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Biomedical subjects

G L Spaeth

Publications and source records attributed to G L Spaeth.

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

A proposed simple method for measurement in the anterior chamber angle: biometric gonioscopy.

OBJECTIVE: To design a system of gonioscopy that will allow greater interobserver reliability and more clearly defined screening cutoffs for angle closure than current systems while being simple to teach and technologically appropriate for use in rural Asia, where the prevalence of angle-closure glaucoma is highest. DESIGN: Clinic-based validation and interobserver reliability trial. PARTICIPANTS: Study 1: 21 patients 18 years of age and older recruited from a university-based specialty glaucoma clinic; study 2: 32 patients 18 years of age and older recruited from the same clinic. INTERVENTION: In study 1, all participants underwent conventional gonioscopy by an experienced observer (GLS) using the Spaeth system and in the same eye also underwent Scheimpflug photography, ultrasonographic measurement of anterior chamber depth and axial length, automatic refraction, and biometric gonioscopy with measurement of the distance from iris insertion to Schwalbe's line using a reticule based in the slit-lamp ocular. In study 2, all participants underwent both conventional gonioscopy and biometric gonioscopy by an experienced gonioscopist (NGC) and a medical student with no previous training in gonioscopy (JK). MAIN OUTCOME MEASURES: Study 1: The association between biometric gonioscopy and conventional gonioscopy, Scheimpflug photography, and other factors known to correlate with the configuration of the angle. Study 2: Interobserver agreement using biometric gonioscopy compared to that obtained with conventional gonioscopy. RESULTS: In study 1, there was an independent, monotonic, statistically significant relationship between biometric gonioscopy and both Spaeth angle (P = 0.001, t test) and Spaeth insertion (P = 0.008, t test) grades. Biometric gonioscopy correctly identified six of six patients with occludable angles according to Spaeth criteria. Biometric gonioscopic grade was also significantly associated with the anterior chamber angle as measured by Scheimpflug photography (P = 0.005, t test). In study 2, the intraclass correlation coefficient between graders for biometric gonioscopy (0.97) was higher than for Spaeth angle grade (0.72) or Spaeth insertion grade (0.84). CONCLUSION: Biometric gonioscopy correlates well with other measures of the anterior chamber angle, shows a higher degree of interobserver reliability than conventional gonioscopy, and can readily be learned by an inexperienced observer.

Adult↗
PubMed1999

Filtration procedures supplemented with mitomycin C in the management of childhood glaucoma.

AIMS: To evaluate the outcome of filtering procedures supplemented with mitomycin C in children with glaucoma. METHODS: All patients aged 17 or younger with glaucoma who underwent filtering surgery supplemented with mitomycin C at a tertiary care centre (n = 21) during a 5 year interval (1992 and 1996) were included. One eye for each patient was entered into the analysis. The postoperative intraocular pressure (IOP), use of antiglaucoma medications, clinical stability of glaucoma, complications, and visual acuity were retrospectively evaluated. Kaplan-Meier survival curves were used to estimate the probability of success. RESULTS: At the time of surgery mean age was 5.7 (SD 5.0) years. The most common diagnoses were trabeculodysgenesis (n = 6) and aphakic glaucoma (n = 8). Mean IOP before surgery was 35.7 (10.5) mm Hg. Average length of follow up was 18.6 (14.7) months. The probability of having IOP less than 21 mm Hg with no antiglaucoma medications and with clinically stable glaucoma 1 year after surgery was 76.9% in phakic eyes (n = 13) and 0% in aphakic eyes (n = 8). A phakic patient with Sturge-Weber's syndrome had choroidal effusion after surgery that resolved spontaneously. In the aphakic group one patient had retinal detachment and another developed an encapsulated bleb. Visual acuity deteriorated in one patient. CONCLUSION: A guarded filtration procedure with mitomycin C is relatively successful in phakic children with glaucoma, but unsuccessful in aphakic ones.

Adolescent↗
PubMed1999

Comparison between laser scanning tomography and computerised image analysis of the optic disc.

AIMS: To study the interchangeability of the measurements of the optic disc topography obtained by one computerised image analyser and one confocal laser tomographic scanner. METHODS: One eye of 28 patients with glaucoma or glaucoma suspects was studied. All cases had simultaneous stereoscopic disc photographs taken with the fundus camera Topcon TRC-SS and optic disc examination with the Heidelberg retina tomograph (HRT) during the same visit. The optic disc photographs were digitised and analysed with the Topcon ImageNet (TI) system. Three variables of the optic disc topography provided by the TI and the HRT were compared--cup volume (CV), rim area (RA), and cup area to disc area ratio (CA/DA). RESULTS: The mean values of CV and RA provided by the TI (0.52 (SD 0.32) mm3 and 1.58 (0.39) mm2, respectively) were greater (p < 0.01) than the mean values of CV and RA determined by the HRT (0.32 (0.25) mm3, and 1.33 (0.47) mm2, respectively). The mean value of CA/DA provided by the TI (0.42 (0.14)) and the HRT (0.42 (0.18)) was similar (p = 0.93). Correlation coefficients between measurements obtained by the two methods ranged from 0.53 to 0.73. CONCLUSION: There was a significant discrepancy in the measurements of rim area and cup volume of the optic disc obtained by a computerised image analyser and a laser scanning tomograph.

