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Biomedical subjects

H L Lieberman

Publications and source records attributed to H L Lieberman.

At least 19 recordsLinked to original sources
PubMed1989

Effect of a pupillary light occluder on cystoid macular edema.

A prospective, randomized study of 291 patients was performed to determine the effect of a pupillary light occluder on the incidence of angiographic cystoid macular edema (CME) in patients having extracapsular surgery with implantation of a posterior chamber lens. Patients were randomized preoperatively into two groups: those having surgery with and without a pupillary light occluder on the cornea. The occluder was placed on the cornea during suture placement, following the extracapsular lens extraction and intraocular lens implantation. Of the 291 patients, 198 had angiograms readable for the presence or absence of CME. The incidence of angiographic CME in patients with the occluder was 15.0%; in those without the occluder it was 12.5%. The difference was not statistically significant. The presence or absence of an occluder on the cornea during suture placement does not affect the incidence of angiographic CME or the visual results of these cases.

Adult↗
PubMed1989

Lactate dehydrogenase of concentric zones of human senile cataracts and calf lenses produced by ultrasound.

Cataractous lenses from men and women averaging 77.7 years of age were sonicated for intervals of 10 min with 0.85% saline under cooling in a laboratory sonicator, followed by centrifugation. The respective supernatants were analyzed for LDH and the weights of the zonal portions obtained by difference. The initial fraction averaged 60 and 47% in solids and LDH, respectively, with decreasing contents to the final harder core residue. The procedures were also applied to calf lenses. Much shorter sonication periods and stepwise increases in wattage from one fraction to the next were also investigated. The calf lens displayed higher LDH activity/mg at settings of 6-8 W in contrast to the cataracts, the initial fraction containing 80% of the enzyme activity and the solids; the values were far lower at settings of 1-3 W. As compared to the sonicated outer layer fractions, the calf nuclear portions showed small but significant decrements in the isoenzymes, LDH-1 and LDH-2, and increases in LDH-4 and LDH-5, possibly indicative of heightened anaerobiasis.

Aged↗
PubMed1987

Secondary intraocular lens implantation: rigid/semi-rigid versus flexible lenses.

Two series of secondary intraocular lens implantations with anterior chamber lenses are reported. Series 1 consisted of our first 199 consecutive procedures using rigid or semi-rigid lenses, performed between May 1, 1977, and September 30, 1982. Series 2 consisted of our first 101 consecutive procedures using flexible lenses, performed between October 1, 1982, and October 30, 1984. Best-corrected final postoperative visual acuity was either better than or within one Snellen line of best-corrected preoperative vision in 84% of cases with rigid or semi-rigid lenses and in 85% of cases with flexible lenses. Surgical complications were minimal in both series. No instances of uveitis-glaucoma-hyphema syndrome were encountered. Endothelial cell loss was low. Because of the short follow-up in Series 2 and the fact that these groups were operated upon at different times, the two series are not directly comparable. Nonetheless, the results do show that secondary intraocular lens implantation is a viable alternative for aphakic patients, particularly those who are intolerant of aphakic spectacles and contact lenses. Certain provisos involving patient education and motivation as well as lens selection are noted in this report.

Adult↗
PubMed1985

Intraocular pressure and the corneal endothelium after neodymium-YAG laser posterior capsulotomy. Relative effects of aphakia and pseudophakia.

We studied intraocular pressure (IOP) changes and specular microscopic findings in 118 consecutive neodymium-YAG laser posterior capsulotomy procedures; 37 cases were aphakic, and 81 were pseudophakic. There was a significantly greater rise in IOP one hour after Nd-YAG laser treatment in the aphakic group than in the pseudophakic group (8.2 mm Hg vs 3.5 mm Hg, respectively). At one week postoperatively, IOPs in the aphakic group were still significantly elevated over baseline levels (3.6 mm Hg), while those in the pseudophakic group had returned to baseline levels. Differences in treatment between the aphakic and pseudophakic groups in total number of pulses, average energy, and total energy did not explain the differences in IOP. No significant change in endothelial cell densities was seen between pretreatment measurements and those taken one week after Nd-YAG laser treatment.

