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Biomedical subjects

C D Belcher

Publications and source records attributed to C D Belcher.

At least 19 recordsLinked to original sources
PubMed1992

Contact transscleral Nd:YAG laser cyclophotocoagulation. Midterm results.

BACKGROUND: Early reports of both contact and noncontact transscleral Nd:YAG laser cyclophotocoagulation have been encouraging; however, recent evidence indicates a significant incidence of hypotony, visual loss, and phthisis with the noncontact technique with more than 6 months of follow-up. The authors sought to determine the intermediate term effects of contact transscleral Nd:YAG laser cyclophotocoagulation (CYC). METHODS: The authors followed 116 eyes of 114 patients for a minimum of 1 year after treatment of advanced glaucoma with CYC. RESULTS: The mean preoperative intraocular pressure (IOP) of 35.0 +/- 1.0 mmHg decreased to 18.6 +/- 1.1 mmHg (P less than 0.0001) during the average follow-up of 19.0 +/- 0.6 months (range, 12 to 36 months). Intraocular pressure control of 3 to 25 mmHg was achieved in 72%, 3 to 22 mmHg in 65%, and 3 to 19 mmHg in 56% of eyes. Retreatment was required in 31 of the 116 eyes (27%). Intraocular pressure decreased to less than 3 mmHg in 9 eyes and to 0 mmHg in 6 of these 9 eyes. Nineteen eyes, all with initial visual acuity of counting fingers or worse, progressed to no light perception; 17 of 36 eyes (47%) with visual acuity of 20/200 or better lost 2 or more Snellen lines. CONCLUSION: Midterm results of CYC continue to be encouraging but are tempered by a nearly 10% incidence of hypotony or phthisis and the progression of visual loss.

Adolescent↗
PubMed1990

Contact transscleral continuous wave neodymium:YAG laser cyclophotocoagulation.

Advanced glaucoma in 140 eyes of 136 patients was treated with contact transscleral continuous wave neodymium:YAG (Nd:YAG) laser cyclophotocoagulation (CYC) with a sapphire-tipped probe. The anterior edge of the probe was placed 0.5 to 1.5 mm posterior to the limbus, using 7 to 9 W of power for 0.7 seconds with 32 to 40 applications, sparing the 3 and 9 o'clock meridians. Patients were studied prospectively. The mean preoperative intraocular pressure (IOP) of 36.7 +/- 0.97 mmHg decreased to 21.2 +/- 0.99 mmHg (P = 0.004) after treatment (mean follow-up, 3.2 +/- 0.35 months) for a mean decrease in IOP of 15.5 +/- 1.21 mmHg and a mean percent decrease of 39%. Forty-one eyes were followed 6 or more months (mean, 6.7 +/- 0.25 months). The CYC reduced IOP to 25 mmHg or less in 71% of eyes, to 22 mmHg or less in 62% of eyes, and to 19 mmHg or less in 49% of eyes. Maximum lowering of IOP occurred 1 week to 1 month after treatment and remained at that level through 6 months of follow-up. Retreatment was required in 11% of patients; only one patient was retreated more than once. Four patients treated with 9 W of power developed IOPs below 5 mmHg; two of these patients had an IOP of 0 mmHg. Other complications of therapy were minimal, and patients had little pain. There was no significant change in visual acuity. Early results of this newly available therapy are encouraging.

Adolescent↗
PubMed1987

Management of leaking filtration blebs.

This study describes 11 patients, in whom filtering surgery was performed, who developed a leaking filtration bleb postoperatively. Average follow-up time was 3 1/2 years. In three patients, suturing of the conjunctiva was performed. In two, anterior chamber reformation and choroidal tap were required, and, in both cases, the leak sealed spontaneously without surgical repair. In two, the glaucoma shell tamponade technique was used to facilitate anterior chamber reformation. These reformed in both cases, and no subsequent shallow anterior chambers have been noted. In four cases, conservative therapy, which consisted of antibiotics, glaucoma medication with or without patching, and careful patient observation, was used to manage the leaking blebs. Complications observed were: iritis (1 case), early infection of the bleb (1), flat anterior chamber (1), and failure of the bleb to allow sufficient aqueous humor outflow (2).

Aged↗
PubMed1987

Visual field improvement after neodymium: YAG laser puncture of miotic cysts.

This case report describes the use of a Q-switched neodymium:YAG laser to puncture miotic cysts. Fifteen shots of 0.06 mJ were needed. The pupil dilated more widely following this procedure, resulting in an improvement in the patient's visual field. Intraocular pressure (IOP) was not able to be controlled medically, however, and filtering surgery 20 days post laser treatment was required. IOP control had been poor prior to the laser-treatment, and did not appear to be more following treatment.

