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Biomedical subjects

C J Helm

Publications and source records attributed to C J Helm.

13 recordsLinked to original sources
PubMed1997

Combination intravenous ceftazidime and aminoglycosides in the treatment of pseudomonal scleritis.

BACKGROUND: Pseudomonal scleritis is a serious and potentially blinding infection that usually is resistant to medical management. METHODS: Results for three patients with pseudomonal scleritis who were treated with both topical anti-infectives and a combination of intravenous ceftazidime and aminoglycoside are presented in this case series. RESULTS: All three patients had a rapid response to the addition of combination intravenous drug therapy to topical therapy; eradication of the infection and healing of the ocular surface occurred within 8 weeks. Only one patient, in whom cystoid macular edema developed, lost useful vision as a result of the infection. CONCLUSIONS: Combination therapy with intravenous ceftazidime and aminoglycoside may be more effective than single-intravenous agents when used in addition to topical antibiotics and may obviate the need for adjunctive surgical procedures, such ascryotherapy, surgical extirpation, or conjunctival recession.

Administration, Topical↗
PubMed1996

Causes of uveitis in the general practice of ophthalmology. UCLA Community-Based Uveitis Study Group.

PURPOSE: Most uveitis case series have come from tertiary care centers, and the relative frequencies of disorders they report may reflect referral bias. We sought information about the types of uveitis encountered in the general practice of ophthalmology. METHODS: We prospectively examined 213 consecutive cases of general uveitis, defined as intraocular inflammation other than cytomegalovirus retinopathy, seen by a group of community-based comprehensive ophthalmologists. This group of cases was compared with 213 consecutive cases of general uveitis examined by a uveitis specialist at a university referral center in the same community. All cases were categorized by anatomic site of inflammation and disease course, and, if possible, they were assigned a specific diagnosis. Cases of cytomegalovirus retinopathy and masquerade syndrome seen during the same intervals were recorded separately. RESULTS: The distribution of general uveitis cases by anatomic site of disease was significantly different between the community-based practices (anterior, 90.6%; intermediate, 1.4%; posterior 4.7%; panuveitis, 1.4%) and the university referral practice (anterior, 60.6%; intermediate, 12.2%; posterior, 14.6%; panuveitis, 9.4%; P < .00005). A cause or clinical syndrome could be assigned to 47.4% of cases in the community-based practices, and to 57.8% of cases in the university referral practice (P = .03). HLA-B27-associated anterior uveitis, cytomegalovirus retinopathy, and toxoplasmic retinochoroiditis were among the five most common forms of uveitis in both practice settings. CONCLUSION: The relative frequencies with which various forms of uveitis are seen in a tertiary referral center do not necessarily reflect the experience of ophthalmologists from the community in which the center is located. Anterior uveitis and disorders of sudden onset constitute a greater proportion of cases seen by community-based comprehensive ophthalmologists.

Adolescent↗
PubMed1995

The effects of posterior subtenon injection of triamcinolone acetonide in patients with intermediate uveitis.

PURPOSE: Periocular injection of corticosteroids is a common treatment for vision loss in patients with intermediate uveitis. However, this treatment has the potential for serious side effects. We sought to determine the effects of such injections in a series of patients. METHODS: We reviewed charts of 20 consecutive patients (20 eyes, 43 injections) who had received posterior subtenon injections of triamcinolone acetonide for treatment of intermediate uveitis. We collected data on visual outcome and side effects. RESULTS: Median follow-up was 23.5 months (range, one to 50 months). Snellen visual acuity improved by at least two lines in 12 (67%) of 18 patients who were examined after initial injection. Median time to improvement was three weeks. Patients with visual improvement had a median age of 29.0 years, compared with 41.5 years for nonresponders (P = .024). There was a weak association between response to treatment and a history of not smoking (P = .073) after correction for patient age. Increase of intraocular pressure (> 21 mm Hg) occurred in six patients (30%), with onset at a median of three weeks after initial injection; the median interval to peak increase (median, 32 mm Hg; range, 25 to 40 mm Hg) was 14 weeks after the injection. CONCLUSIONS: A subtenon injection of triamcinolone acetonide appears to be an effective treatment for decreased vision associated with intermediate uveitis but may contribute to increase of intraocular pressure in some patients with this disorder.

Adolescent↗
PubMed1994

Comparative efficacy of topical ciprofloxacin for treating Mycobacterium fortuitum and Mycobacterium chelonae keratitis in an animal model.

Mycobacterium fortuitum and M. chelonae are the two most common causes of nontuberculous mycobacterial keratitis, and they may be difficult to differentiate at diagnosis. Mycobacterium fortuitum is generally more sensitive to ciprofloxacin in vitro than is M. chelonae. Using a rabbit model, we compared the efficacy of topical ciprofloxacin (3 mg/ml) against M. chelonae keratitis to its efficacy against M. fortuitum keratitis. After four days of therapy, ciprofloxacin significantly reduced the number of both organisms in treated eyes compared to untreated control eyes (both P values < .001). Mean culture ratios (colony-forming units in treated eye divided by colony-forming units in untreated eye for each rabbit) were used to compare efficacy between groups. When all treated animals were considered, no significant difference was found between groups (P = .13). When outlier values were excluded, ciprofloxacin was more effective against M. fortuitum than M. chelonae (P = .01). When treated and untreated eyes were compared after therapy in the M. fortuitum group, ciprofloxacin treatment was associated with a reduction in mean stromal infiltrate area (P = .03) and in the tendency to form satellite lesions (P = .07). A clinical effect was not observed in the M. chelonae group. Although ciprofloxacin is effective against both organisms, it appears to be less effective against M. chelonae than M. fortuitum in vivo.

