 1 mm from the corneoscleral limbus, and a sclerocorneal tunnel without scleral radial incisions. RESULT: Among the various clinical and technical advantages of the procedure is the possibility of performing more operations through the superior limbus rather than reverting to an inferior trabeculectomy or implantation of an aqueous shunt. CONCLUSION: The reduced surgical area and manipulations of the current procedure appear to offer advantages over the standard approach.

Aged↗

PubMed1994

Protection of the transiently ischemic cat retina by zinc-desferrioxamine.

PURPOSE: A previous study indicated that hydroxyl radicals are generated in the cat retina during the early reperfusion phase after 90 minutes of ischemia. Salicylate was injected intravenously, and its conversion to 2,3-dihydroxybenzoic acid (2,3-DHBA) served as a marker of hydroxyl radicals. The authors attempted to prevent this free radical generation during reperfusion. METHODS: After salicylate administration, both eyes (15 minutes apart) of 15 cats were subjected to 90 minutes retinal ischemia. Following 5 minutes of reperfusion in the control eye, it was enucleated and processed for DHBA quantitation. Then, 7.5 mg of Zn-desferrioxamine (Zn-DFO) was injected intravenously into nine cats and saline into six cats. Five minutes later, reperfusion was induced in the experimental eye for 5 minutes, followed by enucleation. In one eye each of 12 other cats, scotopic electroretinographic (ERG) studies were carried out during 90 minutes of ischemia and 16 to 18 hours of reperfusion. Five minutes before termination of the ischemia, six animals were injected with 7.5 mg Zn-DFO and six with saline. RESULTS: The normalized levels of 2,3-DHBA were lower in the experimental eyes than in their fellow controls only after Zn-DFO treatment (P = 0.01). In the ERG studies, after 16 to 18 hours of reperfusion, the mean b-wave-ERG amplitudes in the eyes of the saline-treated cats (n = 6) were 8.4% +/- 4.0% of the preischemic stage, and 70.5% +/- 6.7% of the Zn-DFO-treated cats (n = 6, P = 0.004). CONCLUSIONS: Protection of the cat retina against ischemia and reperfusion injury by Zn-DFO was evident, most probably through its inhibitory effect on the generation of hydroxyl radicals during reperfusion.

Animals↗

PubMed1993

Late complications after glaucoma filtering surgery with adjunctive 5-fluorouracil.

We studied 105 patients (105 eyes) operated on for glaucoma with adjunctive fluorouracil, who were followed up for 12 to 48 months (mean, 34.6 +/- 12.9 months). Fifty eyes that had previous glaucoma or cataract extraction or had inflammatory glaucoma had a high risk for postoperative scarring (high-risk group), and 55 eyes had glaucoma surgery as an initial procedure (initial surgery group). An intraocular pressure of 20 mm Hg or less, with or without hypotensive medications, was found in 42 eyes in the high-risk group (84.0%) and in 53 of the eyes in the initial surgery group (96.4%). Of the 105 eyes, an intraocular pressure of 12 mm Hg or less without medication was achieved in 17 eyes in the high-risk group (34.0%) and in 35 eyes in the initial surgery group (63.6%). Late complications in both groups were as follows: endophthalmitis in four eyes (3.8%) (two of the infected blebs were located superiorly and two inferiorly), transient leaking bleb in two eyes (1.9%), hypotony of an extended period with 180 to 360 degrees of filtration in three eyes (2.9%), giant bleb extending over the cornea in two eyes (1.9%), and a transient, mild iridocyclitis in nine eyes (8.6%). Thus, adjunctive fluorouracil after filtering surgery may entail various, mainly bleb-related, late side effects and complications.

Adolescent↗

PubMed1993

Hydroxyl radical generation in the cat retina during reperfusion following ischemia.

