Primary glaucoma triple procedure.
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Case-Control Studies↗
Biomedical subjects
C E Hugkulstone
Publications and source records attributed to C E Hugkulstone.
Do Mersilene sutures need to be removed after cataract surgery?
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Cataract Extraction↗
The effect of heparin-coated intraocular lenses on intraocular pressure following combined trabeculectomy and cataract surgery.
PURPOSE: To review the effects on intraocular pressure control of the use of standard and heparin-coated intraocular lenses (IOLs) following combined cataract and glaucoma surgery after a minimum period of 2 years. METHODS: Case note review of all patients with glaucoma who required cataract extraction combined with trabeculectomy and who were randomized to either of the two IOL types. The number of ocular hypotensive medications and the intraocular pressures were recorded pre-operatively and at 3, 6, 18 and 24 months following surgery. RESULTS: The two groups (9 receiving standard IOLs and 10 heparin-coated IOLs) were comparable for age, sex and follow-up, as were the pre-operative intraocular pressures and number of treatments. Post-operatively, all patients achieved an intraocular pressure < 21 mmHg at the final visit, with only one patient in each group requiring topical medication, but the standard lens group had a higher intraocular pressure at 2 years (p<0.05). The magnitude of the fall from the pre-operative values was greater in the heparin-coated lens group at 2 years after surgery (p<0.02). The presence of a visible drainage bleb occurred equally frequently in the two groups. CONCLUSIONS: Use of a heparin-coated IOL does not adversely affect the intraocular pressure control following combined cataract and drainage surgery. The greater fall in intraocular pressure at 2 years in those receiving a heparin-coated IOL may have occurred by chance.
Aged↗
Endoscopic holmium:YAG laser dacryocystorhinostomy.
The early results of the first 50 primary endonasal laser dacryocystorhinostomies in 49 patients performed with the holmium:YAG laser are presented. Overall, 35 (70%) were successful in relieving symptoms of nasolacrimal obstruction after a mean follow-up period of 4 months. This improved to 79% in the subgroup of patients who underwent intubation of the naso-lacrimal system. These results were similar to the results of a retrospective study of 67 patients undergoing conventional dacryocystorhinostomy in our unit. Conventional surgery was performed under general anaesthesia in all but 1 case and all were treated as inpatients, with a mean hospital stay of 2.3 days, whereas all but 1 of the laser group had their surgery under local anaesthesia and 46 operations (94%) were performed as an outpatient procedure. Surgery was significantly quicker with the endonasal laser technique and 90% of patients questioned found this technique to be entirely acceptable.
Aged↗
Low-dose perioperative 5-fluorouracil in trabeculectomy.
BACKGROUND AND OBJECTIVES: 5-Fluorouracil (5-FU) has been used to improve the outcome of trabeculectomy in high-risk cases, employing a postoperative regimen of subconjunctival injections. In light of recent laboratory evidence of the use of perioperative exposure to 5-FU, the authors investigated the outcome of this approach in their patients. PATIENTS AND METHODS: Twenty-three eyes of 21 patients who underwent trabeculectomy with a perioperative application of low-dose (25 mg/ml) 5-FU, with a minimum follow-up of 1 year, were reviewed retrospectively. RESULTS: At 1 year postoperatively, 15 (65%) of the eyes had an intraocular pressure (IOP) of less than 21 mm Hg without treatment and 3 (13%) of the eyes achieved the same IOP with the same number of or fewer medications compared with on admission. The outright successful patients had a significantly shorter disease duration than the remaining patients (P < .05), despite having used a similar number of treatments on admission, and also had a significantly lower mean number of indications for antimetabolite use (P < .02). Few complications attributable to 5-FU were noted. CONCLUSION: This route of administration appears to be safe and effective in patients requiring trabeculectomy who are not at a high risk for failure.
Antimetabolites↗
Congenital hypertrophy of the retinal pigment epithelium and mandibular osteomata as markers in familial colorectal cancer.
