Visual field loss attributable to misting of the trial lens.
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Eyeglasses↗
Biomedical subjects
I A Cunliffe
Publications and source records attributed to I A Cunliffe.
Between-algorithm, between-individual differences in normal perimetric sensitivity: full threshold, FASTPAC, and SITA. Swedish Interactive Threshold algorithm.
PURPOSE: To determine the between-algorithm differences in perimetric sensitivity for the Swedish Interactive Threshold algorithm (SITA) Standard, SITA Fast, FASTPAC, and Full Threshold algorithms; to determine the between-subject, between-algorithm differences in the magnitude of the normal variation in sensitivity. METHODS: The sample comprised 50 normal subjects (mean age, 52.9 +/- 18.5 years) experienced in automated perimetry. One randomly assigned eye was examined at three visits with Program 30-2 of the Humphrey Field Analyzer (HFA). The first visit was a familiarization session. A two-period crossover design with order randomization within visits was used over the second and third visits. SITA Standard, SITA Fast, and HFA 640 Full Threshold were administered during one visit. FASTPAC and HFA 750 Full Threshold were administered during the remaining visit. RESULTS: Group mean Mean Sensitivity was 0.8 dB higher for SITA Standard than for Full Threshold (P < 0.001) and 1.3 dB higher for SITA Fast than for Full Threshold (P < 0.001). A similar trend was found between SITA and FASTPAC. The group mean Mean Sensitivity for SITA Fast was 0.5 dB higher than for SITA Standard (P < 0.001). The pointwise between-algorithm difference in sensitivity was similar for all algorithms. The pointwise between-algorithm, between-subject variability was lower for SITA. The examination durations for SITA Fast and SITA Standard were half those for FASTPAC and Full Threshold; SITA Fast was 41% that of SITA Standard (P < 0.001). CONCLUSIONS: SITA produced marginally higher mean mean sensitivity compared with that of existing algorithms and markedly reduced examination duration. The reduced between-subject variability of SITA should result in narrower confidence limits for definition of normality.
Adult↗
The SITA perimetric threshold algorithms in glaucoma.
PURPOSE: To determine the within-visit between-algorithm and the within-algorithm between-visit differences in sensitivity for the SITA Standard, SITA Fast, FASTPAC, and Full Threshold algorithms in stable primary open angle glaucoma. METHODS: One designated eye from each of 29 patients (age 67.3 +/- 10.2 years; mean +/- SD) experienced in automated perimetry was examined with the four algorithms on each of three visits, using the Humphrey Field Analyzer 750 and Program 30-2. RESULTS: The group mean Mean Sensitivity was 1.0 dB greater for SITA Standard than Full Threshold (P < 0.001), 0.7 dB greater for SITA Standard than FASTPAC (P < 0.001), 1.6 dB greater for SITA Fast than FASTPAC (P < 0.001), and 0.9 dB greater for SITA Fast than SITA Standard (P < 0.001). The higher pointwise sensitivity for SITA Fast compared to Full Threshold, FASTPAC, and SITA Standard increased with increase in defect depth. The examination duration for SITA Standard was 53% of that for Full Threshold and 50% shorter for SITA Fast compared to FASTPAC (P < 0.001), regardless of age (P = 0.932). The examination duration increased with increase in severity of field loss (P < 0.001), and this increase was proportionately greater for both SITA algorithms (P < 0.001), particularly SITA Fast. The Total and Pattern Deviation probability analyses of both SITA algorithms yielded a statistically greater defect than Full Threshold or FASTPAC (P < 0.001). The within-algorithm between-visit differences were similar between SITA Standard and Full Threshold and between SITA Fast and FASTPAC. CONCLUSIONS: Both SITA algorithms produce a marginally higher differential light sensitivity compared to existing algorithms but with a statistically deeper defect and a marked reduction in examination duration.
Adult↗
Long-term follow-up of Molteno drains used in the treatment of glaucoma presenting in childhood.
PURPOSE AND METHODS: This study reviews the long-term follow-up (mean 11.2 years, range 9 months to 16 years 9 months) of Molteno drains used in the treatment of glaucoma presenting in childhood, in 34 eyes of 25 patients. RESULTS: Intraocular pressure control was achieved in 85% of eyes, and vision (where measurable) was maintained in 57% of eyes. Seventy-one per cent of eyes required further surgical intervention. Thirty-two per cent of these cases were for drain-related problems, which may be avoidable with the use of current surgical techniques. The remaining interventions were for associated ocular defects, and for problems caused by multiple surgical procedures and periods of high intraocular pressure during early childhood. CONCLUSIONS: Today the implants are used at an earlier stage in the disease process to try to obtain early and definitive IOP control and so help to optimise the long-term visual prognosis.
