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Biomedical subjects

G L Spaeth

Publications and source records attributed to G L Spaeth.

At least 55 records · Page 3Linked to original sources
PubMed1997

Tube-shunt surgery versus neodymium:YAG cyclophotocoagulation in the management of neovascular glaucoma.

OBJECTIVE: To determine the relative effectiveness of neodymium:YAG (Nd:YAG) cyclophotocoagulation (CPC) and tube-shunt surgery on intraocular pressure (IOP) control in eyes with neovascular glaucoma (NVG). DESIGN: Retrospective, case-by-case matched, comparative group study. PARTICIPANTS: Twenty-four patients with NVG treated with noncontact Nd:YAG-CPC were matched with 24 patients who underwent tube-shunt surgery. Matching criteria included the underlying disorder causing angle neovascularization, the lens status, and patient's age. INTERVENTIONS: Tube-shunt surgery or Nd:YAG-CPC. MAIN OUTCOME MEASURE: Postoperative IOP (IOP > or = 6 and < or = 25 mmHg), visual acuity, and presence of any postoperative complications. RESULTS: Satisfactory IOP control (IOP < or = 25 mmHg and > or = 6 mmHg) was achieved in 9 eyes (37.5%) treated with Nd:YAG-CPC compared with 16 eyes (66.7%) receiving a tube-shunt procedure (P = 0.04) over a mean follow-up of 16.9 +/- 14.6 and 15.2 +/- 11.8 months, respectively. In the matched pairs in both groups that had nonequivalent outcomes, the proportions with persistently high IOP or hypotony were both greater in the CPC group than in the tube-shunt group. The cumulative proportion of failure in the CPC group was 20.8% at 6 months, 35.4% at 1 year, and 71.2% at 3 years postoperatively. In the tube-shunt group, the cumulative proportions of failure at 6 months and 1 year were close to those in the CPC group (12.5% and 29.2%, respectively), but lower 3 years after surgery (43.3%). Eleven eyes (45.8%) in the CPC group lost light perception versus four eyes (16.7%) in the tube-shunt group. Complication rate was higher in the tube-shunt group. CONCLUSIONS: This study suggests that, in the management of NVG, tube-shunt surgery more frequently controls IOP in a satisfactory range, with less hypotony and less visual loss, than noncontact Nd:YAG-CPC.

Adult↗
PubMed1997

Ultrasound biomicroscopy in infantile glaucoma.

BACKGROUND: Glaucoma in infants has many causes: Evaluation of the anatomy of the anterior segment of eyes with infantile glaucoma may help to determine the pathogenesis of an infant's disease and influence therapeutic decisions. METHODS: Eleven eyes of six infants with glaucoma were evaluated with ultrasound biomicroscopy (UBM) to evaluate the anatomic characteristics and relationships of the anterior segment structures. RESULTS: The anterior chamber angle, iris, lens, ciliary body, and posterior chamber angle could be imaged in detail. Elongated and anteriorly placed ciliary processes were noted in all eight eyes with trabeculodysgenesis. There were no apparent anomalies in the trabecular meshwork, or anterior chamber. In three eyes with dense corneal opacities, ultrasound biomicroscopy showed severe anterior segment disorganization and thin central corneas with posterior corneal excavation. CONCLUSIONS: Ultrasound biomicroscopy is a useful non-invasive method for evaluating infants with glaucoma in cases with corneal opacities. This information can help in surgical planning for glaucoma management.

Anterior Eye Segment↗
PubMed1997

Long-term effects of tube-shunt procedures on management of refractory childhood glaucoma.

PURPOSE: The authors evaluated the long-term results of tube-shunt surgery in management of childhood glaucoma. METHODS: The results of tube-shunt surgery in children who had glaucoma refractory to medical or alternative surgical treatment in the Glaucoma Service of Wills Eye Hospital during the period 1986 through 1993 were reviewed. Eighteen eyes of 15 patients were included in the analysis. Follow-up ranged from 14 to 80 months (mean +/- standard deviation, 47.3 +/- 25.1 months). RESULTS: In the early postoperative course (6 months after surgery), the intraocular pressure (IOP) was between 6 and 21 mmHg in 13 eyes (72.2%) with or without glaucoma medication. Two or more years later, IOP was between 6 and 21 mmHg in four eyes without further glaucoma medication (22.2%) and four eyes (22.2%) with the addition of antihypertensive therapy. Five eyes (27.8%) lost light perception, whereas seven (38.9%) remained within one line of preoperative vision or improved. Twelve eyes underwent 28 additional surgical procedures after the tube-shunt operation, mostly to control IOP or manage tube-related complications. CONCLUSION: The limited success rate, relatively high complication rate, and need for frequent surgical intervention suggest caution regarding the prognosis of tube-shunt surgery in children with glaucoma.

