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Biomedical subjects

G L Spaeth

Publications and source records attributed to G L Spaeth.

At least 73 records · Page 4Linked to original sources
PubMed1995

Management of overfiltering and leaking blebs with autologous blood injection.

We describe our experience with intrableb autologous blood injection to manage over-filtering and leaking blebs. Autologous blood was injected into 12 thin cystic filtration blebs of 12 eyes. Indications for blood injection included symptomatic hypotony in five eyes, hypotony associated with bleb leakage in five eyes, and bleb leakage without hypotony in two eyes. Seven eyes (58.3%) were classified as successes and five eyes (41.7%) were classified as failures. The mean (+/- SD) follow-up was 6.8 +/- 2.6 months. Among the eyes classified as successes, a significant increase was noted in intraocular pressure and visual acuity by a mean (+/- SD) of 5.1 +/- 2.9 mm Hg and 5.3 +/- 2.1 lines, respectively. Bleb leakage resolved in four of seven eyes. The most common complication was hyphema formation. Injection of autologous blood into a filtration bleb is an alternative procedure for management of excessive filtration or bleb leakage in selected patients.

Adult↗
PubMed1995

Retrobulbar arterial hemodynamic effects of betaxolol and timolol in normal-tension glaucoma.

PURPOSE: beta-Adrenergic blocking drugs lower intraocular pressure. The question of whether these drugs also alter, either directly or indirectly, orbital hemodynamics is potentially of great importance for patients with normal-tension glaucoma who may have some degree of reversible vasospasm. METHODS: We compared the effect of selective (betaxolol) and nonselective (timolol) beta-adrenergic blocking drugs on flow velocities (as determined by color Doppler imaging) in orbital vessels in 13 patients with normal-tension glaucoma (mean age, 62 +/- 3 years; mean intraocular pressure, 15 +/- 2 mm Hg). A one-month drug treatment double-masked crossover design, with a three-week washout before each drug, was used. RESULTS: Neither drug changed peak systolic velocity in any of the four vessels studied (ophthalmic, nasal and temporal posterior ciliary, and central retinal arteries). Additionally, timolol did not alter end-diastolic velocity or resistance index (defined as [peak systolic velocity minus end-diastolic velocity] divided by peak systolic velocity) in any of the vessels measured. In contrast, betaxolol tended to increase end-diastolic velocity and to decrease resistance index: the four-vessel average end-diastolic velocity increased 30% (P = .08), and the four-vessel average resistance index decreased significantly (P = .04). These reductions in resistance index occurred despite that betaxolol, in contrast to timolol, did not significantly decrease intraocular pressure. CONCLUSIONS: These results suggest that, in patients with normal-tension glaucoma, selective beta-adrenergic blockade (betaxolol) may have ocular vasorelaxant effects independent of any influence on intraocular pressure, whereas nonselective blockade (timolol) lowers intraocular pressure without apparently altering orbital hemodynamics.

Arteries↗
PubMed1995

A ten-year follow-up on a prospective, randomized trial of postoperative corticosteroids after trabeculectomy.

PURPOSE: Patients prospectively enrolled in a clinical trial to evaluate the effect of corticosteroid use after guarded filtration procedure (trabeculectomy) were re-evaluated after 10 years to determine whether (1) there were differences in intraocular pressure (IOP) level and stability of glaucoma between treated and nontreated eyes, (2) surgery had altered the clinical course of the patients, and (3) there was any relation between level of IOP and glaucoma control. METHODS: Forty-six eyes of 35 patients were evaluated individually. Stabilization/ progression of glaucoma was established based on IOP, clinical evaluation of visual fields, and stereoscopic analysis of disc using ophthalmoscopy and photography. RESULTS: The nonsteroid-treated eyes underwent more additional glaucoma surgeries, were treated with more glaucoma medicines, and had higher IOPs. Glaucoma was stabilized in 82.8% of the steroid-treated eyes and 67% of the nonsteroid-treated eyes. There was a direct correlation between level of IOP and stabilization of optic nerve and visual field in both groups. CONCLUSION: The use of corticosteroids after guarded filtration procedure was correlated with better glaucoma control. Patients with lower IOPs were more likely to be stabilized than those with higher pressures.

