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Biomedical subjects

D L Budenz

Publications and source records attributed to D L Budenz.

At least 37 records · Page 2Linked to original sources
PubMed1999

Elevated intraocular pressure and hypotony following silicone oil retinal tamponade for complex retinal detachment: incidence and risk factors.

OBJECTIVE: To evaluate the incidence of and risk factors for persistently elevated intraocular pressure (IOP) and hypotony in patients who have undergone pars plana vitrectomy with silicone oil injection for the management of complex retinal detachment. SUBJECTS AND METHODS: The medical records of 532 patients who underwent silicone oil injection for the management of complex retinal detachments between January 1, 1991, and December 31, 1996, at the Bascom Palmer Eye Institute, Miami, Fla, were reviewed. Elevated IOP was defined as elevated IOP requiring an operation at any time postoperatively or a persistently elevated IOP of greater than 25 mm Hg at or after the 6-month visit. Hypotony was defined as a persistent IOP of 5 mm Hg or less at or after the 6-month visit. Patients with transient perioperative IOP fluctuations were not counted. RESULTS: Survival analysis for patients without cytomegalovirus retinitis (n = 383) revealed that 12.9% had an elevated IOP and 14.1% had hypotony by 6 months, 21% had an elevated IOP and 20.3% had hypotony by 1 year, and 29.5% had an elevated IOP and 27.3% had hypotony by 2 years. Among patients with cytomegalovirus retinitis (n = 149), none had a persistently elevated IOP, 10% had hypotony by 6 months, and 5.9% had persistently elevated IOP and 10% developed chronic hypotony by 1 year. A history of glaucoma before silicone oil retinal tamponade (P = .03), diabetes mellitus (P = .02), and a high IOP on the first postoperative day (P = .006) were risk factors for elevated postoperative IOP in patients without cytomegalovirus retinitis. Risk factors for postoperative hypotony in patients without cytomegalovirus retinitis included preoperative hypotony (P<.001) and aphakia (P = .03). CONCLUSIONS: An elevated or low IOP often develops postoperatively in patients without cytomegalovirus retinitis who undergo silicone oil injection for the management of complex retinal detachment. Risk factors for an elevated postoperative IOP include a history of glaucoma, diabetes mellitus, and a high IOP on the first postoperative day. Risk factors for hypotony include preoperative hypotony and aphakia.

Adolescent↗
PubMed1999

Conjunctival advancement for late-onset filtering bleb leaks: indications and outcomes.

OBJECTIVE: To determine the indications and outcome of conjunctival advancement surgery for late-onset filtering bleb leaks. PATIENTS AND METHODS: Retrospective medical record review of a consecutive case series of all patients who underwent conjunctival advancement surgery for persistent late-onset glaucoma filtering bleb leaks at a tertiary referral center between December 1, 1985, and April 30, 1997. MAIN OUTCOME MEASURES: Indications for surgery, preoperative and postoperative intraocular pressure (IOP), visual acuity, status of bleb leak, and need for reinstitution of medical therapy or reoperation for glaucoma. RESULTS: Twenty-six eyes of 26 patients were analyzed. Complications from bleb leaks that necessitated surgical intervention included chronic ocular hypotony (n = 21), decreased visual acuity (n = 9), bleb-related infection (n = 11), hypotony maculopathy (n = 4), corneal edema with folds (n = 7), choroidal effusion (n = 3), and persistent shallow anterior chamber (n = 3). The mean +/- SD preoperative IOP was 5.7 +/- 4.9 mm Hg (range, 0-16 mm Hg). After a follow-up of 19.6 +/- 22.6 months, the IOP was 14.2 +/- 4.1 mm Hg for patients taking 1.1 +/- 1.3 glaucoma medications (all data given as mean +/- SD). Twelve patients (46%) had early-onset bleb leaks after revision, of which 7 (27%) closed spontaneously and 5 (19%) required resuturing. Two patients (8%) had a persistent bleb leak throughout the follow-up period. Thirteen patients (50%) required reinstitution of medical therapy during the follow-up period, and 2 (8%) required a reoperation for glaucoma for uncontrolled IOP. CONCLUSIONS: Conjunctival advancement is a successful procedure for closing late-onset filtering bleb leaks. Some patients require suturing in the early postoperative period, but most patients eventually obtain permanent closure of the leak. Patients should be counseled of the possibility of requiring medical or surgical intervention for IOP control after revision.

Adolescent↗
PubMed1999

Aqueous misdirection after glaucoma drainage device implantation.