Adolescent↗
PubMed1997

Methods to objectify reversibility of glaucomatous cupping.

Lowering intraocular pressure in adults with glaucoma may be associated with an improvement in appearance of the optic nerve head. The stage of disease, the amount of intraocular pressure reduction, and the age of the patient probably influence the occurrence of this event. The clinical relevance of "reversal" has not been established with certainty. The reversibility of glaucomatous cupping can be detected by subjective and qualitative means (examination of the patient or of fundus photographs) or by quantitative techniques such as photogrammetry, computerized image analysis, and scanning laser tomography. Clinical and experimental studies are providing new information about the behavior of the optic nerve head tissues in response to changes in intraocular pressure.

Adult↗
PubMed1997

Intraobserver and interobserver agreement in evaluating the anterior chamber angle configuration by ultrasound biomicroscopy.

PURPOSE: To determine the intra- and interobserver agreement in assessing the configuration of the human anterior chamber angle using ultrasound biomicroscopy (UBM). METHODS: Two masked clinicians used ubm images to estimate, in 41 eyes, (a) the position of contact between the peripheral iris and the inside of the eye wall, (b) the angular size of the anterior chamber angle (ACA), and (c) the curvature of the peripheral iris. Both observers, masked to the previous results, examined the same images in a second session. Agreement was evaluated using the unweighted kappa statistic. RESULTS: Intraobserver agreement in assessing the iris insertion, angular width, and the iris curvature was high (range of kappa values, 0.83-0.92). Interobserver agreement in evaluating the level of iris insertion (kappa = 0.79), the angular width (kappa = 0.95), and the iris curvature (kappa = 0.84) was also high. CONCLUSION: The agreement within the same observer and between observers in evaluating the ACA configuration by UBM was excellent.

Anterior Chamber↗
PubMed1997

Quantitative estimation of retinal nerve fiber layer height in glaucoma and the relationship with optic nerve head topography and visual field.

PURPOSE: The authors estimated the retinal nerve fiber layer height (RNFLH) measurements in patients with glaucoma compared with those in age-matched healthy subjects as obtained by the laser scanning tomography and assessed the relationship between RNFLH measurements and optic and visual field status. METHODS: Parameters of optic nerve head topography and RNFLH were evaluated in 125 eyes of 21 healthy subjects and 104 patients with glaucoma using the Heidelberg Retina Tomograph ([HRT] Heidelberg Engineering GmbH, Heidelberg, Germany) for the entire disc area and for the superior 70 degrees (50 degrees temporal and 20 degrees nasal to the vertical midline) and inferior 70 degrees sectors of the optic disc. The mean deviation of the visual field, as determined by the Humphrey program 24-2 (Humphrey Instruments, Inc., San Leonardo, CA, U.S.A) was calculated in the entire field and in the superior and inferior Bjerrum area. RESULT: Retinal nerve fiber layer height parameters (mean RNFLH and RNFL cross-sectional area) were decreased significantly in patients with glaucoma compared with healthy individuals. Retinal nerve fiber layer height parameters was correlated strongly with rim volume, rim area, and cup/disc area ratio. Of the various topography measures, retinal nerve fiber layer (RNFL) parameters and cup/disc area ratio showed the strongest correlation with visual field mean deviation in patients with glaucoma. CONCLUSION: Retinal nerve fiber layer height measures were reduced substantially in patients with glaucoma compared with age-matched healthy subjects. Retinal nerve fiber layer height was correlated strongly with topographic optic disc parameters and visual field changes in patients with glaucoma.

Female↗
PubMed1997

Early successful treatment of postoperative necrotizing pseudomonas scleritis after trabeculectomy.

PURPOSE: The authors describe a patient who developed pseudomonas scleritis after a routine trabeculectomy. METHOD: The patient underwent trabeculectomy for poorly controlled intraocular pressure and progressive visual field loss. On the second postoperative date he developed severe pain, significant anterior chamber reaction, and hypotony. Scleral cultures taken at the time of surgical choroidal drainage grew pseudomonas aeruginosa. RESULT: Surgical reconstruction of the necrotic scleral area and intensive antibiotic treatment lead to a successful outcome. CONCLUSION: Early recognition and aggressive treatment with antibiotics initially, followed by surgical debridement of necrotic tissue, resulted in an unexpected successful outcome in a patient with pseudomonas scleritis.

