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Biomedical subjects

C E Traverso

Publications and source records attributed to C E Traverso.

34 records · Page 2Linked to original sources
PubMed1989

The long-tube single plate Molteno implant for the treatment of recalcitrant glaucoma.

One hundred cases of recalcitrant glaucoma were operated with a long tube single-plate Molteno implant (LSMI). At the median follow-up of 15 months an intraocular pressure of less than or equal to 19 mm Hg was obtained in 64 of the 87 eyes (73%) which have a minimum follow-up of 6 months (secondary non-neovascular glaucomas = 19; congenital glaucomas = 26; secondary neovascular glaucomas = 12). The interval probability (percentage +/- standard error) of obtaining a successful result (IOP less than or equal to 19 mm Hg) was 79% (+/- 13) at twelve months from surgery, and 53% (+/- 24) at the eighteen month interval. The least favorable results were obtained in the secondary non-neovascular glaucomas. Complications observed included choroidal detachment (24%), tube exposure (4%), tube-endothelium contact (6%), plus band keratopathy, fibrous ingrowth, traction retinal detachment and corneal ulcers. Seventeen cases needed repeated surgery for the management of complications. In order to decrease the post-operative hypotony, we have been using a tourniquet suture around the tube at the time of implantation to occlude it temporarily and limit the outflow.

Follow-Up Studies↗
PubMed1988

Extracapsular cataract extraction using a temporal limbal approach after filtering operations.

We reviewed the charts of 29 patients who underwent extracapsular cataract extraction after filtering surgery. Seven of these patients also had simultaneous implantation of a posterior chamber intraocular lens. All eyes were operated on using a temporal limbal approach. The median postoperative follow-up was 13 months. There was no statistically significant difference between the preoperative and postoperative intraocular pressures, but there tended to be an increase in the number of antiglaucoma medications administered postoperatively. None of these patients, however, required further surgery for intraocular pressure control.

Adult↗
PubMed1987

Limbal- vs fornix-based conjunctival trabeculectomy flaps.

We studied 20 patients with uncontrolled symmetric glaucoma who had undergone bilateral trabeculectomy after having received the same medical or laser treatment to both eyes. In each patient, the techniques and suture material used in the two eyes were identical, and the surgeon was the same. The only variable was the type of conjunctival flap used: one eye received a limbal-based flap and the other a fornix-based flap. These patients were followed up from three to 13 months (median, 8.5 months). There was no difference between the two groups in postoperative anterior chamber depth, intraocular pressure control, occurrence of hyphema, size and shape of the bleb, or the rate of complications. The fornix- and limbal-based conjunctival flaps in trabeculectomy were found to yield comparable results in terms of safety and short-term efficacy of pressure control.

Conjunctiva↗
PubMed1987

Neodymium-YAG laser iridotomy in the treatment and prevention of angle closure glaucoma. A review of 373 eyes.

The records of 271 consecutive patients (373 eyes) who underwent neodymium-YAG laser iridotomy at our institution over a period of 12 months were reviewed. The majority of eyes (60.5%) were treated for chronic primary angle closure glaucoma, 23.3% had prophylactic iridotomy for occludable angles, 7.8% were treated for acute angle closure glaucoma, 3.2% required iridotomy for the relief of iris bombé secondary to anterior uveitis, and the rest (5.2%) were treated for miscellaneous causes of secondary angle closure. Laser iridotomy, with or without medical treatment, obviated further surgical treatment in most categories of eyes. Visual acuity remained unchanged or improved in the great majority (92%) of cases over the period of follow-up (range, two to 12 months; median, four months). Visual deterioration in 8% of eyes was attributed to the usual causes, such as normal cataract progression, but none was believed to be related to the laser treatment. This article discusses the advantages of the neodymium-YAG laser (over argon) for performing iridotomies.

Female↗
PubMed1987

Aqueous misdirection and flat chamber after posterior chamber implants with and without trabeculectomy.

Three patients developed flat anterior chamber and were ultimately diagnosed as having aqueous misdirection after trabeculectomy with extracapsular cataract extraction and posterior chamber lens implantation (glaucoma triple procedure). A fourth patient developed aqueous misdirection after posterior chamber lens implantation only (without trabeculectomy). This latter was cured by repeated pars plana vitrectomy, not requiring removal of the pseudophakos. In only one of the three eyes with the triple procedure did the lens have to be removed and anterior vitrectomy performed, whereas the remaining two were cured by neodymium-YAG laser disruption of the anterior hyaloid. In these two cases, the posterior capsule remained intact. Neodymium-YAG laser vitreolysis should be the first step in the management of these cases because of its safety compared with open surgery.

