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Biomedical subjects

H C Geijssen

Publications and source records attributed to H C Geijssen.

12 recordsLinked to original sources
PubMed1997

Design of low cost glaucoma screening.

In 1991 the Netherlands Glaucoma Patient Association organized a glaucoma screening survey. This survey was designed to evaluate the effectiveness of a low cost screening setting. During a screening period of 8 days, 1259 subjects over the age of 49 years were examined by a team of non-ophthalmologically trained students. The following screening methods were used: visual field analysis (Henson CFS3000 perimeter), retinal nerve fiber layer photography (Canon non-mydriatic camera), intraocular pressure measurement (Pulsair non-contact tonometer) and determination of the peripheral anterior chamber depth (slitlamp biomicroscope, the van Herick method). In a later stage, subjects with glaucomatous abnormalities in the visual field and/or the photograph were re-examined by a glaucoma specialist using applanation tonometry, gonioscopy, ophthalmoscopy and Humphrey 30-2 visual field analysis. The time taken to conduct the individual screening tests in a subject varied from 1 to 5 min: perimetry took 5 min, photography 2 min, tonometry 3 min and angle-width determination 1 min. Fifty-six (4.4%) subjects showed glaucomatous defects in perimetry and/or photography. Thirty-seven could be re-examined and glaucoma was diagnosed in 16 subjects. Visual field defects and glaucomatous abnormalities in the photograph were confirmed by Humphrey perimetry in 72.7% and 35.7% respectively. Sixty-seven (5.3%) subjects had an intraocular pressure above 21 mm Hg, while no cases of angle closure glaucoma were found in this population. The costs of this screening setting were estimated at F1. 48,60 per screen. A future low cost screening survey might be limited to non-contact tonometry and visual field analysis with the Henson CFS3000 perimeter or a similar device, using suprathreshold testing with a limited number of points. Screening might be performed by non-medically trained employees. The costs of such a screening program may be estimated at F1. 16,- per screen and F1. 1.989,- per glaucoma case using a mobile screening unit (addendum).

Diagnostic Techniques, Ophthalmological↗
PubMed1996

Reduction of intraocular pressure with treatment of latanoprost once daily in patients with normal-pressure glaucoma.

PURPOSE: Currently available ocular hypotensive agents often fail to lower intraocular pressure (IOP) in patients with normal-pressure glaucoma (NPG). The authors evaluated the IOP-reducing potential and side effects of latanoprost, a newly developed ocular hypotensive agent, in this patient group. METHODS: A randomized, double-masked, placebo-controlled cross-over study was performed in 30 patients with NPG, 29 of whom completed the study. During three periods of 3 weeks each, patients received, in a random order, 50 micrograms/ml latanoprost once daily, 15 micrograms/ml latanoprost twice daily, and placebo. Per dose, one drop of the study medication was applied topically in both eyes. At the end of each treatment period, diurnal IOP measurements were obtained. General and ocular symptoms were recorded, and a detailed ocular examination was performed on each visit to monitor side effects. RESULTS: Average IOP reduction after 50 micrograms/ml latanoprost once daily, 15 micrograms/ml latanoprost twice daily, and placebo was 3.6 +/- 1.9 mmHg (21.3%, P < 0.001), 2.4 +/- 1.5 mmHg (14.2%, P < 0.001), and 0.4 +/- 1.8 mmHg (2.4%, not significant), respectively. The difference between the two latanoprost dose regimens was significant (P = 0.001). Efficacy of latanoprost correlated with initial IOP (r2 = 0.76, P < 0.001). A mild, but statistically significant, increase in conjunctival hyperemia was observed in both latanoprost treatment groups. CONCLUSION: Both latanoprost regimens significantly reduce IOP in patients with NPG, but 50 micrograms/ml latanoprost once daily is more effective in reducing IOP than 15 micrograms/ml latanoprost twice daily. Lowering the concentration did not result in an improved side effects profile. Latanoprost is more effective at higher IOP levels.

Administration, Topical↗
PubMed1995

Vascular concepts in glaucoma.

A relationship has been found among vascular risk factors, normal-tension glaucoma (NTG), and visual field progression. All these factors have been measured qualitatively. These factors are disc hemorrhages, peripapillary atrophy, myopic disc, choroidal sclerosis, slow filling of the choroid and veins, and vasospasms. Now we are in a transition period where more and more quantitative methods are becoming available: pulsatile ocular blood flow measurement (POBF), scanning laser angiography of the peripapillary choroid (SLAPPC), scanning laser angiography of the retinal circulation (SLARC), scanning laser Doppler flowmetry (SLDF), and color Doppler imaging. With POBF, SLAPPC, SLARC, and SLDF a deficient blood flow was found in at least 50% of patients with NTG. With these results a vascular pathogenesis of NTG becomes more and more evident.