Adult↗
PubMed1999

Oral prednisone in guarded filtration procedures supplemented with antimetabolites.

BACKGROUND AND OBJECTIVE: To evaluate whether a three-day course of oral prednisone perioperatively improves the surgical outcome of guarded filtering procedures supplemented with antifibrosis agents. DESIGN, MATERIALS AND METHODS: A prospective, randomized, double-masked, placebo-controlled, clinical trial was designed. Adult patients with non-inflammatory glaucoma undergoing a guarded filtration procedure supplemented with antimetabolite were enrolled. Patients received a three-day course of prednisone (50 mg BID) or placebo perioperatively. The main outcome measures were intraocular pressure (IOP) and number of antiglaucoma medications. Surgical success was defined before data collection according to two different criteria: "success-I": IOP level < or = 15 mmHg with no more than one anti-glaucoma medication, and "success-II": IOP reduction of at least 20% of baseline level with no more than one antiglaucoma medication. RESULTS: Thirty-five subjects were enrolled. Seventeen patients were treated with prednisone and eighteen with placebo. Mean follow-up was 9.2 months +/-6.2 months. The probability of success-I at 9 months was 63.0% in the study group and 65.6% in the control groups (p>0.05). The probability of success-II at 9 months was 60.2% in the study group and 55.0% in the control groups, (p>0.05). The difference in frequency of postoperative complications between groups was not statistically significant. The most common complication was choroidal detachment (n=2) in the prednisone-treated group and bleb leak (n=2) in the control group. CONCLUSION: The perioperative use of oral prednisone did not alter the surgical outcome of filtering procedures associated with antifibrosis agents in this population of glaucoma patients.

Administration, Oral↗
PubMed1999

First, do no harm?

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Breast Neoplasms↗
PubMed1999

Never say never.

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Humans↗
PubMed1999

Surgical management of the symptomatic overhanging filtering bleb.

PURPOSE: Large filtering blebs that evolve after trabeculectomies can be bothersome to the patient, especially when overhanging the cornea. Partial bleb excision is warranted to relieve the patient from discomfort or even visual impairment. METHODS: Surgical partial excision of the overhanging corneal part of the bleb was performed in four patients who had undergone earlier trabeculectomy without application of antimetabolites. Duration of follow-up after excision ranged from 9 months to 4 years. RESULTS: Successful reduction of the excessive bleb and continued satisfactory control of intraocular pressure (IOP) were achieved in all four cases. Partial excision of the corneal part of the bleb did not lead to bleb leakage in any of the cases. CONCLUSION: Surgical blunt dissection of the overhanging the morphologic features of the bleb and ensuring continued control of IOP and relief of symptoms. Alternative methods, such as autologous blood injection, cryoapplication, application of trichloracetic acid, or application of Nd:YAG laser, are noninvasive but do not allow precise rearrangement of bleb architecture.

Conjunctiva↗
PubMed1999

Autologous patch graft in tube shunt surgery.

PURPOSE: To evaluate an alternate method of covering the subconjunctival portion of the tube in aqueous shunt surgery. Evidence of tube erosion, graft-related infection, graft melting, or other associated intraocular complications were evaluated. METHODS: A retrospective study of 16 patients (17 eyes) who underwent tube shunt surgery at Wills Eye Hospital between July 1991 and October 1996 was conducted. An autologous either "free" or "rotating" scleral lamellar graft was created to cover the subconjunctival portion of the tube shunt. RESULTS: All patients were evaluated for at least 6 months, with a mean follow-up of 14.8 months (range 6-62 months). All eyes tolerated the autologous graft well, with no clinical evidence of tube erosion, or graft-related or intraocular complications. CONCLUSION: Autologous patch graft in tube shunt surgery appears--in selected cases--to be an effective, safe and inexpensive surgical alternative to allogenic graft materials. It also offers ease of availability, and eliminates the risk of transmitting infectious disease.

Adult↗
PubMed1999

Seven steps to assure the best possible treatment of persons with glaucoma or suspected of having glaucoma.