Aphakia↗
PubMed1985

Factors affecting pseudophakic cystoid mascular edema: five randomized trials.

We summarize the findings of five randomized prospective, controlled studies that evaluated the following factors associated with the development of cystoid macular edema (CME) following cataract surgery: ultraviolet (UV) light from the operating microscope; postoperative UV light exposure; primary capsulotomy; retrobulbar hyaluronidase; and prostaglandin synthesis in the eye. The following were the major findings: (1) The presence of a UV-light filter on the operating microscope during cataract surgery made no statistically significant difference in the early postoperative (two to six months) angiographic incidence of CME or the visual outcome. (2) A UV-filtering posterior chamber intraocular lens (IOL) resulted in a statistically significant decrease in the early postoperative incidence of angiographic CME in postcataract-surgery patients but did not affect visual acuity. (3) Patients receiving primary capsulotomy during extracapsular cataract surgery showed a statistically significant higher incidence of early postoperative angiographic CME than did patients with an intact posterior capsule. Again there was no difference in visual acuity. (4) The addition of hyaluronidase to the retrobulbar anesthetic injection made no significant difference in the CME rate or postoperative visual results of patients undergoing extracapsular cataract surgery. (5) Patients undergoing IOL implant surgery who received topical indomethacin before surgery and for nine months postoperatively to inhibit prostaglandin synthesis in the eye showed a statistically significant lower incidence of early postoperative angiographic CME than did placebo-treated patients, but there was no significant difference between the two groups in postoperative visual acuity.

Cataract Extraction↗
PubMed1985

Effect of an ultraviolet-filtering intraocular lens on cystoid macular edema.

A prospective double-masked study of 301 patients was undertaken to compare the effect of ultraviolet (UV) filtering in implant intraocular lenses (IOL) on the angiographic incidence of cystoid macular edema (CME) in patients undergoing extracapsular cataract extraction. Patients were randomized to receive either a posterior chamber IOL that contained UV-absorbing chromophore or an identical IOL which did not contain such a chromophore. All patients were scheduled for fluorescein angiography between three and six months after surgery; 228 angiograms were obtained that were readable for the presence or absence of angiographic CME. The mean interval following surgery was 4.3 months. The incidence of CME was 18.8% (21 of 112) in patients who received lenses without UV-filtering chromophore and 9.5% (11 of 116) in patients who received IOLs that contained UV-filtering chromophore. These findings show that UV-filtering-IOLs resulted in a statistically significant (P = 0.03) decrease in the incidence of CME. The presence or absence of the UV-filtering chromophore did not, however, significantly affect visual acuity in the early postoperative period.

Aged↗
PubMed1984

Effect of primary capsulotomy with extracapsular surgery on the incidence of pseudophakic cystoid macular edema.

We performed a prospective randomized study of 288 patients to assess the effect of primary capsulotomy on the angiographic incidence of cystoid macular edema in patients undergoing extracapsular surgery with implantation of an intraocular lens. Patients either had a primary capsulotomy or the posterior capsule remained intact immediately following uneventful posterior chamber intraocular lens implantation. Of the 288 patients, 183 (63%) underwent fluorescein angiography. Angiographically confirmed cystoid macular edema occurred significantly more often in the primary capsulotomy group (20 of 93 patients) than in the intact capsule group (four of 71 patients), for an incidence of 21.5% vs 5.6% (P = .003). The cystoid macular edema appeared milder in the intact capsule group; all the patients with angiographically confirmed cystoid macular edema achieved visual acuities of 20/50 or better. The presence of cystoid macular edema made no difference on visual outcome in the intact capsule group. In contrast, the patients with angiographically confirmed cystoid macular edema in the primary capsulotomy group had significantly worse vision than those who did not have cystoid macular edema (P less than .02).

Aged↗
PubMed1983

The results of posterior chamber lens implantation.