Adolescent↗
The effect of TGF-beta 1 and TGF-beta 2 on the proliferation of human Tenon's capsule fibroblasts in tissue culture.
This study examines the effect of transforming growth factor beta 1 and 2 (TGF-beta 1 and TGF-beta 2) on the proliferation of human Tenon's capsule fibroblasts in tissue culture. Both TGF-beta 1 and TGF-beta 2 were shown to stimulate proliferation at 1000 and 100 pg/ml concentrations. We discuss the significance of these findings with respect to wound healing following trabeculectomy, and postulate why some eyes are more at risk of failure than others.
Cell Division↗
Pilot study on the effect of topical adrenergic medications on human Tenon's capsule fibroblasts in tissue culture.
Recent publications have suggested that the long term use of topical antiglaucoma medications may be detrimental to the outcome of trabeculectomy. In order to investigate this further, the effect of several adrenergic agents and a preservative on the proliferation and viability of human Tenon's capsule fibroblasts in tissue culture were examined. The following compounds were tested: adrenaline (Eppy 1% and pure adrenaline base 1%, Smith & Nephew Pharmaceuticals Ltd); dipivefrine hydrochloride (Propine 0.1% and pure dipivefrine hydrochloride 0.1% Allergan Ltd and Allergan Pharmaceuticals (Ireland) Ltd); benzalkonium chloride (pure benzalkonium chloride 0.01%, Sigma Chemical Company Ltd); the two adrenaline based preparations were also tested in the presence of an antioxidant. None of the tested compounds stimulated the proliferation of fibroblasts. The commercial products tested, their pure compounds, and the preservative all inhibited proliferation and had toxic effects on the cells. In the presence of antioxidant, commercial Eppy and pure adrenaline base appeared to have less effect on proliferation and toxicity. These findings are discussed with reference to the outcome of trabeculectomy.
Adrenergic Agents↗
Effect of TNF, IL-1, and IL-6 on the proliferation of human Tenon's capsule fibroblasts in tissue culture.
Trabeculectomy is a commonly performed procedure for primary open angle glaucoma and is successful in the majority of cases. However, certain factors including aphakia, previous surgery, secondary glaucomas, ethnic origin, and the long term use of topical antiglaucoma medications may be associated with a reduced success rate. The mechanism (or mechanisms) which influence clinical outcome following trabeculectomy remain elusive. Alterations in the composition of the conjunctiva or aqueous humour may be partly responsible for this effect, and this could be mediated by cytokines. In this study we found that tumour necrosis factor (TNF), and interleukin 1 (IL-1) were capable of stimulating the proliferation of Tenon's capsule fibroblasts in tissue culture. Interleukin 6 (IL-6) did not appear to have any effect. The relevance of this to wound healing following trabeculectomy is discussed.
Aged↗
Influence of apraclonidine and pilocarpine alone and in combination on post laser trabeculoplasty pressure rise.
Apraclonidine and pilocarpine have been shown to be effective in reducing the incidence of intraocular pressure (IOP) spikes following argon laser trabeculoplasty. An additional reduction in the incidence of acute pressure rise might theoretically be expected by combining these two effective agents. In a prospective randomised study we compared the ability of apraclonidine and pilocarpine alone and in combination to prevent post laser pressure spikes. Patients receiving regular pilocarpine to either eye were excluded. Seventy five eyes received either apraclonidine (26 eyes), pilocarpine (23 eyes), or both drugs (26 eyes). Apraclonidine 1% was instilled 1 hour before and immediately after, and pilocarpine 4% immediately after trabeculoplasty. IOP was measured before and at 1, 2, and 3 hours following trabeculoplasty. In only two (8%) eyes receiving combined treatment was a pressure rise observed. This frequency was significantly lower than that seen in eyes treated with apraclonidine alone (38%), or pilocarpine alone (39%). The mean fall in IOP at 1, 2, and 3 hours was significantly greater in those eyes receiving combined treatment than in the other two groups.
Adrenergic beta-Agonists↗
Choroidal melanoma presenting as vitreous haemorrhage.
Vitreous haemorrhage is an unusual presenting feature of malignant melanoma of the choroid. We describe three cases in which this occurred. The three tumours shared a number of common features: all were located in the peripheral choroid, were of a similar size and had a small herniation of tumour tissue through Bruch's membrane. We believe that vascular congestion caused by constriction of the tumour vasculature at the site of herniation is the most probable cause for the haemorrhage in these cases. We review the relevant literature and discuss some of the commoner differential diagnoses.
