The laser step in early glaucoma.
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Glaucoma↗
Biomedical subjects
H Beckman
Publications and source records attributed to H Beckman.
Intraocular pressure changes after neodymium-YAG laser capsulotomy in eyes pretreated with timolol.
Sixty eyes undergoing Q-switched neodymium-YAG laser posterior capsulotomy were randomly assigned to pretreatment with either 0.5% timolol maleate or placebo. Half of the eyes in each group underwent capsulotomies performed with six 2-mJ bursts of energy, and the remaining eyes underwent capsulotomies performed with three 4-mJ bursts of energy. There was no significant difference in pressure responses between eyes treated with 2 or 4 mJ. The mean rise in intraocular pressure was significantly less in the timolol-pretreated group one hour after capsulotomy. After four hours, the difference between groups was not significant. Pretreating with timolol did not prevent late pressure rises. Nonpseudophakic eyes were more likely to sustain pressure increases greater than 10 mm than were pseudophakic eyes.
Humans↗
The effect of coadministration of verapamil on the pharmacokinetics and metabolism of quinidine.
We have previously found that verapamil pretreatment significantly inhibits the metabolism of antipyrine. To assess more fully the implications of this observation, we examined the effect of verapamil on the pharmacokinetics and metabolism of quinidine. Pretreatment with verapamil, 80 mg and 120 mg (every 8 hours for 3 days), reduced the oral clearance of quinidine from 17.0 L/hr to 11.6 and 11.3 L/hr, respectively (P less than 0.01). The half-life of quinidine was also significantly prolonged by verapamil. The formation clearance of 3-hydroxyquinidine was reduced by 61.2% and 70.6% after verapamil pretreatment (80 and 120 mg, respectively) (P less than 0.01), whereas the renal clearance of unchanged quinidine was not affected. These results indicate that verapamil impairs the metabolism of quinidine to 3-hydroxyquinidine and reduces the oral clearance of quinidine to a degree that could be of clinical significance given the narrow therapeutic index of this drug.
Adult↗
'Hello, I'm your new doctor'.
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Internship and Residency↗
CO2 laser excision of xanthelasma lesions.
Xanthelasma of the eyelids traditionally has been treated by excision, followed by suturing of the defect. A new technique of ablating these lesions using a superpulsed CO2 laser was used to treat a series of nine patients with xanthelasma. Advantages of this technique include: (1) superb hemostasis intraoperatively; (2) magnified view of tissue removal, enhancing complete excision; (3) the absence of suturing; (4) the avoidance of reconstructive procedures; and (5) a high degree of patient satisfaction, with minimal or no postoperative pain.
Aged↗
Transscleral laser cyclocoagulation.
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Glass↗
Use of a physician consultant in a primary care nursing practice.
This article describes a study of the nature of consultation requests made to a physician consultant by nurse practitioners in an urban university-affiliated ambulatory nursing practice. During a 50-week period, 1,504 client encounters resulted in 225 consultations, an average consultation rate of 15 percent. The types of consultation requests, the medical specialty to which the content of the request related and the outcomes of the consultations were recorded in a consultation log. Knowledge of the pattern and nature of consultation needs has multiple benefits. Careful study of practice needs may assist in determining the qualifications of a prospective consultant and the amount of time required for on-site consultation. Such a study may provide insight into the types of problems seen in the practice and identify areas of need for continuing education and protocol development. The consultation process enhances continuity of care, while knowledge of practice needs for consultation may lead to more efficient, cost-effective health care.
Consultants↗
Transscleral ruby laser cyclocoagulation.
During a ten-year period, we treated 241 eyes by transscleral ruby laser cyclocoagulation. Each eye had a minimum follow-up of six months. The average was 24 months and the range was six to 92 months. Using a criterion for success of intraocular pressure between 5 and 22 mm Hg, we achieved an overall success rate of 62% (150 of 241 eyes). This success rate varied from 86% for aphakic open-angle glaucoma (32 of 37 eyes) to 53% for neovascular glaucoma (72 of 135 eyes). Most eyes with useful vision preoperatively maintained these levels. Chronic hypotony (41 eyes) and phthisis (17 eyes) were the most frequent complications, although phthisis was common only in the neovascular glaucoma group (13 eyes). The visual results are more favorable and the need for retreatment and postoperative medications is less than with cyclocryotherapy, and postoperative discomfort is considerably reduced.
Glaucoma↗
Intraocular pressure changes after neodymium-YAG laser posterior capsulotomy.