Administration, Topical↗
PubMed1995

Long term effect of apraclonidine.

AIMS: To evaluate the effect of the chronic use of apraclonidine 0.5% on the intraocular pressure (IOP) of patients with glaucoma; also, to study the side effect profile of this drug when used chronically. METHODS: All patients who had uncontrolled IOP, who were either already on glaucoma medications, or who were intolerant of other glaucoma medications were enrolled. A total of 185 patients were started on apraclonidine 0.5% two to three times a day in one eye. RESULTS: Follow up extended to 35 weeks. The mean difference in IOP between treated and control eyes was 2.1 (SD 5.0) mm Hg. A similar IOP lowering effect was obtained comparing IOP difference from baseline in the treated eye only. CONCLUSION: By the end of the follow up period, 46% of patients were still on the medication. The drug was stopped in 23% of patients because of side effects and in 31% of patients because of failure to lower IOP significantly.

Adolescent↗
PubMed1995

Comparison of the configuration of the human anterior chamber angle, as determined by the Spaeth gonioscopic grading system and ultrasound biomicroscopy.

PURPOSE: The primary purpose of this investigation was to validate anatomically, if possible, the Spaeth gonioscopic grading system. METHODS: The gonioscopic appearance of the anterior chamber angle of 22 patients was described, using a Zeiss 4-mirror gonioscopic lens; the angle was graded according to the Spaeth gonioscopic grading system (SGGS) previously described elsewhere. This system provides a more comprehensive characterization of the angle than other methods, including the site of iris insertion, the angular approach to the recess and the curvature of the peripheral iris. The same patients were then evaluated with biomicroscopic ultrasound examination of the anterior segment; the nature of the anterior chamber angle was described independently by two observers. The two methods of characterizing the anterior chamber angle were then compared. RESULTS: There was a high correlation between the two different methods of characterizing the anterior chamber angle. Ultrasound biomicroscopy had limitations relating to inability to distinguish between iris-cornea apposition and iris-cornea adhesion, and to exact location of the posterior trabecular meshwork. The angularity of the approach to the anterior chamber angle using the SGGS tended to be underestimated by about 5 degrees. Other aspects showed high correlation. CONCLUSION: The SGGS appears to be an accurate method of characterizing the anatomic appearance of the anterior chamber angle in patients. It also provides a more comprehensive description of the angle that other grading systems.

Anterior Chamber↗
PubMed1994

Color Doppler analysis of ocular vessel blood velocity in normal-tension glaucoma.

The pathogenesis of normal-tension glaucoma remains unknown. Because ocular vasospasm has been proposed as a possible mechanism, we investigated ocular vessel flow velocity in normal-tension glaucoma patients at rest and under treatment with a cerebral vasodilator. Ten normal-tension glaucoma patients and nine age- and gender-matched controls had flow velocity measured in three vessels (ophthalmic artery, central retinal artery, and temporal short posterior ciliary artery) by using color Doppler imaging, under baseline conditions and during carbon dioxide supplementation sufficient to increase end-tidal PCO2 by 15%. Peak systolic and end-diastolic velocities were measured, and the resistance index (peak systolic velocity minus end-diastolic velocity, divided by peak systolic velocity) was calculated. Compared with controls, these normal-tension glaucoma patients had significantly lower end-diastolic velocities (P = .002) and higher resistance indices (P = .007) in the ophthalmic artery at baseline. When PCO2 was increased, control subjects remained unchanged, whereas it increased end-diastolic velocity in patients (P = .003) and abolished the difference in resistance index between the two groups. Patients and control subjects differed little in their baseline or carbon dioxide response velocities or in resistance in the other two vessels. These results indicate that at baseline these normal-tension glaucoma patients may have increased vascular resistance distal to the ophthalmic artery, although this increased resistance cannot be specifically ascribed to the central retinal arterial or to temporal short posterior ciliary arterial vascular beds. The responsiveness of these patients to a cerebral vasodilator (increased PCO2) indicates further that the increased resistance distal to the ophthalmic artery may be the reversible result of vasospasm.

