Neurosyphilis with optic neuritis: an update.
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Adult↗
Biomedical subjects
C Migdal
Publications and source records attributed to C Migdal.
Single intraoperative application of 5-Fluorouracil versus placebo in low-risk trabeculectomy surgery: a randomized trial.
PURPOSE: Trabeculectomy is the procedure of choice for the surgical control of glaucoma, and is often augmented by intraoperative 5-fluorouracil application to reduce scarring. This study aims to assess the validity of this technique with a randomized placebo-controlled trial. METHODS: Patients without risk factors for bleb failure other than previous drop use who were undergoing trabeculectomy surgery as their first ocular procedure were randomized to receive fluorouracil or placebo. The main outcome measures were intraocular pressure and bleb morphology. RESULTS: Results from 40 eyes of 36 patients are presented; 23 eyes were treated with fluorouracil, and 17 eyes were treated with placebo. Mean intraocular pressure at 1 year and at the final follow-up examination was significantly lower than preoperatively, but was not different between fluorouracil and placebo groups. Kaplan-Meier survival analysis also failed to show any difference, though there was a trend toward better survival of an intraocular pressure of 16 mm Hg or lower. Bleb morphology was examined postoperatively in 24 patients, with no differences found between fluorouracil and placebo groups. CONCLUSIONS: No significant difference was found in trabeculectomy outcome between fluorouracil-treated and placebo-treated eyes. The study was too small to state definitively that no such difference exists, but suggests that any treatment effect is likely to be small.
Aged↗
Prescription of eye drops.
The aim of this study was to assess whether patients have their ocular drops correctly prescribed during non-ophthalmic admissions to hospital. A retrospective review of notes of patients who were admitted to hospital for general medical or surgical care, while on regular eye drops at the time of admission was performed. Twenty two patients were on regular ocular medication when admitted. Only seven out of 22 patients had their eye drops correctly prescribed. Furthermore, six patients had been prescribed topical beta-blockers, yet suffered from medical conditions that may have been aggravated by these drops. These findings demonstrate that the majority of patients on drops do not have their medication correctly prescribed during non-ophthalmic admissions to hospital. Also topical beta-blockers continue to be inappropriately prescribed.
Adrenergic beta-Antagonists↗
Glaucoma medical treatment: philosophy, principles and practice.
There have been numerous recent advances in the management of glaucoma, not least the development of new drugs to help manage raised intraocular pressure. In addition, the concepts of improving blood flow to the optic nerve head and neuroprotection are currently provoking considerable interest. This article considers the aims and philosophy of glaucoma drug therapy, summarises some of the basic facts and principles of modern glaucoma medications, and suggests a practical approach to the choice of therapy.
Adrenergic alpha-Agonists↗
Clinical management of glaucoma.
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Adult↗
Management of chronic choroidal effusions.
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Aged↗
Effect of brimonidine tartrate on ocular hemodynamic measurements.
OBJECTIVE: To study the effect of a selective alpha 2-adrenoreceptor agonist, brimonidine tartrate, on ocular hemodynamics. SUBJECTS AND METHODS: Eighteen patients with ocular hypertension were enrolled in a prospective, randomized, double-masked study in which 0.2% brimonidine tartrate, administered twice daily, was compared with its vehicle in a crossover fashion. The effect on the ocular circulation was assessed by color Doppler ultrasound, which measured blood flow velocities (peak systolic and end diastolic velocities) in the central retinal, ophthalmic, nasal, and temporal ciliary arteries. The following tests were performed at 2 weekly intervals on both treatments, 0.2% brimonidine tartrate and the placebo: intraocular pressure, heart rate, blood pressure, and color Doppler ultrasound. RESULTS: Velocities and resistivity indices measured by color Doppler ultrasound in the ophthalmic artery, central retinal artery, nasal artery, and temporal ciliary arteries showed no statistically significant differences between the placebo and 0.2% brimonidine tartrate when compared with baseline values and between the groups. Intraocular pressure was decreased by 17.7% +/- 9.5% with 0.2% brimonidine tartrate (vs 9% +/- 8% with placebo). CONCLUSION: The hemodynamics of the posterior segment of the eye as measured by color Doppler ultrasound do not appear to be altered by 2% brimonidine tartrate.
Adrenergic alpha-Agonists↗
Spatial and temporal visual filtering in patients with glaucoma and ocular hypertension.
PURPOSE: To investigate the spatial and temporal response characteristics in patients with glaucoma and ocular hypertension (OHT), in order to demonstrate the earliest specific measure of vision loss and to elucidate the precise mechanism of early glaucomatous damage. METHODS: The Open Optical View System was used to assess changes in spatial and temporal vision in patients with clearly defined glaucoma (30 eyes), patients with OHT (30 eyes) and 30 eye-matched normal control eyes. The psychophysical methods applied were developed by Barber and Ruddock, who showed that the responses called ST1 and ST2 have similar characteristics to those found in the parvocellular and magnocellular pathway respectively. The measurement of spatial and temporal responses rests upon the measurement of a target that moves across a background, itself modulated spatially (gratings) and temporally (flicker). RESULTS: The results reported, taken together with the current data on retinal ganglion cell function, reveal damage to both the parvocellular and magnocellular pathway in patients with glaucoma. In the OHT groups only marginal changes were found in the parvocellular response, but significant changes in the magnocellular response. In both OHT and glaucoma, the temporal processing shows greatest abnormalities at a small number of low flicker frequencies. CONCLUSION: We provide psychophysical evidence of the detectable ganglion cell damage in patients with OHT who remain normal on testing with automated perimetry. The psychophysical method chosen (which measures the function of specific sub-divisions of the visual pathway) may prove useful in screening for glaucomatous damage.
