PubMed Health⌕ Search

Biomedical subjects

E L Greve

Publications and source records attributed to E L Greve.

At least 19 recordsLinked to original sources
PubMed1992

Astigmatism following cataract surgery: comparison of a scleral and a corneal incision in a mixed group of patients with and without glaucoma.

We retrospectively analysed the course of postoperative corneal astigmatism and corrected visual acuity after extracapsular cataract extraction and posterior chamber lens implantation with either a corneal or a scleral incision in 170 eyes of 155 patients with and without glaucoma. A continuous 10/0 nylon shoelace suture was used for wound closure in two groups. In a third group, corneal wound closure was performed with a shorter shoelace suture in combination with two vicryl wing sutures at 11 and 1 o'clock. Although early postoperative mean astigmatism in eyes operated through a corneal incision was high (range 2.92-6.67 diopters at 1 month postoperatively) and significantly different when compared to eyes operated through a scleral incision (1.96 diopters), final mean astigmatism did not differ significantly between those two groups. Moreover, in 27% of eyes operated through a corneal incision, mean astigmatism at 2 months postoperatively was not significantly different from the scleral group and suture removal was not necessary. There was no statistically significant difference in corrected visual acuity over the entire study period between groups. Since safety and functional results of the corneal incision were not different from the scleral incision, we prefer a corneal incision in cataract surgery because of its surgical advantages, especially in patients with cataract and coexisting glaucoma.

Astigmatism↗
PubMed1992

Oculokinetic perimetry compared with standard perimetric threshold testing.

To calibrate oculokinetic perimetry (OKP) as developed by Damato in terms of conventional perimetric threshold values, 33 eyes with either glaucoma or ocular hypertension were tested with a standard Humphrey Field Analyzer using the Central 30-2 test and twice with a 26-point OKP chart. The frequency of seeing of the OKP test spot was plotted against 30-2 thresholds. This showed a weak relation between the two tests. Subsequently eyes that were considered to have had poor fixation were omitted, but false positive and false negative results still occurred in 19 remaining eyes. To check whether Troxler's effect (local adaptation) might have caused false positives, 6 subjects were tested with OKP, controlling the fixation times. Increasing the fixation time from 'very short' to 2 and 5 seconds yielded more 'not seen' responses in OKP. False negative data were found to occur preferentially in border areas of visual defects. The average frequency of seeing curve over all data showed a 50% frequency of seeing for the OKP stimulus at a 14.6 dB equivalent conventional threshold value. The spreading of the curve was 7 dB (95% confidence interval 28 dB).

Adult↗
PubMed1992

Mitomycine, suterelysis and hypotony.

In 35 patients 37 trabeculectomies (TE) were performed using mitomycin as a fibrosisinhibitor. Mitomycin (0.5 mg/ml) was applied to the sclera (under the scleral flap) and conjunctiva in the area of the projected TE during 5 minutes using a small sponge. The indications for operation were: visual field progression in 15 eyes, too high IOP in 13 eyes and severe visual field defects (central island and/or centro coecal visual field defects) in 9 eyes. Six patients had Normal Pressure Glaucoma, 17 Primary Open Angle Glaucoma and 12 had other forms of glaucoma. There were 22 first TE's and 15 re-operations. The scleral flap was sutured with 5 to 8 10/0 nylon sutures. The system of a large number of sutures and subsequent suturelysis was our routine management for reducing complications after TE. This report deals with the postoperative period of the first three months. Suturelysis in combination with mitomycine caused an unexpected high number of postoperative hypotonies (IOP < = 6 mmHg with reduced visual acuity and/or retinal folds or large persistent choroidal detachment and shallow anterior chamber) In the 27 eyes who had suturelysis performed, 7 developed a hypotony. The hypotony may develop as late as three weeks postoperative after suturelysis!. Two eyes developed a hypotony without suturelysis. Seven patients needed resuturing of the scleral flap. The use of mitomycine to enhance filtration after TE may cause serious hypotonies if the scleral flap is not securely closed and if suturelysis is used too early or too extensively.

Adult↗
PubMed1992

Early posterior capsular opacification after intercapsular cataract extraction and rigid Galand disc intraocular lens implantation.

From retrospective studies of implantation of the rigid Galand disc intraocular lens (IOL) and the Sinskey style J-loop IOL, we found that posterior capsular opacification was more common and developed faster in eyes implanted with a Galand disc IOL than in eyes implanted with a Sinskey style J-loop IOL. We investigated this further in a clinical study of 20 patients implanted with a Galand disc IOL. We found a specific type of posterior capsular haze, resembling a "moon landscape," in 10 (50%) of the 16 eyes (80%) with capsular fibrosis.

