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Biomedical subjects

Graham A Lee

Publications and source records attributed to Graham A Lee.

15 recordsLinked to original sources
PubMed2006

Topical interferon alfa-2b for the treatment of recalcitrant ocular surface squamous neoplasia.

PURPOSE: To evaluate topical interferon alfa-2b (IFN-alpha2b) for the treatment of recalcitrant ocular surface squamous neoplasia (OSSN). DESIGN: Prospective, noncomparative, interventional consecutive case series. METHODS: Ten patients with recalcitrant OSSN were treated with topical IFN-alpha2b (1 million IU/ml) four times a day until clinical resolution of the lesion or until the lesion appeared nonresponsive-that is, treatment failure. Progress was assessed by clinical examination and photographic records, with a minimum follow-up of six months. RESULTS: Eight of 10 patients achieved clinical resolution from topical IFN-alpha2b treatment. One patient developed invasive squamous cell carcinoma and underwent exenteration. The other patient required further mitomycin C therapy to achieve clinical resolution. The mean duration to clinical resolution for the eight patients treated with IFN-alpha2b was 21.9 weeks (range six to 59 weeks). There have been no recurrences for any of the nine patients during follow-up (mean 55.0 weeks; range 26 to 84 weeks). CONCLUSIONS: Topical IFN-alpha2b is an important treatment modality for recalcitrant OSSN; it avoids the risks of further limbal stem cell destruction from other agents and surgical excision. If invasive disease is diagnosed at any stage, topical therapy is contraindicated, necessitating surgical excision.

Administration, Topical↗
PubMed2006

Phacoemulsification in anterior megalophthalmos.

This case outlines the phacoemulsification technique used to overcome the challenge of the hyperdeep anterior chamber, weak zonules, abnormal anterior capsule, and large capsular bag. Key steps included trypan blue staining of the anterior capsule, a large capsulorhexis, prolapse of the nucleus into the anterior chamber with phacoemulsification anterior to the capsulorhexis, and a posterior chamber-placed iris-clip intraocular lens. Successful visual rehabilitation is achievable in these anatomically challenging eyes.

Adult↗
PubMed2006

Intraocular pressure changes secondary to reduction of orbito-zygomatic complex fractures.

PURPOSE: To investigate intraocular pressure (IOP) changes in the involved eye during orbito-zygomatic complex fracture reduction, compared with the IOP of the eye on the uninjured side. PATIENTS AND METHODS: Twenty patients who presented with displaced, isolated unilateral orbito-zygomatic complex fractures were enrolled. IOPs were measured using a Tono-Pen XL (Medtronic Solan, Jacksonville, FL) in the involved eye and in the non-involved eye. Pressure was recorded at 5 time points (before general anesthetic induction, after induction, immediately after fracture reduction, post operation while still under general anesthetic, and 15 minutes post general anesthetic). RESULTS: There were no significant differences between the injured and control data at any time point. Average IOPs for the involved and control eye decreased after anesthetic induction; however, IOP increased in both eyes after fracture reduction. CONCLUSION: There is no statistical evidence of a difference between the IOP of the control and injured eyes. Routine IOP testing is not indicated during orbito-zygomatic fracture reduction.

Adolescent↗
PubMed2006

Prognostic indicators for open globe injury.

BACKGROUND: The purpose of the study is to identify factors predictive of outcome after open globe injury in 273 patients admitted to the Royal Brisbane Hospital, Queensland, Australia between 1992 and 2003. METHODS: Data were collected retrospectively regarding demographic and geographical factors, injury circumstances, initial visual acuity (VA), injury parameters, details of initial and subsequent surgery, final best corrected VA and complications. Multivariate analysis using binary logistic regression was utilized to identify which factors were related to outcome. RESULTS: 83% of patients were male, with a mean age of 38.3 years. The mean duration of follow up was 16.6 months and 58% of patients (135 of 231) achieved an overall improvement in their vision. Forty-one cases (15%) were enucleated, with half of these cases performed primarily. The prognostic factors indicating the likelihood of a VA of counting fingers or worse were poor initial VA, a large laceration >10 mm and the presence of a relative afferent pupil defect. Rural patients had a significantly worse final VA than city dwellers and had higher rates of endophthalmitis and enucleation. CONCLUSIONS: Assessment of prognostic factors at the time of presentation of an open globe injury enables realistic expectations of final visual outcome by the doctor and the patient. In order to improve outcomes in patients from rural areas, access to specialized eye services need to be upgraded.

Adolescent↗
PubMed2006

Outcomes of autoconjunctival grafting for primary pterygia when performed by consultant compared with trainee ophthalmologists.