There is increasing evidence that oxygen-derived free radicals are generated during the early phase of reperfusion, and account for part of the damage caused by transient ischemia in various tissues. To study this in the retina, cats were injected intravenously with sodium salicylate (100 mg kg-1), which reacts as a hydroxyl radical trap to form 2,3- and 2,5-dihydroxybenzoic acids (DHBA). Thirty minutes following injection, the retina of one eye of each animal was subjected to ischemia by intraocular pressure elevation via cannulation of the anterior chamber, while the fellow eye served as a sham-operated control. Ischemia was induced for 60 min (six eyes) and 90 min (eight eyes) followed by 5 min of reperfusion. In six other eyes, ischemia was induced for 90 min without reperfusion. After enucleation, the retinas were immediately removed, placed in ice-cold buffer and the retinal levels of 2,3- and 2,5-DHBA were quantitated by high pressure liquid chromatography, coupled with electrochemical detection. Results were normalized and expressed as ng DHBA microgram-1 salicylate mg-1 retinal protein. After 60 min of ischemia followed by reperfusion the normalized levels of 2,3- and 2-5-DHBA were no different in the experimental and control retinas. However, the levels of both 2,3- and 2,5-DHBA were significantly higher in the retinas subjected to 90 min ischemia followed by reperfusion than in the control tissues (P = 0.012 and P = 0.036, n = 8 respectively). Following 90 min ischemia without reperfusion, the normalized dihydroxybenzoate levels in the retinas were no higher than in their controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1993

Filtering surgery with 5-fluorouracil subsequent to Molteno implant.

In cases of refractory glaucoma, when Molteno shunt implantation has been performed and resulted in failure, the best surgical option has not yet been established. Filtering surgery with 5-fluorouracil (5-FU) as one option for the above was performed in four non-neovascular glaucomatous eyes (four patients) after failure of Molteno shunt implantation. Injections of 5 mg 5-FU were administered once daily for 9-14 days. After follow-up of 6-18 months in 3 eyes, intraocular pressure ranged from 10 to 16 mm Hg. In the fourth eye, in which bleb scarring ensued, a second filtering surgery with 5-FU was performed after 4 months, and resulted in a successful outcome as recorded 26 months later. These preliminary results suggest that filtering surgery with 5-FU might be an acceptable surgical option in non-neovascular refractory glaucoma subsequent to failure of Molteno shunt implantation.

Adolescent↗

PubMed1993

5-fluorouracil and mast cell precursors in mice.

In the mouse hematopoietic system, 5-fluorouracil (5-FU) reversibly inhibits the generation of multilineage colonies containing granulocyte, erythroid, megakaryocyte, and macrophage lineage. To determine the effect of 5-FU on mastopoiesis in vitro, bone marrow cells were obtained from mice, cultured, and treated with 5-FU for 14 days in an interleukin-3 (IL-3)-enriched medium. A dose-related inhibitory effect of 5-FU on mastopoiesis was found. When an inhibitory dose (1 microgram/mL) of 5-FU was supplemented to the cultures for only 2, 4, or 8 days and the cells were then recultured without the drug, we observed inhibition of mastopoiesis directly related to the time of exposure of the cells to 5-FU. To determine the effect of 5-FU on mastopoiesis in vivo, bone marrow cells from mice that had received a single intravenous (i.v.) 5-FU injection (150 mg/kg) were cultured. A virtually total absence of mast cells was noted at days 1 and 2 following 5-FU administration. A gradual reappearance of mast cells was later observed. Whether mice were injected with the drug once or with four once-daily (100 mg/kg 5-FU) injections, a similar pattern of delay of mast cell appearance was observed. The findings suggest (1) an irreversible, nonadditive, toxic effect of 5-FU on mast cell precursors and (2) that most or all of the mast cell precursors are nonquiescent cells, continuously activated or cycling. In addition, the use of 5-FU may serve as a unique model system for controlling and studying mastopoiesis in normal mice, rather than the mutated mice currently studied.

Animals↗

PubMed1992

[Treatment of anterior uveitis with 5-fluorouracil].

Filtering surgery with use of 5-fluorouracil (5FU) was performed in 5 eyes (4 patients) with inflammatory glaucoma to prevent filtering bleb scarring. Postoperative injections of 5FU were given once or twice a day, according to the degree of anterior chamber inflammation. Complete remission of the uveitis was achieved in all 5 eyes after 7-14 days of postoperative injections of 5FU. There were no recurrences of uveitis during a minimum of 8 months of follow-up.