Cataract↗
PubMed1992

The effects of 5-fluorouracil and mitomycin C on the corneal endothelium.

5-Fluorouracil (5-FU) and Mitomycin C (MMC) are used as adjunct chemotherapy during glaucoma filtering surgery to suppress conjunctival fibroblast proliferation. Since part of these agents may gain access to the anterior chamber and cause cytotoxicity to the corneal endothelium we set up an in vitro system to establish a dose-response effect. Cytotoxicity of MMC and 5-FU was quantified using Mosmann's colorimetric assay in a bovine endothelial cell culture system. In this assay the respiratory activity of the cells is used as a marker for cell viability. After incubation for 5 minutes the 3.0 mg/ml concentration of MMC showed endothelial cytotoxicity, whereas no endothelial toxicity of 5-FU was noted in concentrations up to 50 mg/ml. After incubation for 30 minutes endothelial cytotoxicity was demonstrated for 50 mg/ml of 5-FU and 1 mg/ml of MMC. After an exposure-time of 60 minutes the toxicity level remained 50 mg/ml for 5-FU but decreased to 0.5 mg/ml for MMC. We conclude that with respect to the clinically used concentrations and methods of application of 5-FU and MMC in vivo endothelial toxicity is not to be expected. However, in cases of accidental access of MMC to the anterior eye chamber and following a reduction of aqueous turnover rate the safety of MMC is unwarranted.

Animals↗
PubMed1991

Uncontrolled primary angle closure glaucoma: results of early intercapsular cataract extraction and posterior chamber lens implantation.

In this study we retrospectively evaluated the effect of intercapsular or extracapsular cataract extraction and posterior chamber lens implantation in 67 eyes of 57 patients with different types of primary angle closure glaucoma (PACG) in combination with cataract. We subdivided this patient population into three groups, based on the preoperative methods of intraocular pressure (IOP) control. The best results were obtained in patients with acute PACG (55% IOP reduction) and in patients with uncontrolled PACG (44% IOP reduction). In the other PACG groups an IOP reduction of between 20 and 33% was achieved. A long-term postoperative IOP of less than 21 mmHg was established in 63 eyes or 94%. In 91% the glaucoma medication was reduced, 65% of all eyes needed no glaucoma medication postoperatively. We conclude that an intercapsular cataract extraction with PC-IOL implantation should be considered in both controlled and uncontrolled PACG in patients with cataract, instead of filtering surgery or combined procedures. Even in eyes with relatively good visual acuity, cataract extraction might be considered as a means of achieving glaucoma control.

Acute Disease↗
PubMed1991

Intercapsular cataract extraction with implantation of the Galand disc lens: a retrospective analysis in patients with and without glaucoma.

We studied the results of intercapsular cataract extraction and implantation of the rigid Galand disc intraocular lens (IOL) in 164 cataract patients with and without glaucoma. Eighty-eight percent of the glaucomatous eyes and 98% of the eyes without glaucoma had a postoperative visual acuity of 20/40 or better after best-case analysis. Intercapsular bag placement appeared satisfactory in all but two cases, in which the IOL was slightly tilted. Cataract extraction favorably affected glaucoma control, especially in patients with angle-closure glaucoma (7.3 mm Hg intraocular pressure [IOP] reduction) and in those with primary open-angle glaucoma (2.6 mm Hg IOP reduction). The complications encountered, cystoid macular edema and hyphema, occurred in 1% and 0.5% respectively, and were not more frequent in the glaucoma subgroup. Posterior capsular opacification (30%) and inflammatory complications such as posterior synechiae (7.6%) and prepupillary fibrin (6%) were more often noted in the glaucomatous eyes. Pupillary capture or significant IOL decentration did not occur. We conclude that a circular type of IOL is the best currently available lens for use in glaucoma patients.

Aged↗
PubMed1990

Use of the Megasoft Bandage Lens for treatment of complications after trabeculectomy.