Adult↗
PubMed1994

Race-, age-, gender-, and refractive error-related differences in the normal optic disc.

OBJECTIVE: To determine race-, age-, gender-, and refractive error-related differences in the size and topography of the optic disc in healthy Americans. DESIGN: Population-based study. SETTING: Eastern and southeastern health districts of Baltimore, Md. PARTICIPANTS: A population-based sample of 4877 non-institutionalized black and white individuals aged 40 years or older without evidence of optic nerve disease. MAIN OUTCOME MEASURE: Race-, age-, gender-, and refractive error-related differences in optic disc measurements: disc area, neural rim area, cup area, cup-to-disc ratio, and neural rim area-to-disc area ratio. RESULTS: We analyzed simultaneous stereoscopic optic disc photographs from 3387 (1534 black and 1853 white) of the 4877 healthy individuals using an image analyzer (Topcon Image Analyzer, Topcon Instrument Corporation, Paramus, NJ). A total of 1490 individuals were excluded owing to the absence of good-quality images from either eye. The image analyzer defined the cup margin 150 microns below the surface of the disc margin. On average, blacks had significantly larger disc areas (blacks, 2.94 mm2; whites, 2.63 mm2), larger cup areas (blacks, 1.04 mm2; whites, 0.71 mm2), larger cup-to-disc ratios (blacks, 0.56; whites, 0.49), similar neural rim areas (blacks, 1.90 mm2; whites, 1.92 mm2), and smaller neural rim area-to-disc area ratios (blacks, 0.66; whites, 0.74) compared with whites. There were no age-related differences in any of the disc measurements. Male subjects had 2% to 3% larger optic discs compared with female subjects. No association between refractive error and any of the optic disc measurements studied was detected. CONCLUSIONS: Racial differences in the normal optic disc are present among urban Americans, and these differences must be considered in evaluation of the optic disc for glaucoma and other optic neuropathies. Among the individuals in our study, all of whom were 40 years of age or older, no progressive age-related decline in neural rim area was detectable. Neither gender nor refractive error were associated with any significant differences in the size and topography of the normal optic disc.

Adult↗
PubMed1994

A new classification of glaucoma including focal glaucoma.

This report suggests a new method of classifying glaucoma based upon the appearance of the optic nerve. One subdivision of this classification, focal glaucoma, is discussed in some detail. As is true for all classifications, the system proposed will not be a permanent one. Nor is it intended to be all inclusive. Its purpose is not to replace the system which at present is based on the mechanism for intraocular pressure elevation, i.e., angle-closure glaucoma, open-angle glaucoma, etc., but rather to provide a means by which various subtypes of glaucoma can be better differentiated.

Fundus Oculi↗
PubMed1994

Trabeculectomy is associated with retrobulbar hemodynamic changes. A color Doppler analysis.