Fluorouracil↗

PubMed1992

A randomized study of trabeculectomy and subconjunctival administration of fluorouracil in primary glaucomas.

Forty-one adult patients with primary open angle glaucoma and nine adult patients with chronic angle closure glaucoma underwent trabeculectomy in one eye each. Twenty-one eyes with primary open angle glaucoma and four with chronic angle closure glaucoma were randomly assigned to receive four to six subconjunctival injections of fluorouracil for 10 days after surgery. Twenty-five control eyes did not receive fluorouracil. Intraocular pressure was 20 mm Hg or lower in 24 eyes (96%) in the treatment group after mean follow-up of 17.8 months and in 19 control eyes (76%) after mean follow-up of 17.5 months (P less than .05). Encapsulated bleb developed in three (12%) of the fluorouracil-treated eyes vs two (8%) of the control eyes. A few injections of fluorouracil adequately inhibited scarring. This might be explained by its toxic effect on existing fibroblasts. Overall, trabeculectomy with injection of fluorouracil was found to be efficacious and relatively safe. Further studies regarding late complications are required.

Aged↗

PubMed1992

Changes in Müller cell plasma membrane specializations during subretinal scar formation in the rabbit.

The aim of this study was to identify changes in Müller cell plasma membrane specializations during experimentally induced subretinal gliosis in rabbits. When rabbits are dosed with sodium iodate, large expanses of retinal pigment epithelium and photoreceptors are destroyed. They are replaced by a subretinal scar consisting mainly of the ascending processes of Müller cells. These processes transform from the slender, highly polarized structures seen in normal animals into irregular processes that form a glia limitans along the basement membrane of the pigment epithelium, left bare following its degeneration. As the scar processes extend through the subretinal space and contract this basement membrane, they undergo dramatic changes in shape that are especially apparent in three-dimensional computer reconstructions of serial thick sections examined by high-voltage electron microscopy. Other changes involve the intercellular junctions and apical microvilli normally associated with the external limiting membrane. These structures become scattered over the surfaces of the ascending processes and are eventually lost. Loss of microvilli is associated with disappearance of immunostaining for a specific glycoconjugate normally associated with the microvillar plasma membrane. The observations document profound changes in Müller cell structural and functional polarity during subretinal scar formation.

Animals↗

PubMed1992

Encapsulated filtering bleb. A selective review--new deductions.

Filtering bleb encapsulation may, in some cases, be a severe complication following filtering surgery. The cause and mechanism of its development are not known. A selective review of data that might shed some light on these dilemmas, is presented. Based on these data, it is suggested that: (a) non-contractile collagen-producing fibroblasts play a major role in the process of bleb encapsulation, while in wound healing following filtering surgery, contractile fibroblasts are the major components; (b) the process of bleb encapsulation is less sensitive to the toxic effect of 5-Fluorouracil than would healing; (c) collagen-producing fibroblasts may be less sensitive to the destructive effect of 5-Fluorouracil than contractile fibroblasts; (d) inflammatory mediators are important triggers of bleb encapsulation.

Animals↗

PubMed1992

Toxic effects of 5-fluorouracil on fibroblasts following trabeculectomy.

The inhibitory effect of 5-fluorouracil (5-FU) on fibroblast proliferation is well established. In addition, toxic effects of 5-FU on existing fibroblasts, in rabbits and in vitro, were demonstrated. We examined human subconjunctival scar tissue which was removed during Molteno tube implantation. Surgery was performed 9 weeks after filtering surgery with 5-FU that resulted in bleb scarring. In the tissue, intracytoplasmic vacuoles were detected in some myofibroblasts, with no visible collagen in their vicinity. This presumed toxic effect of 5-FU may be one explanation for the adequacy of fewer than twice 5-FU injections daily following filtering surgery, and for less than 14 days, as originally recommended for inhibiting bleb scarring.

Adult↗