Shallow anterior chambers and leaking filtration blebs are possible complications after trabeculectomy that can be treated with therapeutic contact lenses. In most cases, however, treatment fails because these lenses are not large enough to cover the filtering bleb. We evaluated the use of a newly developed large diameter (20.5 mm) therapeutic soft contact lens. Five patients with shallow anterior chambers and ten patients with leaking filtering blebs after trabeculectomy were fitted with this new extended-wear contact lens. All patients with shallow anterior chambers developed deep chambers after a mean treatment period of five days. Of the ten patients with leaking filtering blebs, in eight (80%) the leak closed after a mean treatment period of 2.2 months. The contact lens used was comfortable and complications occurred in only one eye. This new therapeutic device is an improvement in the treatment of complications after trabeculectomy.

Adult↗
PubMed1990

Focal ischaemic normal pressure glaucoma versus high pressure glaucoma.

In a total group of 130 patients with Normal Pressure Glaucoma (NPG) twenty-six were classified as Focal Ischaemic NPG (FINPG). This subgroup has a typical defect at the disc with a comparable visual field defect in the corresponding half of the visual field. Visual field defects are more often seen in the upper than the lower half of the visual field. The defects in the upper half are on the average larger (stage 1.6) than those in the lower half (stage 0.9). Abnormalities of the chamber angle were observed in 12% of these patients, the same percentage as in the normal population. Hypertension and/or cardiovascular disorders were found significantly more frequently in FINPG patients (65.4%) than in a control group of High Pressure Glaucoma (HPG) patients (22.2%). Of the local vascular risk factors, papillary haemorrhages (46%) and choroidal sclerosis (30%) were seen significantly more frequently in FINPG than in HPG (11% and 0% respectively). The total amount of peripapillary atrophy (PPA) in FINPG and HPG is the same, but the distribution is clearly different: in FINPG there is more PPA on the side of the papillary defect. Wide veins were observed in a high percentage of cases in both groups. FINPGs were found to be more frequently progressive (38.5%) than had been thought at first. Recognition of subgroups in NPG, and of risk factors, has already made it possible to make a better prognosis in some types of NPG.

Adult↗
PubMed1989

Is there general reduction of sensitivity in glaucoma?

Ten normal controls, ten ocular hypertensive patients, ten high tension, 12 medium tension and nine low tension glaucoma patients were studied prospectively by means of automated static perimetry. Multiple double threshold measurements were obtained during at most three years. A computer algorithm estimated for each visual field the Individual General Sensitivity IGS, in which local defects do not contribute. Thus we were able to estimate pure general reduction of sensitivity by comparing the IGS to age-corrected normal reference values. No significant difference in mean general reduction of sensitivity was found between the glaucoma patients and the normal group. Patients with local defects in one field half only also showed IGS values not different from normals. Our findings indicate that the impression of 'general' sensitivity loss may be caused by the presence of multiple local defects, and is not a phenomenon in itself.

Aged↗
PubMed1989

Results of a filtering procedure in low tension glaucoma.

Twenty-six eyes of twenty patients with established low tension glaucoma, who had either a 'double flap' Scheie filtering operation or a trabeculectomy, were followed over a period ranging from one to ten years, with a median of three years. These 26 eyes include two second eyes that served as a contralateral control eye until the visual field deteriorated. All 26 eyes showed progression of visual field defects preoperatively, while postoperatively only 2 eyes showed further progression. Of the 16 nonoperated contralateral eyes, 7 showed progression of visual field defects over the same follow-up period. Two of these 7 eyes had to be operated during the study-period. The difference in progression between the operated and the non-operated eyes was significant (P less than 0.01). The filtering procedure provided a reduction in IOP of 20% or more in 21 of 26 eyes. There was a significant difference in the mean intraocular pressure (IOP) between the operated and the non-operated contralateral eye of 6.8 mmHg (37%) at one year postoperatively. The diurnal variation decreased highly significantly from 4.3 to 2.1 mmHg (P less than 0.001). It is concluded that filtering surgery in low tension glaucoma may result not only in a significant lowering of IOP, but is also effective in slowing further deterioration of the visual fields.

Adult↗
PubMed1988

Primary angle closure glaucoma: extracapsular cataract extraction or filtering procedure?

An extracapsular cataract extraction (ECCE) with posterior-chamber-IOL was performed in 21 eyes of 20 patients with primary angle closure glaucoma (PACG; 2 suspects, 5 acute PACG, 14 chronic PACG). The ECCE was performed to improve the IOP. In 14 cases the ECCE was done in lieu of a filtering procedure. After the ECCE the anterior chamber deepened. The mean IOP was reduced from 31 mmHg preoperative to 16 mmHg postoperative. Only 5 eyes needed additional medication after the ECCE. The IOP was reduced even if extensive peripheral anterior synechiae were diagnosed or after failed filtering procedures. The only temporary complication was the IOP-peak in the immediate postoperative period. It is concluded that an ECCE with PC-IOL should be seriously considered as the procedure of choice in PACG instead of a filtering procedure (or instead of a combined procedure).

