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Biomedical subjects

A R Slomovic

Publications and source records attributed to A R Slomovic.

At least 19 recordsLinked to original sources
PubMed2001

Corneal graft outcome study.

PURPOSE: To determine overall 2- and 5-year corneal graft survival rates and to identify risk factors for corneal graft failure in our patient population. METHODS: A retrospective chart review of 696 patients undergoing corneal transplantation performed by a single surgeon at The Toronto Western Hospital over a 7.5-year period. RESULTS: A total of 468 eyes met the inclusion criteria for this study. Overall, the 2- and 5-year graft survival rates were 78.8% and 64.5%, respectively. In a univariate analysis, patient age, gender, history of glaucoma, preoperative diagnosis, type of operative procedure, and postoperative factors all were shown to be significantly associated with graft survival. In a multivariate analysis, six independent predictors of graft failure were identified: preoperative diagnosis, neovascularization of the graft, the presence of peripheral anterior synechiae, gender, occurrence of one or more rejection episodes, and age of the recipient at the time of corneal transplantation. CONCLUSIONS: Risk of graft failure can vary substantially within a population of patients receiving a corneal transplant. The outcomes of this study concur with the risk factors for corneal graft failure in the literature and can be used as prognostic guidelines for both surgeons and patients.

Adolescent↗
PubMed2000

Anesthesia modalities for cataract surgery.

Research articles on anesthesia modalities for cataract surgery are reviewed. A growing trend toward the use of topical anesthesia is apparent. Particular emphasis in the literature is given to determining the safety and efficacy of various forms of topical anesthesia using injectable anesthesia as a frame of reference. A consensus of opinion points toward the use of topical application of anesthetic drops plus intracameral unpreserved lidocaine 1% as the anesthesia modality that provides the best level of analgesia and comfort to patients while not compromising ocular safety. Several articles reporting complications of injectable anesthesia are also reviewed.

Anesthesia, Local↗
PubMed1998

Topical tetracaine versus topical tetracaine plus intracameral lidocaine for cataract surgery.

PURPOSE: To compare topical tetracaine 0.5% alone and with intracameral lidocaine 1% as a local anesthetic agent in phacoemulsification with intraocular lens (IOL) implantation. SETTING: The Toronto Hospital-Western Division, Toronto, Canada. METHODS: Fifty-nine consecutive patients (60 eyes) having phacoemulsification with implantation of a foldable acrylic IOL (AcrySof) were randomized into 1 of 2 groups: The intracameral balanced salt solution (BSS) group received topical tetracaine 0.5% plus intracameral BSS; the intracameral lidocaine group received topical tetracaine 0.5% with preservative-free intracameral lidocaine 1%. The patients' subjective experience of pain was measured at 4 points during surgery using a 4-point pain scale. Patient and surgeon satisfaction with the anesthesia used was measured using a 5-point satisfaction scale. Central endothelial cell counts were obtained preoperatively and 1 month postoperatively. Best corrected visual acuity (BCVA) was measured preoperatively and 1 hour, 1 day, 1 week, and 1 month postoperatively. RESULTS: The mean pain score after phacoemulsification was significantly higher in the intracameral BSS group than in the intracameral lidocaine group (0.63 +/- 0.7 [SD] and 0.23 +/- 0.4, respectively, P < .019). The mean pain score at the end of surgery was also significantly higher in the intracameral BSS group than in the intracameral lidocaine group (0.60 +/- 0.6 and 0.21 +/- 0.4, respectively; P < .014). The surgeon satisfaction score was significantly lower for the intracameral BSS group than for the intracameral lidocaine group (3.90 +/- 1.2 and 4.73 +/- 0.8, respectively; P < .0007). There was no difference in patient satisfaction between the intracameral BSS and intracameral lidocaine groups (4.60 +/- 0.6 and 4.70 +/- 0.8). Endothelial cell loss 1 month postoperatively was similar between the 2 groups (6.1% +/- 8% and 6.7% +/- 6%). Ninety-seven percent of patients (29/30) in each group noted BCVA improvement from preoperatively. The rate of potential visual acuity recovery was similar in both groups. CONCLUSION: Topical tetracaine 0.5% with intracameral lidocaine was safe and effective in patients having phacoemulsification with IOL implantation. The advantage of using intracameral lidocaine 1% over a placebo was a significant decrease in the patients' subjective experience of pain and in the surgeon's satisfaction with the anesthesia used. None of the other parameters measured in this study differed significantly between the 2 groups.