Aged↗
Brain natriuretic peptide: identification of a second natriuretic peptide in human aqueous humour.
AIMS/BACKGROUND: To measure aqueous humour levels of brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) in humans. To compare peptide levels in glaucomatous and control eyes to test the hypothesis that these peptides are increased in glaucoma. BNP and ANP are cyclic endopeptides whose principal biological effects are natriuresis and vasodilatation. Experimental glaucoma in animal models results in elevated aqueous ANP. Intravenous ANP administration in both animals and humans causes lowering of intraocular pressure (IOP). There are equivocal data to support a role for ANP in IOP regulation in human eyes. There are as yet no published data on BNP in human aqueous humour. METHOD: This was a case-control study. Cases were primary open angle, pseudoexfoliation, and mixed mechanism glaucoma eyes undergoing trabeculectomy. Controls were cataract extraction eyes. There were 47 trabeculectomy eyes (44 patients) and 47 cataract extraction eyes (46 patients) matched for age, sex, race, systemic medications, and type of anaesthetic. 100-200 microliters of aqueous humour were aspirated by paracentesis as the first step in the surgical procedure. Peptide levels were later measured by radioimmunoassay. RESULTS: The presence of BNP and ANP in human aqueous humour was confirmed. BNP was present in higher concentrations than ANP. BNP levels tended to be greater in control eyes--glaucoma median 56.5 (range 0-3526.5) pg/ml versus control median 65.16 (range 0-1788) pg/ml (Wilcoxon signed rank test p = 0.78). ANP levels tended to be greater in glaucoma eyes than in controls: glaucoma median 3 (range 0-68.5) pg/ml versus control median 0 (range 0-60) pg/ml (Wilcoxon signed rank test p = 0.82). ANP and BNP were log linearly related in both groups (r glaucoma group = 0.961, r control group = 0.894). CONCLUSION: This is the first report of BNP and ANP in human aqueous humour. Peptide levels did not differ significantly between glaucoma and cataract extraction eyes. A linear relation between log BNP and ANP was found. Further studies are required to clarify the role of these peptides in aqueous humour production and IOP regulation.
Adult↗
Trabeculectomy with intraoperative sponge 5-fluorouracil in Afro-Caribbeans.
AIM: To study the efficacy and safety of intraoperative 5-fluorouracil (5-FU) in Afro-Caribbean patients. METHODS: The results of trabeculectomy in 18 eyes of 18 Afro-Caribbean patients in whom a sponge soaked in 25 mg/ml solution of 5-FU was applied between Tenon's capsule and sclera for 5 minutes before excision of the trabecula were compared with 16 eyes of 16 Afro-Caribbean patients matched for age, quantity, and duration of preoperative medications, who underwent trabeculectomy without 5-FU. RESULTS: The mean postoperative intraocular pressure (IOP) at 1 month was 15.6 (SD 6.1) mm Hg in the 5-FU group and 18.0 (5.2) mm Hg in the control group (p = 0.15). There was no significant difference in the IOP at 6, 12, 15, 18, and 24 months in the two groups. Success rate at 18 months defined as an IOP less than or equal to 21 mm Hg with no adjunctive medication was 56% in the 5-FU group and 55% in the control group. No major complications were noted in either group. CONCLUSION: Intraoperative sponge 5-FU alone is safe but does not appear to decrease the risk of failure of trabeculectomy in Afro-Caribbeans.
Administration, Topical↗
Funduscopy versus photographic assessment of cytomegalovirus retinitis progression: a clinician's perspective.
OBJECTIVE: Funduscopy was compared with retinal photographs in the documentation of progression of cytomegalovirus (CMV) retinitis. SETTING: Clinical centres provided oral ganciclovir maintenance therapy for AIDS patients with CMV retinitis inaccurately involved in randomized trials of oral versus intravenous ganciclovir for maintenance therapy of patients with newly diagnosed or previously treated CMV retinitis, in North America, Europe and Australia. DESIGN: Serial retinal photographs and funduscopy examinations were conducted at each patient visit in order to detect progression of CMV retinitis during the course of oral ganciclovir maintenance therapy. CONCLUSIONS: Retinal photography is the most accurate for central lesions, funduscopy is preferable for diffuse and peripheral lesions, and in the day-to-day management of patients, the combined approach provides the most accurate information.
AIDS-Related Opportunistic Infections↗
Long-term functional outcome after early surgery compared with laser and medicine in open-angle glaucoma.