PURPOSE: To determine whether color Doppler hemodynamic changes occur in the retrobulbar circulation after trabeculectomy. METHODS: The authors prospectively enrolled 20 patients undergoing trabeculectomy and performed color Doppler imaging of both eyes before surgery and then at approximately 2-, 5-, and 14-week intervals after surgery. The systolic maximum velocity, mean velocity, end-diastolic velocity, and vascular resistance (resistance index) of the central retinal artery, nasal and temporal short posterior ciliary arteries, and ophthalmic arteries were determined. Statistical comparison of the preoperative and postoperative measures were performed on both the operative and nonoperative eye using the paired Student's t test. RESULTS: A statistically significant increase was observed in the mean and end-diastolic velocity and a significant decrease in the vascular resistance of the central retinal artery and both short posterior ciliary arteries at nearly all postoperative intervals (25 of 27 preoperative and postoperative comparisons; P < 0.05) The ophthalmic artery, while showing an increased velocity at all intervals, only attained a statistically significant increase in one of three postoperative intervals for mean velocity and two of three intervals for end-diastolic velocity (P < 0.05). There were no notable changes in resistance. The nonoperative eye did not show a statistically significant change in velocity or in resistance in the central retinal artery or either nasal or temporal short posterior ciliary artery at any interval (0 of 27 preoperative and postoperative comparisons for mean velocity, end-diastolic velocity, and resistance index.) CONCLUSION: Sustained increases in mean velocity and end-diastolic velocity and decreases in resistance index were observed in the central retinal artery and the short posterior arteries with clinically attainable reductions in intraocular pressure after trabeculectomy in patients with chronic glaucoma. These findings are consistent with, but not diagnostic of, increased blood flow through these vessels.

Adult↗
PubMed1994

Agreement among optometrists, ophthalmologists, and residents in evaluating the optic disc for glaucoma.

PURPOSE: To determine the agreement among optometrists, ophthalmologists, and ophthalmology residents in assessing glaucomatous optic nerve damage. The authors also determined the sensitivity of each group of observers for identifying glaucomatous optic nerve damage. METHODS: Six optometrists, six general ophthalmologists, and six third-year ophthalmology residents evaluated 75 stereoscopic optic disc photographs. Observers estimated the vertical cup:disc ratio (C:D) and assessed the presence of glaucomatous damage. Agreement among and within observers was estimated by the kappa statistic (KW, k). The sensitivity and specificity for the identification of glaucomatous optic nerve damage were determined for each group of participants. RESULTS: Intraobserver agreement (KW 0.69-0.79) was greater than interobserver agreement (KW 0.56-0.68) in assessing the C:D ratio and glaucomatous optic nerve damage for optometrists, ophthalmologists, and residents. Interobserver agreement for ophthalmologists (KW 0.68) was substantial and significantly higher than for optometrists (KW 0.56) and residents (KW 0.56) when estimating the C:D ratio. Ophthalmologists and residents had higher sensitivity (78%) in identifying glaucomatous optic nerve damage than did optometrists (56%). The specificity for all three groups was relatively poor (range, 47%-60%). CONCLUSION: The moderate interobserver agreement across all three groups of observers suggests the need to develop standardized criteria for assessing glaucomatous optic disc damage. Ophthalmologists in this study have a higher interobserver agreement in estimating the C:D ratio and are more sensitive than optometrists in assessing glaucomatous optic nerve damage.

Adult↗
PubMed1994

Risk factors for the development of encapsulated filtering blebs. The role of surgical glove powder and 5-fluorouracil.

PURPOSE: To study risk factors for the development of encapsulated filtering bleb, especially the effect of surgical glove powder and 5-fluorouracil on the development of encapsulated blebs. METHODS: One hundred forty-eight patients who underwent trabeculectomy were prospectively studied. After patient of each surgeon were divided into two subgroups of 5-fluorouracil versus no 5-fluorouracil, each subgroup was then randomized for powder versus powder-free surgical gloves. All patients were followed for at least 2 months (mean, 3.5 months; range, 2-10 months). RESULTS: The overall incidence of encapsulated bleb was 11.2% when an encapsulated bleb was defined by clinical characteristics with a peak intraocular pressure of 26 mmHg or higher. The group that received 5-fluorouracil had a lower incidence of encapsulated blebs despite a higher rate of previous surgeries, whereas the group with powdered gloves had increased incidence. The subgroup in which powder-free gloves were used in conjunction with postoperative injections of 5-fluorouracil had the lowest incidence of encapsulated blebs (2.6%) compared with the other subgroups (12.0%-17.9%) (P = 0.01). CONCLUSION: Combined use of powder-free surgical gloves and 5-fluorouracil may reduce the incidence of encapsulated bleb.