Blood Flow Velocity↗
PubMed1994

Treatment of hypotonous maculopathy after trabeculectomy with mitomycin C.

We treated 34 eyes of 32 patients who developed a hypotonous maculopathy after a trabeculectomy with mitomycin C with various treatment strategies. Placement of a Megasoft Bandage Contact Lens in 24 eyes did not result in a notable increase in intraocular pressure or visual acuity. Intrableb injection of autologous blood in 22 eyes resulted in a mean +/- standard deviation (S.D.) increase in intraocular pressure from 4.3 +/- 1.8 mm Hg before injection to 8.6 +/- 4.6 mm Hg after injection. Mean logMAR visual acuity improved from 0.71 +/- 0.40 to 0.32 +/- 0.25. After a surgical revision of 16 eyes, intraocular pressure increased from 4.1 +/- 1.9 mm Hg to 11.3 +/- 4.0 mm Hg, and logMAR visual acuity improved from 0.61 +/- 0.30 to 0.22 +/- 0.24. At the last follow-up examination (12.2 +/- 5.1 months after the trabeculectomy), 31 eyes (91.2%) had an intraocular pressure greater than 6 mm Hg. Hypotonous maculopathy after trabeculectomy with mitomycin C can be treated successfully by autologous blood injection and surgical revision of the filtration site.

Adult↗
PubMed1994

Histopathologic effects of mitomycin C after trabeculectomy in human glaucomatous eyes with persistent hypotony.

We evaluated the histopathologic findings in seven patients who underwent surgical revision of the filtration site after trabeculectomy with mitomycin C because of persistent hypotonous maculopathy. Light microscopic examination of subconjunctival tissue and sclera demonstrated hypocellularity of fibroblasts and disruption of the normal architecture. Tissue fragments at the margin of the bleb wall demonstrated scarring and contained multiple fibroblasts. Additionally, we investigated the histopathologic changes in an eye obtained from a patient who died one week after a trabeculectomy with mitomycin C. Transmission electron microscopy showed myelin figures, increased melanolipofuscin granules, vacuolated cytoplasm, and disrupted mitochondria of the ciliary body epithelium underlying the site of mitomycin C application. On the basis of these findings, both overfiltration because of tissue disorganization of the filtering bleb and aqueous hyposecretion because of ciliary body toxicity might be involved in the causes of persistent hypotony after mitomycin C trabeculectomy.

Adult↗
PubMed1993

Prevention of hypotony after trabeculectomies with mitomycin.

Hypotony with reduced a reduced visual acuity is often seen after trabeculectomy with mitomycin. In this study we describe measures such as reattaching the scleral flap with at least seven nylon sutures and the controlled and delayed use of argon laser suture lysis. With these preventative measures the percentage of hypotonies (IOP < or = 6 mmHg) three months after surgery was reduced from 38 to 15% and chronically reduced visual acuity was reduced from 38 to 5%. With these adaptations in the surgical technique the complication rate of trabeculectomies with mitomycin can be markedly reduced without affecting the mean IOP (10.9 mmHg versus 10.8 mmHg) three months after surgery and the percentage of eyes with IOP 18 mmHg or less without medication (94 versus 91%).

Adult↗
PubMed1992

Mitomycine, suterelysis and hypotony.

In 35 patients 37 trabeculectomies (TE) were performed using mitomycin as a fibrosisinhibitor. Mitomycin (0.5 mg/ml) was applied to the sclera (under the scleral flap) and conjunctiva in the area of the projected TE during 5 minutes using a small sponge. The indications for operation were: visual field progression in 15 eyes, too high IOP in 13 eyes and severe visual field defects (central island and/or centro coecal visual field defects) in 9 eyes. Six patients had Normal Pressure Glaucoma, 17 Primary Open Angle Glaucoma and 12 had other forms of glaucoma. There were 22 first TE's and 15 re-operations. The scleral flap was sutured with 5 to 8 10/0 nylon sutures. The system of a large number of sutures and subsequent suturelysis was our routine management for reducing complications after TE. This report deals with the postoperative period of the first three months. Suturelysis in combination with mitomycine caused an unexpected high number of postoperative hypotonies (IOP < = 6 mmHg with reduced visual acuity and/or retinal folds or large persistent choroidal detachment and shallow anterior chamber) In the 27 eyes who had suturelysis performed, 7 developed a hypotony. The hypotony may develop as late as three weeks postoperative after suturelysis!. Two eyes developed a hypotony without suturelysis. Seven patients needed resuturing of the scleral flap. The use of mitomycine to enhance filtration after TE may cause serious hypotonies if the scleral flap is not securely closed and if suturelysis is used too early or too extensively.