Thirty-seven Q-switched neodymium-YAG laser posterior capsulotomies were performed on 33 aphakic or pseudophakic eyes. The average intraocular pressure increase during the first 24 hours after treatment was 12.0 +/- 6.9 mm Hg from a baseline value of 17.7 mm Hg in the treated eye v +0.7 +/- 3.5 mm Hg in the untreated eye. Seven eyes had larger capsulotomies performed, averaging 250.7 millijoules (mJ) of energy per treatment. Thirty eyes had smaller posterior capsulotomies performed, averaging 48.3 mJ per treatment. Average IOP increases within the first day were 16.1 and 12 mm Hg, respectively. All eyes in which IOP increased more than 5 mm Hg showed the increase within the first 48 hours. In some eyes, IOP remained elevated more than 10 mm Hg above preoperative levels for several weeks. Higher pressures were associated with larger capsulotomies and increased energy. Minimizing debris and shock waves are recommended as well as thorough postoperative pressure monitoring.
Cataract Extraction↗
Visual evoked potentials and ibuprofen (Motrin) toxicity.
A patient taking ibuprofen (Motrin) for the relief of osteoarthritis developed, after two months, decreased visual acuity and decreased color vision. Initially the Visual Evoked Potentials, showed decreased wave amplitudes, and increased conduction times in both eyes. After stopping the drug, the Visual Evoked Potentials returned to normal one month before the visual acuity improved. We feel that Visual Evoked Potentials are useful for screening patients on ibuprofen, and prognosticating their recovery, when a secondary toxic optic neuritis develops.
Aged↗
Visual evoked potentials as an aid in the diagnosis and treatment of temporal arteritis.
A patient who presented with temporal arteritis was followed using pattern visual evoked potentials (VEPs). Prior to treatment, both amplitudes and wave latencies of the VEP were abnormal. Following a two-week course of corticosteroids, both the visual acuity and VEPs returned to normal. It is suggested by this patient, that VEPs may be useful in the diagnosis and management of patients with temporal arteritis.
Aged↗
Argon laser treatment of an eyelid margin capillary hemangioma.
When capillary hemangiomas do not resolve spontaneously, treatment may be indicated. Various forms of therapy have been employed. These include excisional surgery, cryotherapy, sclerosing solutions, embolization, external beam irradiation, steroids, and the argon laser. We report the use of a standard ophthalmic argon laser combined with curettage on a noninvoluting eyelid margin hemangioma found on a 29-year-old man. Details of the surgical technique are provided and postoperative results documented. We believe this to be the first case of a lid margin hemangioma successfully treated in this manner. The technique offers these advantages: (1) Selective absorption of the laser energy by the blood-filled tissue allows microablation of the lesion under ideal hemostatic conditions with minimal loss of normal lid tissue. (2) Oculoplastic lid repair is obviated since minimal normal tissue is removed. (3) The procedure can be performed under local anesthesia on an outpatient basis.
Adult↗
Arthropathies and schizophrenia.
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Genetic Markers↗
Carbon dioxide laser surgery of the eye and adnexa.
A carbon dioxide laser which functions in both rapid superpulsed and continuous wave mode for use in ophthalmic surgery is described. Rapid superpulsed mode was found more effective in the creation of trabeculectomy-like procedures in glaucomatous human eyes with satisfactory results in 12 of 14 eyes treated. Continuous wave energy was found to be superior when full thickness eye wall resection was performed. The carbon dioxide laser was found to be effective in hemostatic resection and ablation of skin lesions about the eye. Rapid superpulse was found to be more effective when puckering and tissue loss were to be minimized, while continuous wave was found to be effective when shrinkage of tissue, as in the performance of a Ziegler cautery type repair for ectropion, was preferred. Rapid superpulse was found to be more controllable in experimental phacovaporization in cats with anterior capsulotomy being easily performed. Continuous wave was found to be a more efficacious modality for corneal shrinkage although attempts at present to create permanent corneal alterations have been fruitless.
Animals↗
Anterior segment metastases from an ovarian choriocarcinoma.
A 28-year old woman with ovarian choriocarcinoma developed a uveitis in her left eye. Subsequently, a mass was observed in the anterior segment of that eye together with a subconjunctival mass that appeared to extend from it. Biopsy of the subconjunctival nodule showed two different cell types consistent with the cytotrophoblastic and syncytiotrophoblastic elements typical and choriocarcinoma. No abnormalities of the posterior segment were found on careful examination. Treatment consisted of systemic chemotherapy with a variety of therapeutic agents, argon laser photocoagulation of tumor seedings in the anterior chamber angle, radiation to the eye, and finally, subconjunctival injections of methotrexate. The eye became blind and painful and was enucleated. Histopathologic examination revealed residual tumor cells in the anterior segment indicating treatment changes, but there were no abnormalities posteriorly. Choriocarcinoma metastatic to the eye has been reported infrequently, and this is the first case in which anterior segment metastases have been observed and the effects of treatment thoroughly documented.
Adult↗