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Biomedical subjects

D Minckler

Publications and source records attributed to D Minckler.

12 recordsLinked to original sources
PubMed1996

Intracameral tissue plasminogen activator after glaucoma surgery. Indications, effectiveness, and complications.

PURPOSE: To describe the authors' clinical experience with intracameral tissue plasminogen activator (tPA) after glaucoma surgery. METHODS: Retrospective review of medical records of all patients who received intracameral tPA after glaucoma surgery at the Doheny Eye Institute from November 4, 1992, to June 14, 1994. There were 20 tPA administrations (18 eyes of 17 patients) in doses ranging from 6 to 25 microgram. Indication for tPA administration was decreased bleb function secondary to blood/fibrin clot in aqueous outflow pathway. RESULTS: Tissue plasminogen activator was given after trabeculectomy (5 drug administrations) and combined cataract extraction/trabeculectomy procedures (9 drug administrations), with increased filtration in 12 (86%). There were five (36%) instances of hyphema and three (21%) of hypotony. All hyphemas occurred after doses of 25 microgram. Final IOP of 18 mmHg or lower and 6 mmHg or higher was achieved in 11 (92%) of 12 patients after a mean follow-up interval of 4.2+/-4.7 months. The six remaining tPA irrigations were done in five patients after glaucoma drainage implant surgery (n=4) or surgical/needle revision of a filtering bleb (n=2). CONCLUSIONS: Aqueous outflow obstruction from blood/fibrin clot after glaucoma surgery may be treated effectively with intracameral tPA in doses of 6 to 25 microgram. The authors recommend using a dose of less than or equal to 6 to 12.5 microgram to minimize risk of hyphema.

Adolescent↗
PubMed1992

Complications of glaucoma surgery. Ocular decompression retinopathy.

In seven eyes of four patients, retinal hemorrhages were observed following trabeculectomy under both local and general anesthesia. The hemorrhages were diffuse, both deep and superficial, and many had white centers when first observed. Two patients were young healthy male myopes undergoing primary trabeculectomy. The third patient was a young man with chronic uveitis. The fourth patient was an elderly man with primary open angle glaucoma who had an acute rise in intraocular pressure following cataract extraction. Intraocular pressure and visual results appeared unaffected by the hemorrhages. Retinal hemorrhages associated with ocular decompression appear to be relatively benign.

Adolescent↗
PubMed1988

Molteno implant for control of glaucoma in eyes after penetrating keratoplasty.

Seventeen patients (17 eyes) underwent implantation of a single plate Molteno implant for medically uncontrollable intraocular pressures after penetrating keratoplasty. Most of the eyes had extensive peripheral anterior synechiae, and 16 of 17 (94%) were pseudophakic or aphakic following keratoplasty. Other glaucoma procedures had been performed previously on 13 eyes: argon laser trabeculoplasty (one eye), trabeculectomy (seven eyes), transpupillary argon laser cyclophotocoagulation (three eyes), and cyclocryotherapy (three eyes). Follow-up ranged from 5 to 28 months (mean, 13 months). Three eyes underwent repeat Molteno implantation when intraocular pressure (IOP) was not satisfactorily reduced after the first procedure. Considering one eye with chronic hypotony as a failure, 12 of 17 eyes (71%) had IOPs of less than 21 mmHg at the time of the three most recent postoperative examinations after a single Molteno implant. Repeat implants in three eyes increased the number of eyes with IOPs of less than 21 mmHg to 14 (82%). Corneal allograft rejection after Molteno implantation occurred in seven eyes; two of these were successfully reversed with corticosteroid therapy. Three of the five eyes with irreversible graft rejection were regrafted, and two of these grafts have remained clear. Including the regrafted eyes, 13 eyes had clear grafts and controlled IOPs at the most recent postoperative examination. The Molteno implant may prove useful in the management of medically uncontrollable glaucoma following penetrating keratoplasty; however, there appears to be a substantial risk of postoperative graft rejection.

Adult↗
PubMed1983

Histopathologic and ultrastructural analysis of congenital corneal staphyloma.