Adult↗
PubMed1986

Instruments for predicting visual acuity. A clinical comparison.

A series of 54 eyes in 50 patients had preoperative predictions of postoperative visual acuity, using both a white-light interferometer (Lotmar Visometer) and a Snellen chart projector (Guyton-Minkowski Potential Acuity Meter). The predicted vision by each instrument was compared with the actual postoperative vision. Forty eyes in 36 of these patients, 25 with concurrent eye disease, had cataract extraction with intraocular lens implantation. Fifteen eyes in 15 patients, 11 with concurrent eye disease, had neodymium-YAG laser posterior capsulotomy. The Visometer gave more accurate predictions than the Potential Acuity Meter in cataract patients with open angle glaucoma, even with glaucomatous visual field loss, and in patients with a visual acuity of less than 20/400 due to advanced cataract formation.

Adult↗
PubMed1985

Extracapsular cataract extraction and posterior chamber intraocular lens implantation in glaucomatous eyes.

Two hundred ninety-six eyes of 250 patients undergoing extracapsular cataract extraction (ECCE) with or without the implantation of a posterior chamber intraocular lens (PC-IOL) were studied. Pre-existing glaucoma of varying severity was present in 139 eyes and no known ocular pathology other than cataract in 157 eyes. During the first eight weeks following surgery, intraocular pressure elevations greater than or equal to 15 mmHg above baseline were seen in 23% of glaucomatous eyes controlled before surgery with glaucoma medications, in 39% of glaucomatous eyes controlled before surgery with argon laser trabeculoplasty, and in only 3% of nonglaucomatous eyes. The implantation of a PC-IOL did not influence the incidence of postoperative intraocular pressure (IOP) elevations. Among glaucomatous eyes with severe preoperative visual field loss (split fixation or central island less than or equal to 10 degrees), 9.7% had worsening of visual field after surgery. Open angle glaucoma of unclear etiology developed in 1.4% of normal eyes following uncomplicated ECCE with PC-IOL implantation. Surgical techniques the authors have found useful in glaucomatous eyes undergoing ECCE with PC-IOL implantation are discussed.

Aged↗
PubMed1985

Effect of pilocarpine in treatment of intraocular pressure elevation following neodymium: YAG laser posterior capsulotomy.

A prospective study was conducted in 30 eyes of 30 patients to determine if pilocarpine would prevent increased intraocular pressure following Q-switched neodymium (Nd):YAG laser posterior capsulotomy. Fifteen eyes were given pilocarpine 4%, immediately following laser therapy and every hour until bedtime. Fifteen eyes served as untreated controls. Our results show that without prophylactic therapy, 10 of 15 eyes (67%) had a post-laser intraocular pressure (IOP) elevation of greater than 10 mmHg, while only one of 15 (6.6%) of the pilocarpine-treated eyes had a rise of that magnitude. The facility of outflow was reduced by 42% in the untreated eyes in contrast to an increase of 3% in those eyes treated with pilocarpine. Thus, pilocarpine 4% is effective in reducing the incidence and magnitude of elevated IOP following Nd:YAG posterior capsulotomy.

Cataract Extraction↗
PubMed1985

Anterior chamber washout for traumatic hyphema.

A surgical approach that involves paracentesis and gentle anterior chamber washout and minimal surgical trauma is presented for dealing with traumatic hyphema. This technique taught by Dr. Paul Chandler produces excellent results and is safe, simple, and without need for elaborate instrumentation.

Adolescent↗
PubMed1984

Pupillary and iridovitreal block in pseudophakic eyes.

Twenty-six cases of pupillary and iridovitreal block in pseudophakic eyes are reported. Although ten patients presented with acute angle closure glaucoma, the majority were asymptomatic and had normal intraocular pressures. While cure was finally achieved in all cases, recurrence of block occurred in six eyes as late as two months after initial successful treatment. A variety of therapeutic modalities including argon laser iridectomy, argon laser gonioplasty (iridoplasty), surgical iridectomy, surgical vitrectomy, Q-switched Nd:YAG laser iridectomy and Nd:YAG laser photodisruption of the anterior vitreous face were needed. Despite successful relief of pupillary and iridovitreal block in these eyes with no evidence of glaucoma prior to cataract and lens implant surgery, four eyes developed eight or more clock hours of peripheral anterior synechiae, and nine eyes continue to require chronic medical therapy for glaucoma.

Aged↗
PubMed1983

Laser iridotomy.

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Humans↗