Glaucoma causes more blindness and disability than any other eye disease except for cataract. Cataract surgery is highly successful, even intracapsular cataract surgery. The major problem, then, with regard to relieving or preventing disability related to cataract is one of access to care. Though access to care is a major problem with glaucoma, it is by no means the only problem. Many patients with glaucoma get worse, even when they are being treated. Additionally, it is not only glaucoma itself that causes disability. In the recent past, far more damage was caused by treatment for glaucoma than by glaucoma itself. To repeat, summarized slightly differently, glaucoma and its treatment damage health more than any other eye disease except cataract, and the medical profession is responsible for a major part of that problem. How can it be that glaucoma and its treatment still cause so much disability? In the first place, care is unavailable in many areas, and, second, care is not utilized even where available, and third, care is often inappropriate even where available. The first two issues are of great importance but are not the subject of this discussion. It is my belief that the major explanation for why care is often poor is because the goals of care are often wrong. Specifically, the goals of care are to lower intraocular pressure, or to prevent visual field loss. These may be appropriate intermediary steps on the way to achieving the appropriate goal, but they are not the goal itself.

Disease Progression↗
PubMed1997

Metipranolol-associated nongranulomatous anterior uveitis.

PURPOSE: To describe the findings in a patient with a nongranulomatous anterior uveitis, presumed to be induced by metipranolol. METHOD: A 69-year-old woman developed bilateral, nongranulomatous, anterior uveitis while undergoing treatment with metipranolol 0.3% for primary open-angle glaucoma. Four months after resolution of the initial episode, the patient was challenged with metipranolol 0.3% in the right eye. RESULT: On reinstituting metipranolol 0.3%, the patient once again developed a unilateral, nongranulomatous, anterior uveitis in the challenged eye. CONCLUSION: Metipranolol 0.3% eyedrops, used to treat primary open-angle glaucoma, appear to cause a nongranulomatous anterior uveitis.

Adrenergic beta-Antagonists↗
PubMed1997

Evaluation of Nd:YAG laser membranectomy in blocked tubes after glaucoma tube-shunt surgery.

PURPOSE: To determine the effectiveness of Nd:YAG laser membranectomy for reopening blocked glaucoma tube shunts and maintaining the patency over time. METHODS: We reviewed retrospectively the records of 13 patients (13 eyes) who, during the period January 1990 through June 1996, underwent Nd:YAG laser membranectomy in an attempt to reopen a blocked glaucoma tube shunt. Intraocular pressure and tube patency were evaluated at each follow-up visit. RESULTS: Nd:YAG laser membranectomy effectively opened the blocked glaucoma tube shunts in 11 (84.6%) of 13 eyes. Two tubes could not be reopened. Reblockage occurred in seven eyes (53.8%) within the first 11 weeks; four tubes (30.8%) remained patent through follow-up periods of 39, 82, 106, and 169 weeks. Postlaser complications were moderate anterior chamber reaction in four eyes (30.8%), hyphema in two eyes (15.4%), corneal edema in two eyes (15.4%), pressure spike in one eye (7.7%), and shallow anterior chamber in one eye (7.7%). CONCLUSIONS: Nd:YAG laser membranectomy is effective in reopening blocked glaucoma tube shunts but is associated with a relatively high rate of subsequent reblockage in the initially successful cases.

Aged↗
PubMed1997

Quantitative differences between the optic nerve head and peripapillary retina in low-tension and high-tension primary open-angle glaucoma.

PURPOSE: To determine whether quantitative differences in optic nerve topography could be identified between patients having primary open-angle glaucoma with normal intraocular pressure (low-tension primary open-angle glaucoma [LT-POAG]) vs those with elevated intraocular pressure (high-tension primary open-angle glaucoma [HT-POAG]). METHODS: We attempted to match 31 eyes of 31 patients in the LT-POAG group on a case-by-case basis with comparable eyes of 31 patients with HT-POAG. We used the Heidelberg Retina Tomograph to evaluate the optic nerve head and retinal nerve fiber layer. RESULTS: Cup areas and cup:disk area ratios were significantly larger (P < .05), whereas rim areas, rim volumes, retinal nerve fiber layer heights, and retinal nerve fiber layer cross-sectional areas were consistently smaller, but not significantly so (P > .05), in the LT-POAG group. The inferior neuroretinal rim area was significantly smaller (P < .05) and the mean deviation of superior arcuate area was significantly greater than the opposite sector in patients with LT-POAG but not in those with HT-POAG. A relationship between localized measurements of the optic nerve head and mean deviation was more apparent in the LT-POAG group than in the HT-POAG group. CONCLUSIONS: The optic cups were larger in patients with LT-POAG than in those with HT-POAG. Measurements of sectors of the optic disk correlated better with visual field changes in LT-POAG than did global measurements of the whole nerve head, indicating more vulnerability of the optic nerve to focal damage with low intraocular pressure.

Case-Control Studies↗