OBJECTIVE: To describe the clinical presentation, outcome, and possible underlying mechanism of aqueous misdirection after glaucoma drainage device implantation. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Ten eyes (five primary open-angle glaucoma, four chronic angle-closure glaucoma, one nanophthalmos) of nine patients with a mean age of 68.5+/-12.0 years (range, 43-83 years). INTERVENTION: The authors reviewed the medical records of all patients with a clinical diagnosis of aqueous misdirection after Baerveldt glaucoma drainage device implantation at two tertiary care referral centers from October 1992 to October 1997. Surgery was performed in a standardized fashion; all drainage tubes were inserted in the anterior chamber and occluded with an external 7-0 polyglactin ligature. All eyes were treated with topical corticosteroids, cycloplegia, and aqueous suppressants. Eyes with persistent aqueous misdirection received neodymium:YAG (Nd:YAG) hyaloidotomy or pars plana vitrectomy. MAIN OUTCOME MEASURES: Visual acuity, intraocular pressure, biomicroscopic anterior chamber depth, and antiglaucomatous medication. RESULTS: All eyes had axial shallowing of the anterior chamber, one or more patent iridotomies, and no ophthalmoscopic or B-scan ultrasonographic evidence of serous or hemorrhagic ciliochoroidal detachment. Median time to the development of angle-closure glaucoma was 33.5 days (range, 1-343 days) and mean intraocular pressure at diagnosis was 27.7+/-18.7 mm Hg (range, 10-62 mm Hg). Normalization of anterior segment anatomy was achieved with aqueous suppression and cycloplegia (one eye); Nd:YAG capsulotomy (four eyes); pars plana vitrectomy alone (two eyes) or with lensectomy (one eye), and pars plana vitrectomy with intraocular lens explanation (two eyes). Mean final intraocular pressure was 14.1+/-6.0 mmHg at a mean follow-up of 9.1+/-7.8 months after the development of aqueous misdirection (range, 1-23 months). CONCLUSIONS: Aqueous misdirection may develop days to months after glaucoma drainage device implantation. In this series, there was a poor response to medical therapy, and normalization in anterior chamber depth required aggressive laser and surgical therapy.

Adult↗
PubMed1999

Comparison of phacotrabeculectomy with 5-fluorouracil, mitomycin-C, and without antifibrotic agents.

BACKGROUND AND OBJECTIVE: To evaluate the potential benefits, complications, and prognostic risk factors for failure of phacotrabeculectomy performed with or without 5-fluorouracil (5-FU) and mitomycin-C (MMC). PATIENTS AND METHODS: Retrospective chart review of 78 patients who underwent phacotrabeculectomy during a 2-year period. Patients were divided into 3 groups, those who received 5-FU (N = 28). MMC (N = 29), or no antifibrotic agent (N = 21). RESULTS: All 3 groups had statistically significant lower intraocular pressures (IOP) on fewer antiglaucomatous medications at 6-month, 12-month, and last follow-up compared to preoperative levels (P < .05). Intraocular pressures were lower in the group that received MMC compared to the 5-FU group, but not in the group that did not receive antimetabolites, at all time intervals measured (P < .05). Black race was a strong predictor of failure of trabeculectomy (P = 009). No differences in final visual acuity or complications were found between groups. CONCLUSIONS: Phacotrabeculectomy is effective regardless of antimetabolite use. Race is a strong predictor of failure.

Aged↗
PubMed1998

Complications of Baerveldt glaucoma drainage implants.

OBJECTIVES: To report the incidence and identify risk factors of postoperative complications after Baerveldt glaucoma drainage implantation. METHODS: A retrospective review of the medical records of all patients at the Bascom Palmer Eye Institute, Miami, Fla, who underwent placement of a Baerveldt glaucoma drainage implant from October 1, 1992, through October 31, 1996, to determine demographic characteristics, preoperative and postoperative intraocular pressures, and complications. Variables were analyzed using the Student t test and Fisher exact test to determine the association between delayed postoperative suprachoroidal hemorrhage and various potential risk factors. RESULTS: A total of 107 eyes of 103 patients were identified. Suprachoroidal hemorrhage occurred in 4 eyes (4%), with onset ranging from 3 to 33 days after implantation. Two eyes (2%) had choroidal effusions requiring surgical drainage, and 20 eyes (19%) had low choroidal effusions requiring only close observation. Tube blockage was observed in 5 eyes (5%). Four eyes (4%) had aqueous misdirection, 2 eyes (2%) had corneal decompensation, and 1 eye (1%) each had endophthalmitis, tube migration, corneal ulcer, hyphema, and implant migration. Patients who were older (P=.04) or had postoperative choroidal effusions (P=.03), low intraocular pressure immediately after the tube opened (P=.03), hypertension (P= .08), or atherosclerosis (P=.09) were more likely to develop suprachoroidal hemorrhage. CONCLUSIONS: A lower incidence of serious postoperative complications was observed in Baerveldt implantations in this study when compared with a recent report. Risk factors for serious complications were similar to trabeculectomy.