Adult↗
PubMed1990

Focal ischaemic normal pressure glaucoma versus high pressure glaucoma.

In a total group of 130 patients with Normal Pressure Glaucoma (NPG) twenty-six were classified as Focal Ischaemic NPG (FINPG). This subgroup has a typical defect at the disc with a comparable visual field defect in the corresponding half of the visual field. Visual field defects are more often seen in the upper than the lower half of the visual field. The defects in the upper half are on the average larger (stage 1.6) than those in the lower half (stage 0.9). Abnormalities of the chamber angle were observed in 12% of these patients, the same percentage as in the normal population. Hypertension and/or cardiovascular disorders were found significantly more frequently in FINPG patients (65.4%) than in a control group of High Pressure Glaucoma (HPG) patients (22.2%). Of the local vascular risk factors, papillary haemorrhages (46%) and choroidal sclerosis (30%) were seen significantly more frequently in FINPG than in HPG (11% and 0% respectively). The total amount of peripapillary atrophy (PPA) in FINPG and HPG is the same, but the distribution is clearly different: in FINPG there is more PPA on the side of the papillary defect. Wide veins were observed in a high percentage of cases in both groups. FINPGs were found to be more frequently progressive (38.5%) than had been thought at first. Recognition of subgroups in NPG, and of risk factors, has already made it possible to make a better prognosis in some types of NPG.

Adult↗
PubMed1989

Results of a filtering procedure in low tension glaucoma.

Twenty-six eyes of twenty patients with established low tension glaucoma, who had either a 'double flap' Scheie filtering operation or a trabeculectomy, were followed over a period ranging from one to ten years, with a median of three years. These 26 eyes include two second eyes that served as a contralateral control eye until the visual field deteriorated. All 26 eyes showed progression of visual field defects preoperatively, while postoperatively only 2 eyes showed further progression. Of the 16 nonoperated contralateral eyes, 7 showed progression of visual field defects over the same follow-up period. Two of these 7 eyes had to be operated during the study-period. The difference in progression between the operated and the non-operated eyes was significant (P less than 0.01). The filtering procedure provided a reduction in IOP of 20% or more in 21 of 26 eyes. There was a significant difference in the mean intraocular pressure (IOP) between the operated and the non-operated contralateral eye of 6.8 mmHg (37%) at one year postoperatively. The diurnal variation decreased highly significantly from 4.3 to 2.1 mmHg (P less than 0.001). It is concluded that filtering surgery in low tension glaucoma may result not only in a significant lowering of IOP, but is also effective in slowing further deterioration of the visual fields.

Adult↗
PubMed1987

The spectrum of primary open angle glaucoma. I: Senile sclerotic glaucoma versus high tension glaucoma.

This paper describes two subgroups of primary open angle glaucoma: senile sclerotic glaucoma in the elderly with relatively low intraocular pressures, normal chamber angles, senile excavation, peripapillary atrophy and choroidal sclerosis; high tension glaucoma in the younger age-group with high intraocular pressures, signs of mesodermal dysgenesis in the chamber angle, deep and steep excavation, little peripapillary atrophy and no choroidal sclerosis. The description of senile sclerotic glaucoma is new as are the differences in the chamber angle and peripapillary atrophy. The size of the visual field defects in the upper and lower half of the visual field is similar in high tension glaucoma. In senile sclerotic glaucoma the larger defect tends to be in the upper half of the visual field. It is suggested that in senile sclerotic glaucoma the primary cause of damage is local vascular disease, and that in high tension glaucoma the intraocular pressure with a secondary role for an insufficient blood supply is the major cause of damage. Primary open angle glaucoma can be characterized by the ratio of pressure risk factors and vascular risk factors.

Aged↗
PubMed1985

Blood and plasma viscosity measurements in patients with glaucoma.

Blood viscosity at 10 shear rates, plasma viscosity, packed cell volume, plasma fibrinogen, serum alpha 2-macroglobulin, and serum proteins were measured in 83 patients with low-tension glaucoma (LTG) and 23 patients with 'high-tension glaucoma' (HTG: at least one IOP reading above 40 mmHg) and compared with those in 50 controls. Blood and plasma viscosity values and packed cell volume were significantly higher in the LTG group than those in controls. The HTG and the LTG groups differed only in plasma viscosity, but smoking and drinking habits in the HTG patients were greatly different from those in LTG patients and controls, thus preventing interpretation of data in the HTG group. Within the LTG group viscosity values were highest in a subgroup designated earlier by us as focal ischaemic LTG, whereas another subgroup, senile sclerotic LTG, did not show significant differences compared with controls. These findings may indicate a factor in the pathogenesis of visual field defects and disc cupping in some patients with LTG.

Aged↗