Aged↗
PubMed1987

The spectrum of primary open angle glaucoma. I: Senile sclerotic glaucoma versus high tension glaucoma.

This paper describes two subgroups of primary open angle glaucoma: senile sclerotic glaucoma in the elderly with relatively low intraocular pressures, normal chamber angles, senile excavation, peripapillary atrophy and choroidal sclerosis; high tension glaucoma in the younger age-group with high intraocular pressures, signs of mesodermal dysgenesis in the chamber angle, deep and steep excavation, little peripapillary atrophy and no choroidal sclerosis. The description of senile sclerotic glaucoma is new as are the differences in the chamber angle and peripapillary atrophy. The size of the visual field defects in the upper and lower half of the visual field is similar in high tension glaucoma. In senile sclerotic glaucoma the larger defect tends to be in the upper half of the visual field. It is suggested that in senile sclerotic glaucoma the primary cause of damage is local vascular disease, and that in high tension glaucoma the intraocular pressure with a secondary role for an insufficient blood supply is the major cause of damage. Primary open angle glaucoma can be characterized by the ratio of pressure risk factors and vascular risk factors.

Aged↗
PubMed1985

Platelet aggregation and glaucoma.

In this study platelet aggregation was determined in 79 patients with primary open angle glaucoma (POAG) and 81 patients suspected of having glaucoma (ocular hypertension). There is a positive association between high age and the presence of vascular diseases (p less than 0.01). An age dependent association between spontaneous platelet aggregation (SPA) and the presence of POAG was also observed (p less than 0.05). This indicates that the incidence of SPA in the elder group of patients with POAG is higher than in the elder glaucoma suspect group and in the group of younger patients. The association between vascular diseases and SPA and between vascular diseases and the presence of POAG were not significant at the 5% level. The incidence of SPA is not influenced by sex distribution, by the presence of diabetes, smoking or the use of timolol maleate topically.

Age Factors↗
PubMed1985

Ten year prospective follow-up of a glaucoma operation. The Double Flap Scheie in primary open angle glaucoma.

The results of a longterm prospective follow-up study after the 'Double Flap' Scheie filtering operation are presented. Fifty-two eyes of 47 patients with primary open angle glaucoma (POAG) were operated; after ten years 29 eyes of 24 patients could be examined. Twenty patients (43%) had died, in three follow-up was incomplete. The two and four year results have been published earlier. In the 29 eyes the mean intraocular pressure (IOP) without medical therapy rose from 15.8 mm Hg at five years to 16.3 mm Hg at ten years (not significant). Additional medical or surgical treatment was necessary in 35% of the eyes. Diurnal variation and outflow facility remained stable. During the ten years 13 eyes showed some deterioration of visual fields. Nearly all clinically important deterioration occurred within five years after the operation. Cataract progression was noticed in 45% (13 of 29); four times a lens extraction was performed (13%). Complete success of the operation, as judged by stable visual fields and IOP levels at or under 21 mm Hg without additional medical or surgical therapy was reached in 13 of 20 eyes (45%). Based on IOP alone the success rate was 62% without and 93% with additional treatment.

Aged↗
PubMed1985

Blood and plasma viscosity measurements in patients with glaucoma.

Blood viscosity at 10 shear rates, plasma viscosity, packed cell volume, plasma fibrinogen, serum alpha 2-macroglobulin, and serum proteins were measured in 83 patients with low-tension glaucoma (LTG) and 23 patients with 'high-tension glaucoma' (HTG: at least one IOP reading above 40 mmHg) and compared with those in 50 controls. Blood and plasma viscosity values and packed cell volume were significantly higher in the LTG group than those in controls. The HTG and the LTG groups differed only in plasma viscosity, but smoking and drinking habits in the HTG patients were greatly different from those in LTG patients and controls, thus preventing interpretation of data in the HTG group. Within the LTG group viscosity values were highest in a subgroup designated earlier by us as focal ischaemic LTG, whereas another subgroup, senile sclerotic LTG, did not show significant differences compared with controls. These findings may indicate a factor in the pathogenesis of visual field defects and disc cupping in some patients with LTG.

Aged↗