Aged↗
Intra-operative use of 5-fluorouracil in glaucoma filtering surgery.
This study reviews the outcome of 14 eyes considered to be at risk of surgical failure undergoing trabeculectomy with 5-Fluorouracil (5-FU). The antimetabolite was administered intra-operatively by placing a surgical sponge soaked in 5-FU (25 mg/ml) directly on the sclera under the conjunctival flap for 5 minutes. All eyes showed a reduction in intraocular pressure (IOP) at a mean follow-up of 18.5 weeks, and only one eye required topical antiglaucoma medication. Mean IOP reduction at final follow-up was 43.1%. No eyes showed any corneal problems associated with the intra-operative use of 5-FU. These results suggest that the intra-operative use of 5-Fluorouracil is an effective way of improving surgical success in at risk eyes. The early complications appear to be less than those associated with post-operative subconjunctival injections of 5-FU, but the long-term differences are still to be shown.
Adult↗
The effect of trabeculectomy on corneal topography.
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Corneal Diseases↗
A prospective study examining the changes in factors that affect visual acuity following trabeculectomy.
Many patients report subjective changes in vision following trabeculectomy. In a prospective study of 16 eyes, we have tried to determine the causes of these visual changes. Ninety-four per cent of eyes showed a change in uncorrected Snellen acuity 1 week following surgery. This change was due to a myopic shift in refraction secondary to changes in the anterior chamber depth. A 1 mm change in anterior chamber depth results in approximately a 2 dioptre change in refractive sphere. Visual acuity starts to return to pre-operative levels by the third post-operative week, from which point no eyes showed a deterioration in corrected acuity of more than one line of Snellen. The vertical corneal radius of curvature is reduced in the early post-operative period and there is a with-the-rule change in corneal astigmatism. This resolves over longer follow-up and the possible causes of this are discussed. No changes were noted in corneal thickness and there was no evidence of macular oedema over the follow-up period. Patients should be warned of these possible visual changes pre-operatively as many will have normal acuity prior to surgery.
Aged↗
Bilateral optic nerve sheath meningiomas in a patient with neurofibromatosis type 2.
A 34-year-old woman who presented with hearing loss and tinnitus was found to have reduced vision bilaterally. Computed tomography scan revealed bilateral acoustic neuromas and bilateral optic nerve sheath meningiomas. The presence of bilateral acoustic neuromas fulfils the criteria for the diagnosis of central neurofibromatosis (neurofibromatosis type 2). Although this is the first report of bilateral optic nerve sheath meningioma in neurofibromatosis type 2, meningiomas are commoner in this dominantly inherited disorder, than in its absence and both forms of central nervous system tumour may be caused by loss of tumour suppressor genes on chromosome 22.
Adult↗
A novel approach to the assessment of afferent pupillary defects.
The pupil response to a flashing light stimulus was observed for a group of 26 healthy volunteer controls, and 15 patients with relative afferent pupillary defects (RAPDs). For the control group, the mean interval between flashes which would just produce a perceptible pupil response was 295 milliseconds (ms). The mean difference between right and left eyes was 8.84 ms. The mean difference between normal and abnormal eyes of the APD group was 78.6 ms. The difference between these results and those of the control group are highly significant statistically (p less than 0.001), and we conclude that this test may be of use in the assessment of defects of the afferent light pathways.
Adult↗
Extracapsular cataract surgery with lens implantation in diabetics with and without proliferative retinopathy.
In a retrospective study we have examined all diabetics (66 operated eyes) and an equal number of non-diabetic matched controls who underwent extracapsular cataract extracation (ECCE) with intraocular lens (IOL) implantation over a two-year period ending in December 1987. Of the diabetic patients' 76% eyes improved by at least two lines of Snellen acuity postoperatively. Of these patients 68% eyes and of the control eyes 83% achieved an acuity of 6/12 or better. In the diabetics the visual outcome depended on the state of the retinopathy and in particular the maculopathy. The diabetic group had a greater incidence of postoperative inflammation, but the major complications were related to continuing neovascularisation. Early postoperative laser photocoagulation may help to prevent these proliferative complications, and, provided a large, adequate capsulotomy is performed for capsular thickening, the presence of an IOL does not interfere with this photocoagulation. We also advise early postoperative assessment, and treatment if necessary, of any maculopathy. Diabetic retinopathy should no longer be regarded as a contraindication to intraocular lens insertion.
Adult↗