Congenital hypertrophy of the retinal pigment epithelium (CHRPE) and multiple mandibular osteomata are markers of familial adenomatous polyposis (FAP). We have assessed their prevalence in non-polyposis familial colorectal neoplasia. Multiple mandibular osteomata were present in 1/29 (3%) patients with familial colorectal neoplasia. CHRPE was present in 11/33 (33%) patients with familial colorectal neoplasia compared with 3/36 (8%) with sporadic disease (P = 0.01) and 4/32 (12.5%) control subjects (P = 0.04). Seven patients with familial colorectal neoplasia had multiple areas of CHRPE compared with one with sporadic disease (P = 0.02) and one control subject (P = 0.02). There was no obvious correlation between calculated familial colorectal cancer risk and the presence of multiple areas of CHRPE. A proportion of patients with familial colorectal cancer have a marker found in FAP and may therefore have a constitutional genetic defect, at least in part responsible for their cancer, making them an interesting group for genetic study. Ophthalmoscopy may contribute to risk assessment in familial colorectal cancer.
Adult↗
Bilateral orbital metastases from transitional cell carcinoma of the bladder.
A case of bilateral orbital metastases arising from a primary transitional cell carcinoma of the bladder is presented, with simultaneous presentation of both primary and metastatic disease. The literature is reviewed.
Carcinoma, Transitional Cell↗
Simultaneous bilateral trabeculectomy.
In a retrospective study, 24 patients who had undergone simultaneous bilateral trabeculectomy over a 6-year period were reviewed. The duration of disease was at least 2 years, indicating that surgery was not performed as a primary procedure. No patients suffered complications leading to bilateral blindness, although 6 (25%) patients had reduced vision in both eyes at the first postoperative visit, with 3 (13%) worse than 6/36 binocularly. There was no evidence of an asymmetric response in the fall in intraocular pressure following trabeculectomy, after a mean follow-up of over 3 years. Compared with a matched group of patients undergoing unilateral trabeculectomy, the simultaneous bilateral group had a similar period of hospital stay. However, this was no shorter than that found in a group having staged bilateral surgery during the same admission, over the same study period. When separate admissions were required for bilateral drainage operations, though, there was a significant increase in the total length of inpatient stay. No convincing advantage was found for simultaneous bilateral trabeculectomy.
Aged↗
Argon laser suture lysis with different suture materials. An experimental study.
In an in vitro study, 10/0 nylon was found to require a significantly lower laser energy density to produce suture lysis following a single shot than either 10/0 Dacron or 10/0 prolene. Nylon and Dacron monofilament sutures ruptured at reproducible energy levels without significant observable changes at subthreshold irradiation. Prolene, however, was observed to stretch at energy levels below the lysis threshold, under the standard tension produced by a weight of 0.36 (SD 0.02) g. This feature may be of value when performing laser treatment to trabeculectomy flap sutures in the early postoperative period.
Lasers↗
Trabeculectomy in diabetic patients with glaucoma.
Forty-one eyes of 41 patients with diabetes mellitus who underwent trabeculectomy over a 4-year period were compared with 41 age- and sex-matched controls, who were also matched for date of operation and surgical technique. The two groups were comparable for glaucoma diagnoses, duration of glaucoma before admission and number of ocular hypotensive medications. The intraocular pressures at diagnosis and on admission were similar. Post-operative complications were equally frequent. The mean intraocular pressure at 6 months was significantly lower in the control group, and fewer diabetic patients achieved either an intraocular pressure < 21 mmHg or successful drainage (defined as an intraocular pressure < 21 mmHg on no treatment) at 6 months and at the final visit, after similar periods of follow-up. Trabeculectomy in diabetic patients with pre-existing retinopathy resulted in a significantly higher intraocular pressure at 6 months than when no retinopathy was present.
Aged↗
Two-year follow-up of intra-ocular pressure control with long duration argon laser trabeculoplasty.
The two-year results of intra-ocular pressure control in the first prospective study of standard (0.1 second) and long (0.2 second) duration argon laser trabeculoplasty are presented. The two groups were comparable for intra-ocular pressures and treatment scores at the start of the study. An early benefit in intra-ocular pressure reduction was found for 0.2 second trabeculoplasty in the first year, which disappeared during the second-ond year of follow-up. No reduction in medications occurred following laser trabeculoplasty. There was no difference in the frequency of further interventions (repeat trabeculoplasty or drainage surgery) between the two groups. There was a strong correlation between the intra-ocular pressures of the first and second treated eyes. No clinical benefit was demonstrated for the longer duration over standard argon laser trabeculoplasty.