Administration, Topical↗
PubMed1998

Establishing guidelines for the role of minor salivary gland biopsy in clinical practice for Sjögren's syndrome.

OBJECTIVE: To evaluate the predictive value of clinical variables for the finding of a positive minor salivary gland biopsy (focus score > or = 2) in patients investigated for Sjögren's syndrome (SS). METHODS: One hundred twenty-one patients with sicca symptoms were referred to a multidisciplinary SS clinic in a tertiary hospital. Each patient was evaluated on protocol and labial salivary gland (LSG) biopsy was obtained. Using the San Diego criteria as a model, patient data were subjected to a cross sectional analysis on an algorithm to determine when the LSG biopsy would be most useful for determining the diagnosis of SS in clinical practice. RESULTS: Eighty-four patients had sufficient data to be included in the study. Forty patients had LSG biopsy with focus score < 2 and 44 had focus score > or = 2. Twenty-three patients had objective evidence of sicca and positive serology according to criteria standards. Eighteen of these had a positive biopsy (78%). The remaining 5 patients had many extraglandular features suggestive of SS, and the biopsies appeared to add little practical information. Patients with incomplete criteria for sicca could be diagnosed as possible SS (3 of 4 criteria) with a positive biopsy in 14 of 18 cases. The finding of anti-Ro or anti-La positivity in patients with incomplete criteria for sicca predicted a positive LSG biopsy in 85.7% of such cases. Patients with incomplete sicca and negative anti-Ro and anti-La had a negative LSG biopsy in 82% of cases. CONCLUSION: The LSG biopsy is most necessary in patients who have partial San Diego criteria for sicca and positive anti-Ro or anti-La antibody. Where SS is not reasonably suspected, or where the diagnosis is clinically obvious, the LSG biopsy adds little useful clinical information.

Antibodies, Antinuclear↗
PubMed1997

Preoperative ultrasound biomicroscopy to assess ease of haptic removal before penetrating keratoplasty combined with lens exchange.

PURPOSE: To evaluate a method of assessing anterior chamber intraocular lens (IOL) haptics before combined penetrating keratoplasty and IOL exchange in eyes with poor corneal clarity resulting from pseudophakic bullous keratopathy (PBK). SETTING: Department of Ophthalmology, Toronto Hospital, Ontario, Canada. METHODS: Twelve eyes (25 haptics) with PBK were studied using ultrasound biomicroscopy (UBM). The degree of haptic encasement was graded. The result was compared with the degree of difficulty and the complications encountered in removing the IOL at the time of surgery. The surgeons were masked as to the UBM results. RESULTS: All haptics were easily visualized with UBM, with 23 in the angle and 2 passing through a peripheral iridectomy. On UBM, 9 haptics were noted to lie free in the angle, and 16 were encased by fibrotic tissue. Eight were covered by less than 100 microns and 8 by more than 100 microns of tissue. Calculations using Kappa statistics found a strong predictive value for the UBM in identifying the presence or absence of fibrotic encasement and degree of difficulty in removing the anterior chamber IOL haptics. Ultrasound biomicroscopy also allowed assessment of the adjacent angle for synechias. CONCLUSION: Ultrasound biomicroscopy provides an alternative method for evaluating anterior chamber IOL haptics when gonioscopy is not possible because of corneal opacity. This method allows the surgeon to predict preoperatively the degree of difficulty that will be encountered in explanting the IOL.

Anterior Chamber↗
PubMed1997

Indications for penetrating keratoplasty in Canada, 1986-1995.