We studied 1,216 consecutive cases where the surgeon's intent was to implant a posterior chamber lens. In 37 cases, the surgeon elected to put in an anterior chamber lens because of events occurring at the time of surgery. In no instance was the intraocular lens procedure aborted and a lens not implanted. In the 37 cases implanted with anterior chamber lenses, 76% had a final visual acuity of 20/40 or better. In the 1,179 cases that had posterior chamber lenses implanted, 90% had visual acuity of 20/40 or better, and only 1% had worse than 20/400 vision. Senile macular degeneration accounted for over one-half of the 104 patients with a visual acuity of 20/40 or worse. Visual results appeared to be age related; 96% of patients who were less than 75-years-old achieved an acuity of 20/40 or better, whereas only 80% of those over 75 years achieved this level. Our results suggest that extracapsular extraction with posterior chamber lens implantation is safe and provides good visual results.

Aged↗
PubMed1983

Serial corneal endothelial cell loss with lathe-cut and injection-molded posterior chamber intraocular lenses.

We compared endothelial cell loss of patients implanted with lathe-cut posterior chamber lenses and those implanted with injection-molded lenses over a three-year postoperative period. Results were based on more than 2,500 measurements of corneal endothelial density. Although the technique of cataract extraction (anterior chamber phacoemulsification, posterior chamber phacoemulsification, or planned extracapsular extraction) significantly affected cell loss (P less than .01), the type of implant (lathe-cut or injection-molded) did not. Significant continuing endothelial cell loss did not occur during the first three postoperative years with injection-molded lenses. There was, however, a statistically significant 7% to 15% additional cell loss after surgery over the first two to three postoperative years with lathe-cut implants. There have been no cases of corneal endothelial decompensation developing after implantation of injection-molded or lathe-cut lenses. Because a standard field clinical specular microscope was used in this study, cell counting errors cannot be ruled out as a cause of these findings.

Cataract Extraction↗
PubMed1983

Secondary intraocular lens implantation.

The visual, refractive, and surgical results with 190 consecutive secondary implantations of an anterior chamber intraocular lens were studied. Best-corrected postoperative visual acuity was either better than or within 1 Snellen line of best-corrected preoperative vision in 87% of the cases. Vision worsened by more than two Snellen lines in ten cases (5%), which included three cases of retinal detachment and one case of ischemic optic neuropathy; however, in only one case (0.5%) did we feel that the visual decrease was directly attributable to the secondary implantation procedure. We believe that secondary intraocular lens implantation can improve functional visual acuity in aphakic patients, especially those unable to tolerate aphakic correction with contact lenses or spectacles.

Adult↗
PubMed1982

Breakdown and reestablishment of blood-aqueous barrier with implant surgery.

Preoperative and serial postoperative anterior chamber fluorophotometry was performed after oral administration of fluorescein sodium in patients undergoing extracapsular cataract extraction combined with intraocular lens implantation. In placebo-treated eyes, the blood-aqueous barrier was reestablished at three months after surgery. The administration of topical indomethacin before and after surgery markedly decreased aqueous fluorescein concentration, and the blood-aqueous barrier was reestablished within five weeks. Because all patients were given sub-Tenon's injection of steroids immediately after surgery and intensive topical steroid therapy postoperatively, the effect of topical indomethacin was additive to or synergistic with steroids. The addition of topical indomethacin caused a small but statistically significant increase in the postoperative intraocular pressure; this effect lasted nine weeks.

Administration, Topical↗
PubMed1982

Prophylaxis of pseudophakic cystoid macular edema with topical indomethacin.

A prospective double-masked study of 500 patients was performed to assess the effect of topical indomethacin on the angiographic incidence of cystoid macular edema (CME) in patients undergoing intraocular lens implant surgery. All patients received either topical indomethacin or placebo before surgery and for nine months after surgery. All patients underwent planned extracapsular extraction (PEC) or posterior chamber phacoemulsification (PC-KPE). Implantation of a posterior chamber lens and a primary capsulotomy were performed in all cases. All cases received postoperative topical corticosteroids. Of the 500 cases, 390 (78%) underwent fluorescein angiography; most were performed between 2 1/2 and 5 months after surgery. The incidence of angiographically confirmed CME was significantly higher in the placebo-treated patients as compared to those treated with indomethacin (18.5% vs 9.6%; P = 0.04). Patients 60 years of age or older had a significantly higher incidence of CME than younger individuals (15% vs. 3.4%; P = 0.03). When corrected for the effects of drug regimen and age, by means of multiple logistic regression, there was no significant correlation between procedure (PEC vs. PC-KPE) and CME rate (P = 0.62). There was no significant difference in postoperative visual acuity between the indomethacin- and placebo-treated patients (P = 0.65).