PURPOSE: This randomly allocated prospective clinical study was designed to assess the relative efficacy of laser trabeculoplasty, medical therapy, and trabeculectomy used as the primary treatment in open-angle glaucoma, with particular regard to the level of intraocular pressure control and the amount of visual field decay. No patient had received any antiglaucoma treatment before entry into the trial. METHODS: One hundred sixty-eight patients were entered into the trial and randomly allocated into one of the three treatment groups--laser, medicine, or surgery. Follow-up was for a minimum of 5 years. The patients were monitored in the standard way, including intraocular pressure estimations and visual field tests (initially using the Friedmann analyzer and later including Humphrey automated perimetry). RESULTS: Despite similar initial composition of the three treatment groups, primary surgery resulted in the lowest mean intraocular pressures. The perimeter Friedmann visual fields were shown to have deteriorated in patients in the medicine-treated group and to a lesser extent in patients in the laser-treated group, but not in patients in the surgery-treated group. Multivariate linear regression analysis showed that the difference in field changes between laser and surgical treatments could be explained entirely by the difference between the intraocular pressure values at 6 months between the two groups. The same was not true for the medicine-treated group. CONCLUSION: Primary trabeculectomy appears to have the desired effect in preserving visual function in patients with high-tension glaucoma. This may be related to laser treatment might be expected to have the same effect.
Aged↗
Ab interno pulsed dye laser sclerostomy for the treatment of glaucoma: preliminary results of a new technique.
Ab interno gonioscopic laser sclerostomy in conjunction with iontophoretic staining of the sclera was performed on 12 patients with end-stage glaucoma in order to ascertain the feasibility of the technique. In 9 of 12 patients (75%) a visible sclerostomy was formed and mean intraocular pressure (IOP) dropped from 36.3 mmHg prior to treatment to 25.3 mmHg at 1 week, a fall of 30.3%. The drop in IOP was maintained throughout a 3-month follow-up period, with 6 of 11 patients having IOP controlled below 21 mmHG. The procedure is described together with our preliminary results, and possible advantages and areas of improvement for the technique are discussed.
Adult↗
Rational choice of therapy in established open angle glaucoma.
Currently, the standard treatment for primary open angle glaucoma favours initial medical therapy. Laser trabeculoplasty and filtering surgery are reserved for those patients who fail medical therapy. There is now, however, good evidence to suggest that perhaps this approach deserves reassessment.
Glaucoma, Open-Angle↗
Treatment of cytomegalovirus retinitis with ganciclovir and foscarnet.
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Adult↗
Cytomegalovirus infection in AIDS. Patterns of disease, response to therapy and trends in survival.
Among 347 AIDS patients seen at St Mary's Hospital, London between 1983 and 1989, cytomegalovirus (CMV) disease was observed in 75 (22%). Of these, 58 (77%) had CMV retinitis, 26 (35%) CMV colitis, and 12 (16%) had CMV infection diagnosed at other sites. Relapse occurred in 71%. A favourable response to the use of ganciclovir as induction therapy for CMV retinitis was observed in 92%. Relapse of CMV retinitis occurred in 54% at a median time of 97 days. Neutropenia was the most frequent and serious side-effect of ganciclovir, 76% patients having neutrophil counts less than 1.0 x 10(9)/l and 48% less than 0.5 x 10(9)/l at some stage of therapy. Thrombocytopenia was also common, and platelet counts of less than 50 x 10(9)/l occurred in 43% patients on ganciclovir. The concurrent use of zidovudine made the development of severe neutropenia and thrombocytopenia more likely. Median survival following the diagnosis of CMV disease increased from 5-8 months between 1984 and 1987, to over 12 months in 1988. Patients with CMV colitis had a worse prognosis than patients with CMV retinitis, with median survival of 4.5 and 7 months respectively. In conclusion, CMV is an important opportunist infection in AIDS and both the disease and its treatment cause considerable morbidity. Hence, it is important to develop more effective and less toxic forms of therapy for CMV infection.
Acquired Immunodeficiency Syndrome↗
New aspects in the surgical treatment of glaucoma.
With modern techniques and advances in materials and instruments, the outcome of glaucoma surgery has been improved. Early filtering surgery has become a definite option in open angle glaucoma, particularly as the complications of such surgery are minimal. Refractory cases of glaucoma are always problematic, but modifications to the routine surgical options such as silicone-tube implants, partial-thickness procedures, 5-fluorouracil, and cyclocryotherapy, have improved the outcome. This article reviews some of the current trends in glaucoma surgery.
Combined Modality Therapy↗
Morbidity following prolonged postoperative hypotony after trabeculectomy.
The postoperative course of a series of 54 patients that had undergone primary trabeculectomy for open-angle glaucoma is reviewed. Almost one third of the eyes had prolonged postoperative hypotony with an intraocular pressure less than 8mm Hg for more than 2 weeks. The possible significance of prolonged hypotony and choroidal effusions is discussed in relation to the final intraocular pressure and the effect on visual acuity.
Choroid↗