PURPOSE: To examine the leading indications for penetrating keratoplasty. METHODS: We retrospectively performed a chart review of 904 cases of penetrating keratoplasty over a 10-year period (1986-1995). Where possible, the clinical indication was corroborated by the pathological report. RESULTS: Leading indications included pseudophakic bullous keratopathy (PBK; 28.5%), regraft (22.4%), keratoconus (10.0%), Fuchs' dystrophy (7.6%), aphakic bullous keratopathy (ABK; 6.1%), herpetic keratopathy (4.2%), bacterial infection (4.2%), physical trauma (4%), interstitial keratitis (3.7%), and corneal scarring (2.8%). The most common type of intraocular lens found in patients with PBK was the anterior-chamber lens [AC IOL, 71.6%; posterior-chamber lens (PC IOL), 16%; iris-plane IOL (IP IOL; 12.5%]. In our series, we noted decreasing trends in the incidences of ABK (p < 0.001) and PBK (p < 0.04) and an increasing trend in the incidence of regraft (p < 0.0083). Our data do not show statistically significant changes in the incidences of Fuchs' dystrophy and keratoconus. Gender differences were present for Fuchs' dystrophy with female exceeding male patients by a 3:1 ratio (p < 0.001). Male exceeded female patients by 2:1 for keratoconus (p < 0.001). Male exceeded female patients by 3:1 for trauma (p < 0.001). CONCLUSIONS: In this series, the leading indications for penetrating keratoplasty were found to be generally in agreement with the data reported in recent literature. Variations may reflect the wide variations in practice and referral patterns.

Adolescent↗
PubMed1997

Postoperative endophthalmitis: incidence, predisposing surgery, clinical course and outcome.

OBJECTIVE: To describe the predisposing surgery, clinical course and final visual outcome for patients with culture-proven and culture-negative postoperative endophthalmitis. DESIGN: Case series. SETTING: University-affiliated teaching hospital in Toronto. PATIENTS: A total of 164 patients with clinically suspected postoperative endophthalmitis admitted between January 1989 and March 1996. OUTCOME MEASURES: Type of surgery, clinical presentation, culture results, infecting organism, treatment and final visual outcome. RESULTS: An infectious agent was identified in 99 cases (60%). The organism most commonly isolated was coagulase-negative Staphylococcus (59 cases [60%]). In the culture-proven group cataract extraction was the most common predisposing surgical procedure, accounting for 85 cases (extracapsular cataract extraction [ECCE] in 60 cases and phacoemulsification in 25). The incidence rates of culture-proven endophthalmitis over the study period at our institution were 0.22% for ECCE and 0.30% for phacoemulsification. Of the 99 patients with culture-proven endophthalmitis 94 received intravitreal injections of antibiotics and 52 underwent vitrectomy. Of the 83 patients in this group for whom the final outcome was known, 29 (35%) had a visual acuity of 20/50 or better, and 15 (18%) had a vision of no light perception, with four eyes undergoing enucleation. Infection with organisms of low virulence (coagulase-negative Staphylococcus or Propionibacterium acnes) was associated with higher rates of 20/50 or better visual acuity compared with more virulent organisms (Staphylococcus aureus, streptococcal species and gram-negative bacilli) (46% vs. 10%) (p < 0.05). The culture-negative group had a significantly lower frequency of hypopyon on presentation (55% vs. 85%) and final outcome of no light perception (2% vs. 18%) (p < 0.01) than the culture-proven group. CONCLUSIONS: Endophthalmitis was most common after cataract surgery. The rates of endophthalmitis after ECCE and phacoemulsification were similar. Postoperative endophthalmitis caused by organisms other than coagulase-negative Staphylococcus or P. acnes carries a poor visual outcome.

Adult↗
PubMed1995

Microbial etiology and predisposing factors among patients hospitalized for corneal ulceration.