Administration, Topical↗
PubMed1993

Comparison of topical antibiotics for treating Mycobacterium fortuitum keratitis in an animal model.

The efficacy of three topical antibiotic treatments for Mycobacterium fortuitum (strain ATCC-6841) keratitis were compared in rabbits. Rabbits were treated with ciprofloxacin (3 mg/ml) or clarithromycin (20 mg/ml) or a combination of amikacin (100 mg/ml) and vancomycin (50 mg/ml). All three treatments significantly reduced the number of organisms in treated eyes compared to untreated, control eyes (all P values < .001). No significant difference in treatment efficacy was found between the three treatment groups (all P values > or = .48), although ciprofloxacin (3 mg/ml) was more effective than clarithromycin (20 mg/ml) after excluding outliers (P = .01). All treatments stabilized or reduced the size of stromal infiltrates after four days of therapy, whereas infiltrates continued to enlarge in untreated eyes. These results suggest that topical clarithromycin, topical ciprofloxacin, and combined amikacin and vancomycin may all be clinically useful for treating M. fortuitum keratitis. Both clarithromycin and ciprofloxacin were better tolerated than combined amikacin and vancomycin. This study supports the further development of clarithromycin, a new macrolide antibiotic, as a topical drug for treatment of M. fortuitum keratitis.

Administration, Topical↗
PubMed1988

Visual results after keratoplasty in patients with posterior chamber intraocular lenses.

We performed penetrating keratoplasty in 20 consecutive patients who had posterior chamber intraocular lenses and who developed pseudophakic bullous keratopathy. All patients received 8.0-mm grafts placed in 7.5-mm recipient beds. None of the intraocular lenses were removed. Final visual acuity was 20/40 or better in eight (40%) and 20/80 or better in 15 (75%) of the patients. Senile macular degeneration (one case), corneal graft rejection (two cases), and wound infection (one case) contributed to poor visual results in the remaining patients.

Aged↗
PubMed1987

Topical vs systemic gentamicin penetration into the human cornea and aqueous humor.

Twenty-two patients undergoing penetrating keratoplasty received either topical fortified gentamicin (13.6 mg/mL) or a loading dose of intramuscular gentamicin before surgery. Cornea and aqueous humor samples were obtained and assayed by radioimmunoassay for gentamicin. In the topical group, the average gentamicin levels in the cornea and aqueous were 16.2 micrograms/g and 0.3 microgram/mL, respectively. Parenteral drug levels were less variable and averaged 6.1 micrograms/g in the cornea and 0.4 microgram/mL in the aqueous. Although this study demonstrates that parenteral therapy can be used to deliver adequate drug levels to the cornea, it requires far more antibiotic and subjects the patient to potentially toxic systemic side effects. Therefore, topical administration is the preferred route of delivery of antibiotic to the cornea.

Administration, Topical↗
PubMed1987

Ankyloblepharon associated with systemic 5-fluorouracil treatment.

A 59-year-old man undergoing systemic 5-fluorouracil treatment for metastatic adenocarcinoma of the stomach developed ocular lesions consisting of bilateral conjunctival ulcers and ulcerative blepharitis leading to ankyloblepharon. Ophthalmologists should be cognizant of potential ocular side effects of chemotherapy, in order to institute appropriate changes in treatment.

Adenocarcinoma↗
PubMedDate not supplied

Ocular tuberculosis.

In recent years tuberculosis has reemerged as a serious public health problem, raising the possibility that tuberculous eye disease may also become more prevalent. The predominant route by which tubercle bacilli reach the eye is through the bloodstream, after infecting the lungs. The pulmonary loci might not be evident clinically or radiographically. The most common manifestation of ocular tuberculosis in patients with pulmonary tuberculosis is choroiditis. Retinal periphlebitis is rarely caused by direct invasion of the retina by tubercle bacilli. Retinal tuberculosis is usually, but not always, secondary to an underlying choroiditis. Tuberculoprotein hypersensitivity may have a role in the pathogenesis of phlyctenulosis and Eales' disease. Both ocular and orbital tuberculosis are usually unilateral. Skin testing should be performed in selected patients based on the clinical presentation and/or a history of exposure to tuberculosis. The specificity of the PPD skin test for Mycobacterium tuberculosis increases with larger skin reactions and with a history of exposure to an active case of tuberculosis. Because of the potential for serious drug toxicities, empiric treatment with antituberculous chemotherapy should be reserved only for those cases that have an identifiable risk of tuberculous disease.

Antitubercular Agents↗
PubMedDate not supplied

Traumatic cataract management in penetrating ocular injury.

Eight patients with lens damage caused by penetrating ocular trauma underwent delayed cataract removal four to 30 days after the initial injury. All but one patient, who had a retinal detachment, achieved a visual acuity of 20/50 or better. A short delay in the treatment of the cataract as well as the use of intraocular lenses did not appear to have an adverse effect on the visual prognosis.

Adolescent↗