Aged↗
PubMed1987

Eye parameters influencing the results of argon laser trabeculoplasty in primary open-angle glaucoma.

Argon laser trabeculoplasty (ALT) was performed on 173 eyes of 126 patients affected by uncontrolled primary open-angle glaucoma. All subjects were phakic. An overall decrease of intraocular pressure (IOP) from baseline of 19.1 (+/- 18) were observed. With linear regression analysis, a positive correlation was found between baseline IOP and percentage IOP fall. The effect of ALT in myopes, hyperopes, younger and older patients was also analyzed. Although a less pronounced IOP fall was observed in the subgroups of higher myopes and of younger patients, no direct relationship could be established between amount of IOP change and age or refraction. In subjects treated bilaterally, a significant correspondence of effect was found between the two eyes.

Aging↗
PubMed1986

Factors affecting the results of argon laser trabeculoplasty in open-angle glaucoma.

Argon laser trabeculoplasty (ALT) was performed in 232 eyes of 180 patients affected by uncontrolled primary open-angle glaucoma (POAG), exfoliation syndrome glaucoma (ESG) or pigment dispersion syndrome glaucoma (PDSG). Mean follow-up was 9 months (3-22). Mean IOP change was -21.6% (+/- 19) from the initial value. The effect of IOP was larger in patients with ESG, PDSG, and in POAG cases with more pigmented trabecular meshwork. No relationship was found between IOP changes and age or refraction of patients; the association with iridoplasty did not influence final results. An Octopus computerized perimeter was used for pre and post-treatment visual field tests. In 113 eyes Octopus exams met the requirements for quantitative analysis. In this group 17% of visual field improved, 64% remained stable and 19% worsened. A good functional response was more frequent among the eyes with less advanced disease.

Aged↗
PubMed1985

Short- and long-term effects of postoperative corticosteroids on trabeculectomy.

All patients with primary open-angle or primary angle-closure glaucoma requiring trabeculectomy between January 1982 and January 1983 were entered into a randomized prospective study to evaluate the effect of postoperative corticosteroids. Twenty-three eyes in Group 1 received a cycloplegic and topical antibiotic. Twenty-nine eyes in Group 2 received the same treatment, with the addition of topical 1% prednisolone acetate. Twenty-three eyes in Group 3 received the same treatment as Group 2, with the addition of systemic prednisone. Success rate was significantly improved with the use of topical corticosteroids. Systemic steroids did not prove to be of any added benefit over topical use alone.

Adult↗
PubMed1985

Change in appearance of the optic disc associated with lowering of intraocular pressure.

This report provides additional documentation that the appearance of the optic disc may improve after intraocular pressure is lowered in patients with glaucoma. Photographic records of one of the authors (GLS) were reviewed retrospectively. Seven previously unreported cases showing apparent improvement of the optic disc were found, and the patients' charts were reviewed. In two cases the improvement was transient, and in five it was lasting. Patients with evidence of disc improvement had an age range of 5 to 55 years. In one case, the scleral ring decreased in size following the lowering of intraocular pressure. In the other cases, the disc appeared to "fill in" without change in the size of the scleral ring. When improvement is short-lived, it presumably represents edema. When of longer duration, it may be a response to anterior repositioning of a posteriorly displaced lamina cribrosa, a decrease in diameter of the scleral ring, hypertrophy and/or proliferation of glial cells, or return towards normal of axonal metabolism. Because apparent improvement in the appearance of the optic disc can be subtle, it is usually not sought and is probably often unrecognized. Its true incidence is still unknown but appears to be underestimated.

Adolescent↗
PubMed1984

Formation of peripheral anterior synechiae following argon laser trabeculoplasty. A prospective study to determine relationship to position of laser burns.

One hundred eighteen eyes with primary open-angle glaucoma underwent argon laser trabeculoplasty . Laser burns were placed in the anterior trabecular meshwork (ATM) in 58 eyes and directly over Schlemm's canal in the posterior trabecular meshwork (PTM) in 60 eyes. Twenty-nine eyes received 100 burns and 89 eyes received 50 burns distributed equally over 360 degrees. Peripheral anterior synechiae (PAS) developed in seven (12%) of the eyes having anterior trabeculoplasty and in 26 (43%) of those having posterior trabeculoplasty . There was no correlation between the development of PAS and sex, width of the anterior chamber angle, or the number of laser burns. Eyes having anterior trabeculoplasty had a final decrease in intraocular pressure equal to those having posterior trabeculoplasties . Our results strongly suggest that trabeculoplasty is a safer but no less effective procedure when the laser burns are placed on the ATM rather than the PTM.