Although the visual prognosis for eyes with congenital corneal staphyloma has been considered hopeless, we successfully treated a 1-month-old girl with this condition. We performed two penetrating keratoplasties, operating on the left eye first and then, one week later, on the right eye. During each procedure, we totally resected the staphyloma and excised the iris which was adherent to the posterior surface of the cornea. We then sutured an 11-mm corneal button into place with 34 interrupted 10-0 nylon sutures. Light and transmission electron microscopy of the Descemet's membrane and endothelium. The left eye had two rejection episodes and underwent a second penetrating keratoplasty. The graft in this eye is now opaque. The child follows objects well with her right eye.

Cornea↗
PubMed1980

Orbital abscess.

A staphylococcal orbital abscess developed in a 55-year-old diabetic woman. Initial antibiotic therapy was apparently incomplete and resulted in an unusual clinical manifestation for an orbital infection. These unusual features included an insidious course of monocular visual loss and proptosis in the absence of fever, substantial orbital pain, and evidence of sinus disease; pancytopenia rather than leukocytosis was present. Surgical drainage followed by intravenous and oral antibiotic therapy resulted in marked clinical improvement, including a partial return of visual acuity. In the patient, however, a staphylococcal osteomyelitis of the shoulder and subsequent fatal septicemia developed several months later. Orbital infection continues to be a life-threatening condition, especially in debilitated patients.

Abscess↗
PubMed1980

Orbital and adnexal lymphomas. A multiparameter approach.

The application of immunologic, cytochemical, and electron-microscopic technics to the study of lymphoid lesions of the orbit and adnexa was found to enhance the accuracy of diagnoses of malignant lymphoma in five challenging referral cases. Although careful specimen collection, ideal fixation, and processing constitute the cornerstone of the morphologic diagnosis of nodal and extranodal lymphomas, the immunologic characterization of these lymphoproliferative disorders is emphasized as an especially useful diagnostic parameter. The occurrence of false-negative diagnoses of pseudolymphoma of the orbital region may be partially explained by a failure to recognize the relatively frequent plasma-cytoid lymphocytic lymphoma, a distinctive entity that may mimic a reactive inflammatory process. All of the cases of malignant lymphoma reported represented stage I or stage II disease, suggesting that primary lymphoma of the orbital region may be a disease with a favorable prognosis.

Adult↗
PubMed1979

Photocoagulation of malignant melanoma.

A 59-year-old woman developed a pigmented, expanding posterior pole choroidal lesion nasally that was clinically consistent with malignant melanoma. She refused enucleation, but agreed to a trial of photocoagulation therapy. Four weeks after photocoagulation, a reaccumulation of pigmentation and apparent elevation prompted a second photocoagulation treatment. During the second photocoagulation episode corneal edema occurred, and thereafter the fundus view was poor. Again, four weeks after the second treatment there appeared to be increasing pigmentation and possible elevation in the lesion centrally. Because of apparent continued growth of the tumor, the globe was enucleated 82 days after the initial photocoagulation. Serial section histopathologic examination of the lesion revealed only rare neoplastic cells along the base of the lesion. However, myriad pigment-laden macrophages were present around a central area of necrosis. Pigment accumulation within macrophages had simulated tumor growth clinically.

Choroid Neoplasms↗
PubMed1979

Pyogenic granuloma of the cornea simulating squamous cell carcinoma.

A case of pyogenic granuloma involving the cornea simulated recurrent squamous cell carcinoma clinically and was misdiagnosed as invasive squamous cell carcinoma on biopsy. Ophthalmologists and pathologists should be aware of the capability of the corneal or conjunctival tissues to mount a granulation tissue response to injury.

Aged↗
PubMed1978

Adenocarcinoma of the retinal pigment epithelium.

A 57-year-old woman complaining of decreased vision for six months had a mass expanding the choroid inferonasally in the right eye. Clinical examination, ultrasonography, and fluorescein angiography were consistent with a malignant melanoma. The eye was enucleated and pathologic studies showed an adenocarcinoma of the retinal pigment epithelium (RPE). Malignant tumors of the RPE may simulate exactly choroidal melanomas clinically, but apparently have a much better prognosis, in that very few cases have been documented to produce metastatic disease. The vast majority of cases studied histopathologically, in which a diagnosis of adenocarcinoma of the RPE has been made, are low-grade malignant neoplasms with the absence of invasion beyond the choroid or lamina cribrosa at the time of enucleation.

Adenocarcinoma↗