OBJECTIVE: To report the spectrum of microorganisms causing corneal ulceration in patients treated on an inpatient basis and to characterize the predisposing factors. DESIGN: Case series. SETTING: Large university-affiliated hospital in Toronto. PATIENTS: All inpatients with corneal ulcers managed between February 1991 and February 1993 (n = 95). RESULTS: Coagulase-negative staphylococci (30% of the 60 culture-positive cases), Staphylococcus aureus (23%), Streptococcus pneumoniae (12%), Pseudomonas aeruginosa (12%) and Moraxella (7%) were the predominant isolates. Previous eye surgery (cataract extraction in 30 cases [32%], penetrating keratoplasty in 12 [13%] and both procedures in 9 [9%]) was a common predisposing factor. Eleven cases (12%) were associated with the use of contact lenses, in all cases extended-wear soft contact lenses; six patients wore bandage lenses and five wore contact lenses for cosmetic reasons. Pseudomonas was the predominant isolate among contact lens wearers (four cases). Most of the 95 cases involved older patients (average age 62.5 years) with concomitant eye or systemic disease. Sixteen patients (17%) ultimately required penetrating keratoplasty. CONCLUSIONS: Recognition of the risk factors for corneal ulceration and prompt, intensive therapy are important to decrease the morbidity associated with this potentially blinding disease.

Adult↗
PubMed1994

Visual acuity, refractive and keratometric results of 140 consecutive radial keratotomy procedures.

We reviewed the results of the first 140 consecutive radial keratotomy procedures (83 patients) performed by one surgeon from March 1986 to April 1992. The mean follow-up time per eye was 9.9 (standard deviation [SD] 9.1) months. The mean preoperative spherical equivalent refraction of -3.74 (SD 1.70) dioptres decreased by a mean of 2.75 D (SD 1.11 D) to a postoperative mean refraction of -0.99 D (SD 1.50 D). The postoperative uncorrected visual acuity was 20/40 or better in 120 eyes (86%). All eyes had a postoperative best corrected visual acuity of 20/40 or better. Correction to within +/- 1 D of emmetropia occurred in 98 eyes (70%), and no overcorrection of more than 1 D occurred. The mean amount of corneal flattening, as determined with keratometry, was 2.68 D (SD 1.23 D). Of the 42 eyes with high myopia (-4.50 to -9.12 D) preoperatively 57% had uncorrected vision of 20/40 or better postoperatively, and 31% had correction to within +/- 1 D of emmetropia. The corresponding figures for the 39 eyes with moderate myopia (-3.25 to -4.37 D) were 100% and 82%, and for the 59 eyes with low myopia (-1.00 to -3.12 D) 98% and 90%. There were no vision-threatening complications. The only significant loss of best corrected visual acuity occurred in one eye (1%) that lost two Snellen lines.

Adolescent↗
PubMed1990

The effects of donor age and cause of death on corneal graft survival.

The Ontario Corneal Recipient Registry followed 299 recipients of 326 corneal transplants performed between October 1985 and October 1987. This report describes the joint effects of donor age and cause of death on subsequent graft survival in these procedures up to two years after surgery. Cox regression analysis established that grafts from donors dying of injury experienced half the risk of graft failure of those from donors dying of heart disease or other natural causes (P less than 0.05). Although donor age differed substantially between these causes of death, controlling for donor age did not alter the association. There were no statistically or clinically significant differences in graft survival associated with either donor age or recipient age. These results suggest that the health of the donor and the circumstances surrounding death may influence the quality of corneal tissue, and deserve more attention and detailed study.

Actuarial Analysis↗
PubMed1990

Acanthamoeba keratitis with two species of Acanthamoeba.

We describe a case of Acanthamoeba keratitis related to soft contact lens wear. The patient presented with a 3-week history of severe uniocular pain, radial stromal infiltrates and subepithelial infiltrates with no epithelial defect. Acanthamoeba was cultured from the corneal biopsy specimen, contact lens and lens case. The corneal biopsy culture grew both A. castellani and A. polyphaga as well as Escherichia coli. The patient was treated with topical dibromopropamidine isethionate (Brolene) drops, neomycin and polymyxin B drops and fortified gentamicin drops. Gradual clinical improvement ensued.

Acanthamoeba↗
PubMed1990

A prospective study of angiographic cystoid macular edema one year after Nd: YAG posterior capsulotomy.