Aged↗
Blue versus white stimuli in ocular hypertension with the Friedmann Mark 1 Visual Field Analyser.
Fifty eyes of fifty patients with ocular hypertension had their visual fields tested on a Friedmann Mark 1 field analyser whilst wearing a Wratten 47B blue filter in a spectacle frame. All had normal visual fields to a white stimulus. Use of a scoring system with the blue field identified 11 patients (22%) with ocular hypertension as abnormal. The scores from this subgroup were indistinguishable from a group of subjects with early glaucomatous field loss, whilst the remaining scores were similar to normal subjects. These two subgroups of ocular hypertensive patients were similar in age and intraocular pressure. The use of a blue filter in front of the eye may offer a simple test to identify a subgroup of patients with ocular hypertension who are at increased risk of developing field loss.
Color↗
Use of a bandage contact lens in perforating injuries of the cornea.
Four cases of perforating corneal injuries as a result of work-related injuries are presented. All were managed with a bandage contact lens and surgical intervention was avoided. Topical pilocarpine was used to free incarcerated iris in two cases. All patients received a course of broad-spectrum systemic antibiotics, and also used topical preservative-free chloramphenicol for the duration of contact lens wear. No lens related complications occurred. Final unaided visual acuities were the same or better than at presentation.
Adult↗
Use of a blue filter in visual field analysis.
One hundred and twenty seven eyes of 127 patients were studied by means of a Kodak 47B Wratten blue gelatin filter in conjunction with the Friedmann Mark 1 visual field analyser. There were 49 patients in the normal group, 50 patients in the ocular hypertension group, and 28 patients in a group with early glaucoma. A simple scoring system did not show a useful difference between these three groups. However, use of a derived threshold value for each target group designated by the letters B to P (giving selective blue field scores) differentiated between normal subjects and those with early glaucomatous field loss. When used with a calculated upper limit of normal to give a specificity of 96%, this test had a sensitivity of 64%. Of the ocular hypertension group 22% gave abnormal results in comparison with normal persons. This simple adaptation to the Friedmann protocol may aid the ophthalmologist in the detection and confirmation of early glaucoma.
Evaluation Studies as Topic↗
Endophthalmitis after removal of an encircling band.
A case of endophthalmitis following the removal of an encircling band is presented. A possible route of entry in the absence of scleral perforation during the procedure is proposed.
Adult↗
Changes in keratometry following trabeculectomy.
The results of keratometry following trabeculectomy are presented. In contrast to the effects of wound gape after cataract extraction, trabeculectomy produces a reduction in the vertical corneal radius. An initial corresponding increase in horizontal radius is found immediately postoperatively, but this is not apparent by two and seven weeks after surgery. A possible explanation for these findings is proposed.
Aged↗
Standard and long duration repeat argon laser trabeculoplasty.
A retrospective survey was performed on 22 patients with chronic simple glaucoma who had undergone a single repetition of argon laser trabeculoplasty. Two groups were identified who had received treatment with either 0.1 or 0.2 sec duration. The 0.2 sec group showed a reduction in the medications used, in addition to a comparable fall in intra-ocular pressure to the 0.1 sec group, and had a lower rate of drainage surgery. These findings may have arisen because of the higher energy delivered as a result of the longer duration employed. However, there are risks of repeating argon laser trabeculoplasty: one patient in the 0.2 sec group developed a rise in intra-ocular pressure of 15 mmHg following the repeat treatment, and required drainage surgery one month later.
Aged↗
Argon laser trabeculoplasty with standard and long duration.
A prospective study of 0.1 sec and 0.2 sec duration argon laser trabeculoplasty was undertaken in 33 patients with chronic simple glaucoma. Patients were randomly allocated to receive 0.1 sec trabeculoplasty to the eye and 0.2 sec trabeculoplasty to the other. No difference was found in the fall in intra-ocular pressure or in glaucoma control between the two durations over the six months of the study. However, 0.2 sec argon laser trabeculoplasty was reported to be more uncomfortable of 60% of patients.
Aged↗