Anti-Bacterial Agents↗
PubMed1996

Plateau iris syndrome associated with multiple ciliary body cysts. Report of three cases.

OBJECTIVE: To describe plateau iris syndrome associated with multiple neuroepithelial cysts of the pars plicata. METHODS: Case reports of 3 patients with plateau iris syndrome who were found to have multiple bilateral ciliary body cysts on ultrasound biomicroscopic examination. RESULTS: Ultrasound biomicroscopy revealed classic features of plateau iris syndrome in each patient but also showed multiple neuroepithelial cysts of the ciliary body in each eye. CONCLUSION: Plateau iris syndrome may be associated with multiple ciliary body cysts.

Aged↗
PubMed1996

Unilateral open-angle glaucoma secondary to idiopathic dilated episcleral veins.

PURPOSE: To determine the cause of unilateral dilated tortuous episcleral vessels in a 34-year-old patient. METHODS: The patient underwent slit-lamp examination, visual field testing, tonographic measurement, orbital ultrasound examination, orbital color Doppler blood flow measurement, dye-enhanced computed topographic scan, and selective carotid angiography. RESULTS: Disk cupping and early scotoma were present. Gonioscopy showed Schlemm's canal engorged with blood. The only pathologic findings were an increased tonographic resistance to outflow and increased arterial and venous episcleral flow on color-coded Doppler sonography. CONCLUSION: The origin of this episcleral vessel abnormality is still unknown.

Adult↗
PubMed1996

Relative optic cup depth assessments using three stereo photograph viewing methods.

PURPOSE: A consistent stereoscopic (stereo) effect in disc photographs is important to be certain that apparent depth changes are real and are not the result of artifact caused by a variable stereo angle. The purpose of this study is to compare the accuracy of relative depth assessments using three different stereo photo viewing methods. METHODS: We evaluated the ability of 12 observers to arrange sets of simultaneous stereo photographs (Nidek 3-Dx split-frame slides, Lentec transparencies) and sequential stereo photographs (Zeiss full-frame slides) according to apparent cup depth. Observer arrangements of each set of 10 photographs were compared to a "reference standard" sequence determined from cup depth measurements made by the Imagenet optic nerve analyzer. RESULTS: The median number of sequence errors (n = 6) made by all examiners in arranging the Nidek 3-Dx simultaneous stereo slides was significantly lower than the median number of errors (n = 12) with the Zeiss sequential stereo slides. CONCLUSIONS: Simultaneous stereo slides provide significantly more interobserver consistency for judgements of cup depth than sequential stereo slides.

Analysis of Variance↗
PubMed1996

Effects of apraclonidine on short-term outcome of glaucoma surgery.

We evaluated the influence of apraclonidine on the outcome of filtering surgery. Patients treated with apraclonidine who underwent a guarded filtration procedure were retrospectively evaluated and compared to a control group. Complications were more frequent in patients treated with apraclonidine than in the control group, but the difference was not statistically significant. We encourage further studies regarding the effects of apraclonidine in filtering procedures.

Adrenergic alpha-Agonists↗
PubMed1996

Lack of effect of calcium channel blockers on open-angle glaucoma.

PURPOSE: The objective of this study is to evaluate the effect of calcium channel blockers (CCB) on the clinical course of glaucoma. METHODS: Open-angle glaucoma patients receiving oral CCB for nonophthalmic diseases were sequentially selected from the private practice of the Glaucoma Service of Wills Eye Hospital. The course of visual fields and optic discs and serial intraocular pressures were analyzed in subsequent follow-ups. The findings in these 83 cases were compared with a control group of patients with the same ocular diagnosis, but who were not on CCB. A subset of 43 cases of the study group was compared with an age-matched subset of the control group. RESULTS: There was no apparent difference in the absolute intraocular pressure, stability/change of visual fields or optic discs when we compared patients using CCB with the control group. Among patients with the diagnosis of "low-tension glaucoma," we also could not demonstrate any statistically significant difference between the two groups. CONCLUSIONS: In this study, neither a beneficial nor a detrimental effect of CCB on the course of the patients glaucomatous disease was apparent.

Aged↗