Adult↗
PubMed1994

The anterior chamber angle is different in different racial groups: a gonioscopic study.

The purpose of the study was to determine racial and sexual differences and age-related changes in the anterior chamber angle to evaluate the reliability of a standardised gonioscopic grading system. The anterior chamber angle was studied prospectively in 291 patients who included Afro-Americans, Caucasians and Far East Asians. No statistically significant difference was found between the angle width of these three groups, but the iris joins the scleral wall more anteriorly in Asians, slightly more posteriorly in Afro-Americans, and most posteriorly in Caucasians (p = 0.03). The anterior chamber tends to be narrower in females (p = 0.002) and to become narrower with increasing age (p < 0.0001) in all ethnic groups. Refractive error significantly affects both the level of iris insertion (p < 0.003) and the angle width (p < 0.001). The consistency of the angle grading system in this project is demonstrated by a close agreement between the examiners. It is concluded that the difference in the angle configuration may account for racial differences in the incidence of angle-closure glaucoma, this being least common in Caucasians, more common in Afro-Americans and most common in Asians.

Adult↗
PubMed1994

Long-term results of ab externo neodymium:YAG cyclophotocoagulation.

Neodymium: YAG cyclophotocoagulation (CPC) was performed in 128 eyes of 123 patients with refractory glaucoma. In each eye, 40 burns delivered with energy of up to 7 J were placed 1.5 mm behind the limbus in a 360 degrees pattern. The minimal follow-up period was 24 months, with the mean being 36.9 (range, 24-84; SD, 5.8) months. The mean intraocular pressure was 35.0 (range 23-54; SD, 12.2) mmHg preoperatively, 20.6 (range 15-24; SD, 3.5) mmHg after 1 year, and 20.2 (range 12-24; SD, 8.1) mmHg after 2 years. A total of 25 eyes (19.5%) lost 2 or more lines in visual acuity. Success was defined as a lowering of intraocular pressure by > 30% and a decrease in visual acuity of < 2 Snellen lines. By this definition the success rate was 52.4%. There was no correlation with either the diagnosis, the stage of the disease, or the pigmentation of the trabecular meshwork, although patients with secondary traumatic or uveitic glaucoma tended to be less responsive to CPC. The most common acute complication of treatment was transient corneal edema. Phthisis bulbi developed in 1 eye (0.8%). In conclusion, CPC achieved satisfactory long-term control of intraocular pressure in the majority of patients with severe late-stage glaucoma.

Adolescent↗
PubMed1994

Long-term prognosis of eyes having had operative suprachoroidal expulsive hemorrhage.

We reviewed the charts of 15 patients having had an operative suprachoroidal expulsive hemorrhage (SEH) at least 5 years prior to the time of review. In all cases the eyes were glaucomatous. All SEH occurred in close association with the surgery, with 14 cases occurring at the time of surgery and 1 case developing within 2 days of the procedure. Three eyes were markedly worse following the SEH, losing six or more lines of vision; in all cases this loss was due to retinal detachment. In a fourth eye in which a retinal detachment occurred postoperatively, fair acuity (20/100) was preserved. The other 11 eyes not having retinal detachment had no further complications, though 6 eyes eventually lost acuity during the next 5-15 years; this loss was due to progressive glaucoma and/or macular degenerative change and did not appear to be a function of damage related to the SEH itself. Two eyes subsequently had uncomplicated cataract extraction resulting in visual improvement. When an SEH neither causes immediate loss of choroid or retina nor is associated with postoperative retinal detachment, the SEH itself may not damage the long-term clinical course of the affected eye.

Adolescent↗