PURPOSE: To define rates of recurrence and surgical complications of primary pterygia excision with autoconjunctival grafting when the surgery is performed by consultant ophthalmologists compared with trainee ophthalmologists. METHODS: A total of 174 patients with primary pterygia treated by excision and autoconjunctival grafting were included for analysis. Patients were divided into two groups according to whether their surgery was performed by a consultant ophthalmologist (group A) or a trainee ophthalmologist (group B). Data were collected with respect to demographics, surgical complications and recurrence. Recurrence rates were analysed utilizing Fisher's exact test. Additionally, Kaplan-Meier survival curves for interval censored data were constructed. Surgical complications were analysed utilizing Fisher's exact test. RESULTS: The recurrence rate in group A was 6.8% and in group B was 19.4%. This difference was statistically significant (P = 0.05). The rate of surgical complication occurring in group A was 6.6% and in group B was 23.3% and this was also statistically significant (P = 0.005). No relationship was found between either patient age or the size of pterygium and recurrence or complications in either group A or group B. CONCLUSION: Autoconjunctival grafting is regarded as the gold standard for preventing pterygium recurrence following excision. This study suggests that the experience of the surgeon can influence success rates and complications. There is a significant learning curve indicating the need to supervise trainee surgeons.

Adult↗
PubMed2005

Perforated corneal hydrops treated with sulfur hexafluoride (SF6) gas and tissue adhesive.

PURPOSE: To report a case of a perforated acute hydrops in a mentally retarded patient that was successfully managed with intracameral sulfur hexafluoride gas and cyanoacrylate tissue adhesive. METHODS: Interventional case report. RESULTS: A 14-year-old mentally retarded male patient with keratoconus presented with a perforated acute hydrops. A bandage contact lens was applied. However, following a large emesis 2 days later, the aqueous leak worsened with shallowing of the anterior chamber. Under general anesthesia, sulfur hexafluoride was injected to reform the anterior chamber and cyanoacrylate tissue adhesive was applied to the perforated site and covered by a bandage contact lens and temporary tarsorrhaphy. A follow-up examination at 1 month showed a formed anterior chamber with tissue adhesive in situ and no aqueous leak. CONCLUSIONS: The successful use of intracameral sulfur hexafluoride and tissue adhesive in the management of perforated acute hydrops may avoid emergency tectonic penetrating keratoplasty and reduce potential complications in the poorly cooperative patient.

Adolescent↗
PubMed2005

Suicide-related perforating injury of globe with nail gun.

A case is reported of nail gun injury due to suicide attempt involving both orbits, frontal lobe and abdomen, which resulted in an unusual posterior perforation of the left globe. Injury was inflicted with a total of eight nails. Three nails entered the left orbit, one of which perforated the posterior aspect of the left globe. One nail entered the right orbit involving the optic nerve and crossed the midline to finish in the left sphenoid sinus. Three nails entered the frontal lobe near the midline and the final nail pierced the left lobe of the liver. The left eye underwent primary repair, lensectomy and vitrectomy with silicone oil and achieved a visual acuity of 6/60, 3 months post removal of oil with sutured posterior chamber intraocular lens. The right eye suffered traumatic optic neuropathy and currently has a visual acuity of 6/36 due to senile cataract formation. No other serious sequelae resulted from the other injuries and the patient has recovered from his episode of depression.

Brain Injuries↗
PubMed2005

Fibrin glue in the management of corneal melt.

Human fibrin glue aids physiological healing thereby reducing corneal vascularization and scarring compared with cyanoacrylate tissue adhesive. A 40-year-old intellectually disabled man with a corneal melt is reported who was managed successfully using human fibrin glue, alleviating the need for emergency penetrating keratoplasty.

Adult↗
PubMed2004

Diode laser treatment of pre-threshold and threshold retinopathy of prematurity.

PURPOSE: Retinopathy of prematurity (ROP) is a sight-threatening condition of premature infants. This study aimed to investigate the efficacy of diode laser photocoagulation in the treatment of pre-threshold and threshold ROP. METHODS: A retrospective review was conducted of patients who underwent diode laser treatment for ROP by one author (GAG) from 1992 to 2000. During this time, 2137 babies <1500 g birthweight or <32 weeks post-conception age were examined. RESULTS: Seventy-six eyes in 40 infants (20 male, 20 female) were treated for ROP. Treatment was performed on average at 37 weeks post-conception age (range 31-50 weeks, SD = 3.2). The number of burns per eye for the first session of laser ranged between 193 and 1937 (mean 933), with power ranging from 200 to 1000 mW (mean 484). Eighteen (45.0%) of these 40 infants underwent a second session of laser (mean number of burns 683, range 167-1618), which was performed in 29 (38.2%) of the 76 eyes that initially underwent laser treatment. Complete regression was observed in 61 eyes (80.3%), occurring on average at 39 weeks post-conception age (range 35-45, SD = 2.2). Six (7.9%) eyes progressed to stage IVA disease, two (2.6%) to stage IVB and three (3.9%) to stage V ROP. In the latter part of the study as the number of laser burns per eye increased it was found that the number of patients requiring a second session of laser treatment decreased, with no adverse outcomes observed in the last 3 years of the study. At last follow up, the average refractive error in the treated eyes was -0.40 D spherical equivalent (range -12.75 D to +4.25 D, SD = 3.0). The degree of myopia induced showed no significant correlation with the number of laser burns administered. CONCLUSION: Diode laser treatment is able to stop progression of ROP in the majority of cases.