We prospectively studied 120 eyes with intact opacified posterior capsules in 120 consecutive patients to determine the incidence of new late-onset angiographic cystoid macular edema (CME) after neodynium: yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy. Fifty-seven of 120 patients (48%) had both precapsulotomy and one-year post-capsulotomy angiograms done. Of these 57 patients, three eyes had angiographic CME before capsulotomy and two of these three cases had persistent CME one year after capsulotomy. In the other 54 patients, three new late-onset cases occurred (5.6%). Because the incidence of postcapsulotomy new CME was low, the statistical significance of possible risk factors, such as rupture of the anterior hyaloid face or pseudophakic status cannot be determined. However, aphakic patients with vitreous prolapse after capsulotomy tended to have a higher incidence to CME than pseudophakic patients. We recommend fluorescein angiography to identify occult CME in cases of unexplained visual-acuity decrease after capsulotomy.

Aged↗
PubMed1988

Comparison of 2% hydroxypropyl methylcellulose and 1% sodium hyaluronate in implant surgery.

We conducted a prospective randomized clinical trial of 2% hydroxypropyl methylcellulose and 1% sodium hyaluronate (Healon) in routine extracapsular cataract surgery with implantation of a posterior chamber intraocular lens. Of the 84 patients 40 received methylcellulose and 44 received sodium hyaluronate. There was no statistically significant difference in endothelial-cell loss or induced cellular polymegathism between the two groups. The intraocular pressure before and after surgery was similar in the two groups, as was the visual acuity 8 weeks after surgery. The results suggest that 2% hydroxypropyl methylcellulose is a safe and effective alternative to 1% sodium hyaluronate in routine implant surgery.

Cataract Extraction↗
PubMed1986

Neodymium-YAG laser posterior capsulotomy. Central corneal endothelial cell density.

We determined central corneal endothelial cell densities in 39 eyes in a masked fashion before and after Q-switched neodymium-YAG laser posterior capsulotomy. The mean preoperative endothelial cell count was 1,840 cells per square millimeter (SD, 611 cells per square millimeter; range, 522 to 2,742 cells per square millimeter). The mean postoperative endothelial cell count was 1,798 cells per square millimeter (SD, 600 cells per square millimeter; range, 478 to 2,750 cells per square millimeter). The difference between the mean preoperative and postoperative cell density was 42 cells per square millimeter (2.3% cell loss). There was no significant correlation between central corneal endothelial cell loss and the laser energy used, pseudophakic status (posterior chamber intraocular lens vs no intraocular lens), size of capsulotomy, vitreocorneal touch, or preoperative corneal endothelial cell density.

Cataract Extraction↗
PubMed1986

Visual acuity prediction before neodymium-YAG laser posterior capsulotomy.

A laser interferometer (Retinometer) and the Potential Acuity Meter (PAM) was used to assess macular function before neodymium-YAG laser posterior capsulotomy in 40 patients. Although specificity was excellent with the PAM (91%) and Retinometer (93%), sensitivity was limited to 42% and 33%, respectively. Diffuse posterior capsular opacification which precluded the delivery of light through a clear portion of the capsule was the most likely cause of the high false negative rate. A positive result on either test has good predictive value, reducing the changes of the capsulotomy being a failure by fourfold.

Evaluation Studies as Topic↗
PubMed1985

Glare measurements before and after neodymium-YAG laser posterior capsulotomy.

We measured glare produced by opacified posterior capsules before and after neodymium-YAG laser posterior capsulotomy. In many eyes, particularly those with visual acuities of 20/200 or worse, glare threshold could not be determined. In 32 eyes with measurable preoperative glare, the median glare threshold improved from 45% to 12% and median visual acuity improved from 20/60 to 20/25. For 56 eyes the median postoperative glare threshold was also 12% and the median visual acuity improved from 20/80 to 20/25. Forty eyes achieved postoperative visual acuities of 20/25 or better, but in 16 eyes other ocular conditions limited visual acuity to 20/30 or worse. Glare and visual acuity were correlated preoperatively and usually improved concomitantly. One patient in whom wrinkles in a clear capsule produced streaks around bright lights had a glare threshold lower than other types of opacities. Capsulotomy improved the glare threshold and relieved the symptoms.

Adolescent↗