Adolescent↗
PubMed1998

The effects of cataract extraction on the visual field of eyes with chronic open-angle glaucoma.

PURPOSE: To investigate effects of cataract extraction and intraocular lens placement on the visual field of eyes with chronic open-angle glaucoma. METHODS: A retrospective review was conducted of 41 eyes of 41 patients with visually significant cataract and chronic open-angle glaucoma who had undergone automated static perimetry within 6 months before and 6 months after phacoemulsification with intraocular lens placement. RESULTS: Comparison of preoperative and postoperative testing showed that the mean visual acuity, foveal threshold, and mean deviation improved significantly (P < .0001), while the mean pattern standard deviation and corrected pattern standard deviation worsened significantly (P < or = .03). Eyes not receiving miotics preoperatively did not have a significant postoperative change in the mean pattern and corrected pattern standard deviations. Increasing severity of glaucoma-related visual field loss was significantly associated with less improvement in the postoperative mean deviation (P = .0001). Only two (5%) of 41 eyes had worsening of the mean deviation of 1.0 dB or greater. The foveal threshold improved more than the mean deviation did but not significantly more, except in eyes with severe visual field loss. CONCLUSIONS: Cataract extraction resulted in statistically significant improvement in visual acuity and foveal threshold in most eyes with glaucoma. In eyes with mild or moderate glaucoma-related damage, the mean deviation often improved significantly after cataract extraction, but improvement was less predictable in eyes with severe or end-stage damage. The pattern and corrected pattern standard deviations may be reliable indicators of glaucoma-related damage in eyes with cataract but without constricted pupils.

Aged↗
PubMed1998

Trabeculectomy function after cataract extraction.

OBJECTIVE: To examine the effect of cataract extraction (CE) after trabeculectomy on intraocular pressure (IOP) control. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: A total of 115 consecutive patients who underwent extracapsular CE (N = 58) or phacoemulsification (N = 57) with intraocular lens (IOL) placement after trabeculectomy were studied. INTERVENTION: Cataract extraction with IOL after trabeculectomy was performed. MAIN OUTCOME MEASURES: Preoperative, intraoperative, and postoperative factors were evaluated for association with loss of IOP control requiring additional medications, bleb needling, or further glaucoma surgery, using Kaplan-Meier survival analysis and Cox multivariate proportional hazards survival regression. RESULTS: After mean postoperative follow-up of 21.1 +/- 14.3 months, additional glaucoma medication or needling of the filtering bleb to maintain IOP control was required in 35 eyes (30.4%) and was significantly associated with intraoperative iris manipulation and early postoperative peak IOP greater than 25 mmHg. Additional glaucoma surgery was eventually required in 11 eyes (9.6%) and was significantly associated with age of 50 years or younger, preoperative IOP greater than 10 mmHg, and early postoperative peak IOP greater than 25 mmHg. The cumulative proportion of patients who did not require reoperation for glaucoma was 93% and 90% at 1 and 2 years, respectively. The mean IOP at last visit had increased 1.6 mmHg above the pre-CE level and did not vary significantly after the first postoperative month. The median interval from CE to the addition of glaucoma medication or bleb needling was 1.6 months (within 3 months in 20 of 33 eyes) and that from nonsurgical intervention to further glaucoma surgery was 3.6 months (before the 7th postoperative month in 6 of 11 eyes). Of 19 eyes with hypotony (IOP < or = 6 mmHg) before CE, 11 eyes remained hypotonous after CE despite an increase in the mean IOP from 4.6 to 7.5 mmHg. CONCLUSIONS: When CE is performed after trabeculectomy, age of 50 years or younger, preoperative IOP greater than 10 mmHg, intraoperative iris manipulation, and early postoperative IOP greater than 25 mmHg are associated with worsened postoperative IOP control. Most bleb failures occur soon after CE. Resolution of pre-existing hypotony after CE is unpredictable.

Adolescent↗
PubMed1997

Outpatient treatment of bleb infection.