Adrenal Cortex Hormones↗
PubMed1982

Monitoring for continuing endothelial cell loss with cataract extraction and intraocular lens implantation.

For a period of three years, more than 2,700 endothelial cell density measurements were performed in over 1,000 patients undergoing cataract extraction with and without intraocular lens implantation. We concluded the following from the data: (1) Significant cell loss occurred with all surgical procedures, averaging between 11.6% and 25.6%, depending on type of procedure and implant used; anterior chamber phacoemulsification without intraocular lens implantation caused the most cell loss. (2) Patients with Medallion suture implants produced by one of two manufacturers studied demonstrated statistically significant cell loss during the first (15.6% additional cells lost) and second (22.9% additional cells lost) postoperative years following the initial cell loss due to surgery. This evidence for continuing cell loss with the Medallion suture lens correlated with the clinical observation of an increasing incidence of late bullous keratopathy in these patients. (3) No other surgical procedure or implant type, including Choyce and Shearing implants and Medallion style lenses from another manufacturer, demonstrated any evidence of continuing endothelial cell loss following the initial loss due to surgery.

Cataract Extraction↗
PubMed1980

Specular microscopy in cataract and intraocular lens patients. A report of 564 cases.

We studied 564 patients who underwent cataract surgery, using preoperative and postoperative endothelial cell photographs and corneal thickness measurements. No statistically significant difference was noted in endothelial cell loss between patients with intracapsular cataract extraction (12.6%) and those undergoing posterior chamber phacoemulsification (15.2%). Both procedures had significantly less cell loss than with anterior chamber phacoemulsification (27.3%). Intraocular lens implantation produced a mean endothelial cell loss of 15.8% to 20.9%, depending on surgical technique and implant type. A Choyce-style lens resulted in statistically less cell loss than with other implants. Mean endothelial cell loss was 17.8% with clinically atraumatic and 27.3% with clinically traumatic implantations. Corneal thickness measurements did not correlate with endothelial cell loss or trauma observed clinically at the time of surgery and did not seem helpful in the preoperative evaluation of cataract cases.

Cataract Extraction↗
PubMed1980

Membrane formation after implantation of polyvinyl alcohol-coated intraocular lenses.

Two PVA-coated intraocular lenses were implanted. In the first case there was an acute onset of severe intraocular inflammation and dense membrane formation on the surface of the implant. The inflammation developed on the fifty-third postoperative day in a previously quiet eye. The second case demonstrated a relentless increase in intraocular inflammation that was unresponsive to medical therapy. An acute exacerbation with membrane formation occurred between the fortieth and forty-fifth postoperative days. In both cases the fibrinous membranes and the implants were removed with prompt resolution of symptoms.

Aged↗
PubMed1980

Slit-lamp fluorophotometry in intraocular lens patients.

Two hundred and sixty-four patients who had unilateral implant surgery and normal contralateral unoperated eyes were studied by slit-lamp anterior segment fluorophotomety. Patients tested five weeks to six months after surgeryb averaged 22% more fluorescein in the operated than in the unoperated eye, while those tested after six months averaged only 12% more fluorescein. Patients receiving topical indomethacin demonstrated an 11% increase in fluorescein, while those taking a placebo averaged a 33% increase. Patients with cystoid macular edema averaged a 46% increase in fluorescein compared with a 17% increase in the other patients. Twenty-seven control patients with unilaterally aphakic eyes and normal contralateral unoperated eyes, tested on an average of two years after surgery, showed essentially no increase in fluorescein in the operated eye. Fluorophotometry may be a valuable clinical tool in testing the effect of drugs on the blood-aqueous barrier and to screen patients for cystoid macular edema.

Aqueous Humor↗