Glaucoma, Open-Angle↗
PubMed1984

Focal pressure: a new method to encourage filtration after trabeculectomy.

One cause of failure of trabeculectomy is early closure of the sclerostomy with insufficient aqueous outflow and subsequent scarring of Tenon's capsule and conjunctiva. Ocular massage and other forms of manipulation of the scleral flap have been used in the past to enhance filtration in cases where full-thickness filtration procedures were performed, and they have been suggested for use with trabeculectomy as well. The authors propose a new method in which focal pressure is applied with an anesthetic-moistened applicator directly to the conjunctiva beside the edge of the scleral flap. This appears to be particularly indicated in trabeculectomy, and has both theoretical and practical advantages over the conventional forms of enhancing filtration in eyes having been treated with trabeculectomy. In 17 of 18 cases having trabeculectomy according to Watson's technique and in which it appeared that no filtration would develop in the postoperative period, focal pressure was successful in creating a satisfactory bleb.

Aqueous Humor↗
PubMed1984

Acute intraocular pressure elevation after argon laser trabeculoplasty and iridectomy: a clinicopathologic study.

Trabeculectomy specimens excised from five patients with persistent, medically unresponsive elevation of pressure following argon laser trabeculoplasty and argon laser peripheral iridectomy were studied by light and electron microscopy. Histological examination disclosed macrophages, lymphocytes, activated trabecular endothelial cells, and tissue debris from trabecular beams. This inflammatory response and tissue debris initiated by laser treatment appears to be an important factor in the postoperative decompensation of the aqueous outflow system.

Acute Disease↗
PubMedDate not supplied

Decreased corneal complications after no-reflux, low-dose 5 fluorouracil subconjunctival injection following trabeculectomy.

In order to reduce corneal complications in 27 glaucomatous eyes that underwent trabeculectomy and postoperative subconjunctival injection of 5-fluorouracil we tried 1) a low-dose administration of 5-fluorouracil and 2) a modified subconjunctival injection technique. The mean total 5-fluorouracil dose was 18.0 +/- 6 mg. A life-table analysis showed a success rate, at 15 months, of 78% (+/- 7 S.E.). Four of the 27 eyes (13%) had corneal complications, limited to punctate keratopathy, with no corneal epithelial defects and/or abrasions. Our study shows that corneal complications decreased when the contact between 5-fluorouracil and the ocular surface was reduced.

Adolescent↗
PubMedDate not supplied

The glaucomas in aphakia and pseudophakia.

Intraocular pressure may become temporarily or permanently elevated at various intervals following cataract surgery. There are several mechanisms by which glaucoma develops as a complication of the cataract extraction itself. The presence of a pseudophakos may or may not contribute to the pathogenesis. Important diagnostic clues include the anterior chamber depth, the presence or absence of an iridectomy, gonioscopic findings, and the appearance of the optic nerve head. Life-long medical treatment is frequently justified, as alternative laser or surgical modalities may not be successful. The exact causes for high failure of filtration surgery in aphakic eyes is not clearly understood; scarring of the conjunctiva, the vitreous, and altered characteristics of the aqueous humor have all been incriminated. Current research to improve surgical success includes the development of effective artificial drainage implants or the use of pharmacologic modulators of wound healing, which promote filtration by preventing scar formation.

Aphakia↗
PubMedDate not supplied

Argon laser trabeculoplasty: long-term results.

We analyzed the long-term success of argon laser trabeculoplasty (ALT) performed in 237 eyes of 175 patients diagnosed with primary open-angle glaucoma and followed for up to 11 years (maximum, 132 months) after treatment. The cumulative proportion of success, defined as the avoidance of glaucoma surgery or an intraocular pressure never exceeding 22 mm Hg, was calculated throughout follow up using the Kaplan-Meier life-table analysis. The success rates were: 78% at 1 year (n = 205), 71% at 3 years (n = 139), 61% at 5 years (n = 73), and 40% at 10.5 years (n = 19). Our data confirm previous reports of the high initial success rate of ALT, followed by a time-dependent decrease in its efficacy.

Aged↗