OBJECTIVE: To determine the outcome of outpatient treatment of bleb infection after trabeculectomy. DESIGN: Retrospective review. SETTING: University referral center. PATIENTS: Twelve eyes with bleb infection and without clinical vitreous involvement of 11 patients treated as out-patients from January 1994 to May 1996. INTERVENTIONS: After culture of the bleb surface, treatment consisted of intensive topical antibiotics alone (9 eyes), combined with subconjunctival antibiotic injection (1 eye), oral antibiotics (1 eye), or both (1 eye). Five eyes received topical corticosteroids. MAIN OUTCOME MEASURES: Visual acuity, intraocular pressure, and bleb characteristics. RESULTS: All eyes responded to treatment within 24 to 48 hours, and recovered visual acuity to within 1 line of the preinfection level. Intraocular pressure continued to be controlled after resolution of infection in 11 eyes (92%); 1 bleb failed and medical therapy was resumed. Bleb leaks were noted during treatment of infection in 11 eyes, and 5 eyes (42%) underwent bleb revision. Organisms cultured from the bleb surface included Staphylococcus aureus (8 eyes), Haemophilus influenzae (2 eyes), and Streptococcus (1 eye). Outpatient treatment costs were estimated to be 78% less than inpatient treatment costs, per 24 hours. CONCLUSION: Outpatient treatment of bleb infection was efficacious in this group of patients.

Administration, Topical↗
PubMed1997

Trabeculectomy with intraoperative 5-fluorouracil vs mitomycin C.

PURPOSE: To compare the effectiveness of intraoperative 5-fluorouracil (5-FU) and mitomycin C used adjunctively with trabeculectomy in a black West African population. METHODS: Eighty-five consecutive eyes of 85 black patients undergoing primary trabeculectomy for open-angle glaucoma were prospectively randomly assigned to receive either 5-FU (50 mg/ml for 5 minutes) or mitomycin C (0.5 mg/ml for 3 1/2 minutes) intraoperatively by soaked sponge. RESULTS: Of the 81 eyes with at least a 3-month postoperative follow-up, 41 of 44 (93.2%) in the mitomycin C group and 27 of 37 (73.0%) in the 5-FU group had a final intraocular pressure of less than 21 mm Hg (P = .01). Twenty-eight of 44 eyes (63.6%) in the mitomycin C group and 18 of 37 (51.4%) in the 5-FU group had a final intraocular pressure of less than 15 mm Hg (P = .26). Mean postoperative intraocular pressure was 13.7 mm Hg in the mitomycin C group and 16.3 mm Hg in the 5-FU group (P = .05). There were no differences between the two groups in mean age, preoperative intraocular pressure, postoperative visual acuity, and complications. Mean follow-up was 10.0 +/- 4.41 months (range, 4 to 19 months). CONCLUSIONS: The adjunctive use of mitomycin C with trabeculectomy is equally safe and more efficacious compared to 5-FU in this West African population. Use of mitomycin C in this study was not associated with a statistically significantly greater proportion of patients achieving low intraocular pressure (less than 15 mm Hg) compared to 5-FU.

Antimetabolites↗
PubMed1996

Current cost-effective work-up of the glaucoma suspect.

Given the limited resources for medical care, ophthalmologists are increasingly being called on to provide care in a cost-effective manner without compromising quality. This review provides a framework for the difficult task of working up suspected glaucoma in a cost-effective manner. Several new developments in early detection of glaucoma will also be described.

Cost-Benefit Analysis↗
PubMed1995

Vitrectomy lens for examination of the optic disk in young children with glaucoma.

PURPOSE/METHODS: To examine the optic disk in infants and young children with glaucoma after the administration of anesthesia, a lens designed for vitrectomy surgery was used to obtain magnified stereoscopic images of the optic disk. RESULT/CONCLUSIONS: Excellent visualization of the optic disk was obtained with our method. Comparison of optic disk appearance is facilitated by using an inexpensive lens designed for vitrectomy surgery.

Anesthesia↗
PubMed1995

In vivo gene transfer into murine corneal endothelial and trabecular meshwork cells.

PURPOSE: To determine whether a reporter gene can be introduced into adult mammalian corneal endothelial and trabecular meshwork cells in vivo using a recombinant replication-deficient adenovirus. METHODS: Purified replication-deficient adenovirus containing the cytomegalovirus-promoted Escherichia coli reporter gene, lacZ, was injected into the vitreous cavities or anterior chambers of 30 adult CD-1 mice using the contralateral eyes as controls. LacZ expression was assessed histochemically in enucleated eyes from 2 to 21 days after injection using the beta-Galactosidase (beta-Gal) assay. RESULTS: LacZ expression was demonstrated in corneal endothelial and trabecular meshwork cells for as long as 14 days after injection. beta-Gal activity was also observed in lens and iris epithelial cells. There was no toxicity of the adenoviral vector demonstrated histologically, and no nonocular tissues expressed lacZ as measured by beta-Gal assay. CONCLUSIONS: A functional gene can be transferred in vivo into adult mammalian corneal endothelial and trabecular meshwork cells using a replication-defective adenoviral vector. Gene expression is relatively short-lived compared to that demonstrated previously in other ocular tissues (photoreceptors and retinal pigment epithelium). Adenoviral vectors may be a viable means for short-term delivery of therapeutic genes in vivo to cells in the anterior segment of the eye.