Female↗
PubMed2004

Retained intraocular foreign body.

The presence of an intraocular foreign body following eye trauma may not be readily apparent. Serous complications may include, inter alia, endophthalmitis, cataract, retinal detachment and siderosis bulbi. We report an iron intraocular injury due to hammering 'metal on metal', which was diagnosed using ultrasonic biomicroscopy and successfully removed. Two months post-operatively, unaided vision was 6/6.

Accidents, Occupational↗
PubMed2004

Pellucid marginal degeneration and scleroderma.

Systemic scleroderma is a progressive multi-system connective tissue disease. Ocular involvement includes keratoconjunctivitis sicca, progressive shallowing of conjunctival fornices, peripheral ulcerative keratitis and eyelid tightness. No association has been reported between scleroderma and pellucid marginal degeneration, which is a rare bilateral corneal ectasia. Pellucid marginal degeneration is characterised by non-inflammatory and progressive peripheral corneal thinning inferiorly, often with high against-the-rule astigmatism. We report a case of a 55-year-old woman with systemic scleroderma who presented with rapidly progressing against-the-rule astigmatism. The differential diagnosis of peripheral corneal thinning and the challenge of the surgical management of pellucid marginal degeneration are briefly discussed.

Astigmatism↗
PubMed2002

Acanthamoeba sclerokeratitis: treatment with systemic immunosuppression.

OBJECTIVE: This study describes the clinical features, management, and outcome of 19 patients who had severe Acanthamoeba sclerokeratitis (ASK) unresponsive to conventional management, requiring systemic immunosuppression to control disease. DESIGN: Retrospective, non-comparative, interventional case series. PARTICIPANTS: Records of all patients with Acanthamoeba keratitis treated at Moorfields Eye Hospital between 1989 and 2000 were reviewed. From more than 200 patients, 19 who developed ASK treated with systemic immunosuppression were identified. MAIN OUTCOME MEASURES: Visual acuity, level of pain, and degree of inflammation were recorded after immunosuppressive treatment. RESULTS: ASK requiring immunosuppression occurred in 20 eyes of 19 patients (11 males and 8 females). The mean age (mean +/- standard deviation) at onset was 38.6 +/- 13.2 years. On presentation, best-corrected visual acuity was counting fingers or worse in 11 eyes (55%), 6/18 to 6/60 in 5 eyes (25%), and 6/12 or better in 4 eyes (20%). The mean time between onset of initial symptoms of Acanthamoeba keratitis and commencement of systemic immunosuppression was 4.8 +/- 3.5 months. The mean duration of immunosuppression required to control inflammation was 7.2 +/- 3.9 months. Severe scleritic pain remained uncontrolled in two patients and resulted in enucleation. Best-corrected visual acuity at final follow-up was counting fingers or worse in eight eyes (40%), 6/18 to 6/60 in six eyes (30%), and 20/40 or better in six eyes (30%). The mean follow-up period after resolution of inflammation was 24.3 +/- 20.9 months (range, 0.2-59.7 months). CONCLUSIONS: ASK is an uncommon complication of Acanthamoeba keratitis. The scleritis associated with this infection seems to be an immune-mediated response. After topical amebicidal treatment, systemic immunosuppression may be required to control the pain and tissue destruction associated with ASK.

Acanthamoeba Keratitis↗
PubMed2002

The corneal thickness and intraocular pressure story: where are we now?

A review of the current literature was conducted regarding the effect of corneal thickness on the diagnosis of glaucoma, and the influence of excimer laser refractive surgery on intraocular pressure (IOP) measurement with Goldmann applanation tonometry. In general, normals and primary open angle glaucoma patients have a similar distribution of corneal thickness; however, there is a wide variation, ranging from 427 to 716 micro m. Normal tension glaucoma patients have a tendency towards thinner corneas than normals; however, there is an overlap of thickness measurements of more than two-thirds in 95% of patients. There is a trend for ocular hypertensives to have thicker corneas than normals, but again there is an overlap of about one-third in 95% of patients. The general trend after excimer laser refractive surgery is for a decrease in IOP, with a mean fall in IOP measured of 0.63 mmHg per dioptre correction. There is, however, a large scatter of values with some patients having the same or lower IOP post-laser, but with other patients measuring higher pressures. Corneal thickness can influence IOP measurement by Goldmann applanation tonometry; however, the magnitude of the effect is subject to much individual variation.

Cornea↗
PubMedDate not supplied

Migratory intraocular cilium following phacoemulsification.

A case of an intraocular cilium noted in the anterior chamber after routine small incision phacoemulsification is described. The cilium was noted on the third postoperative day. It initially protruded internally from the paracentesis site and subsequently pierced the peripheral iris to migrate through to the posterior chamber to finally re-emerge through the pupil and come to rest in the inferior angle. No adverse effects have been noted and the patient's visual acuity was stable at 6/5 after 6 months of follow up.

Anterior Chamber↗