Adenoviruses, Human↗
PubMed1994

Ocular and optic nerve hemorrhages in abused infants with intracranial injuries.

PURPOSE: To ascertain whether the pathology of the eye and optic nerve might be useful in determining the manner of death in infants who died after sustaining apparent nonaccidental intracranial injury. METHODS: Complete autopsies were performed on 13 infants who died of acute intracranial injuries after nonaccidental trauma. The infants were divided into two groups: nine with physical evidence of blunt trauma to the head, and four without detectable scalp or skull injury whose intracranial injuries were attributed to violent shaking (shaken baby syndrome). Six infants with no intracranial injuries who died suddenly from unidentifiable causes (the so-called sudden infant death syndrome) served as controls. RESULTS: Optic nerve sheath hemorrhage, most prominent in the subdural space, was present in all 13 infants with nonaccidental intracranial injury. Multilayered retinal hemorrhage was present in at least one eye of 11 of these 13 infants. The location and quantity of the intraocular and optic nerve sheath hemorrhages did not differ in those with external head trauma and those without scalp or skull lesions. A single control infant had a few erythrocytes in the nerve fiber layer of the anterior optic nerve of one eye. The remainder of the control infants did not have evidence of hemorrhage in the eye or optic nerve sheath. CONCLUSION: Histopathologic analysis of optic nerve sheath and intraocular hemorrhages may be helpful in distinguishing traumatic from non-traumatic causes of death in infants.

Battered Child Syndrome↗
PubMed1993

The effect of simulated cataract on the glaucomatous visual field.

PURPOSE: The current study is designed to determine the effect of light scattering (simulated cataract) on glaucomatous visual fields. METHODS: Twelve patients with relative scotomas caused by glaucoma underwent the 30-2 threshold test with the Humphrey Visual Field Analyzer twice: once with and once without having a light-diffusing piece of ground glass in front of the eye, which, in previous experiments, has been shown to decrease perimetric threshold by 4.4 decibels (dB) in normal eyes. As controls, 12 patients underwent the same examination with and without a piece of clear glass in front of the eye. In each pair of fields, five points were analyzed within the relative scotoma and compared with five points in a normal area of the opposite hemifield. RESULTS: The diffusing ground glass produced a mean decrease of perimetric threshold of 5.7 dB (standard deviation [SD] = 3.3 dB) within the area of relative scotoma compared with 6.1 dB (SD = 2.4 dB) within the normal area and 4.4 dB (SD = 2.25 dB) at the fovea. The differences between means were not statistically significant. In addition, the diffusing glass did not affect the corrected pattern SD (CPSD) index (6.5 dB with the diffuser and 6.5 dB without). CONCLUSION: Light scattering depresses the glaucomatous visual field diffusely. Relative glaucomatous scotomas and normal areas are depressed equally, expressed as change in decibel of sensitivity. Therefore, in following patients with cataracts and glaucoma, depression of threshold sensitivity in glaucomatous areas out of proportion to normal areas should not be attributed to the light-scattering effect of the cataract, but rather to possible worsening of glaucomatous damage.

Aged↗
PubMed1991

Bell's palsy in Moebius syndrome.

We report a case of unilateral transient and reversible facial paresis, which was superimposed on a congenital bifacial palsy in a young adult with Moebius syndrome. Our case illustrates the potential for two conditions, both affecting the facial nerve and both of unknown etiology, to be juxtaposed in a single individual. Worsening of facial palsy in the Moebius syndrome may not signify progressive disease.

Abnormalities, Multiple↗
PubMed1989

Histology of partial thickness double composite eyelid graft.

Double composite grafting is a technique used in the repair of large (greater than 75%) eyelid defects due to tumor resection, trauma, or congenital coloboma. The procedure utilizes two partial thickness composite grafts derived from two unaffected lids. The skin defect is covered by a pedicle skin graft to provide an adequate blood supply. This is thought to be superior to revascularization occurring from the margin of the graft alone. We examined histologically the lid margins of two such grafts 2 and 9 months postoperatively. Each demonstrated scarred tarsus and absent meibomian glands. One of the two grafts had loss of cilia. The architecture of the graft tissue otherwise was preserved.

Aged↗