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Biomedical subjects

J B Jonas

Publications and source records attributed to J B Jonas.

At least 73 records · Page 4Linked to original sources
PubMed2001

Autologous ipsilateral rotating penetrating keratoplasty.

PURPOSE: To evaluate visual outcome after autologous ipsilateral rotating penetrating keratoplasty. METHODS: The study included nine patients who consecutively underwent autologous ipsilateral rotating penetrating keratoplasty for treatment of traumatic central corneal avascular scars. These patients were compared with 105 patients who consecutively underwent homologous central penetrating keratoplasty in the same study period for treatment of avascular corneal scars extending to the corneal periphery. All operations were performed by the same surgeon. Mean follow-up time for both study groups was 31.27 +/- 21.54 and 32.0 +/- 19.4 months, respectively. RESULTS: In the autologous rotating keratoplasty group, visual acuity increased significantly (P = 0.03; Wilcoxon test) from 0.13 +/- 0.11 preoperatively to 0.29 +/- 0.16 postoperatively. Refractive astigmatism and keratometric astigmatism, respectively, increased (P = 0.02) from 3.19 +/- 2.53 diopters and 3.20 +/- 2.24 diopters, respectively, preoperatively to 6.9 +/- 1.82 diopters and 9.55 +/- 4.32 diopters, respectively, postoperatively. Comparing the study groups, postoperative visual acuity was significantly lower (P = 0.01), and keratometric astigmatism (P = 0.003) and refractive astigmatism (P = 0.01) were significantly higher in the autologous rotating keratoplasty group than in the control group. CONCLUSIONS: Autologous ipsilateral rotating penetrating keratoplasty compared with homologous central penetrating keratoplasty is associated with a high postoperative refractive and keratometric astigmatism leading to a relatively low postoperative visual acuity. It suggests that, in normal clinical conditions when donor material is available and postoperative follow-up examinations can be performed, homologous central penetrating keratoplasty may be superior to autologous ipsilateral rotating keratoplasty.

Adolescent↗
PubMed2001

Intravitreal injection of crystalline cortisone as adjunctive treatment of proliferative diabetic retinopathy.

PURPOSE: To report the clinical outcome and complications of intravitreal injections of crystalline cortisone in patients undergoing pars plana vitrectomy for treatment of proliferative diabetic retinopathy. METHODS: The prospective, interventional case series study included 29 consecutive patients (29 eyes) who underwent pars plana vitrectomy for treatment of complicated proliferative diabetic retinopathy associated with central retinal traction detachment. All patients received an intravitreal injection of 15 to 20 mg of crystalline triamcinolone acetonide at the end of surgery, and were operated on by the same surgeon. Mean follow-up time was 1.4 +/- 1.1 months (median, 1 month; range, 0.30 to 4.9 months). RESULTS: At the end of the follow-up period, the retina was attached in 26 of the 29 patients (89.7%). In three of the 29 patients (10.3%), a retinal redetachment had occurred. None of the patients developed iris neovascularization, and the iris neovascularization, present preoperatively in 12 patients, slightly to markedly regressed in all 12 patients. Preoperative and postoperative intraocular pressure values (P =.72) and blood glucose measurements did not vary significantly. A pseudohypopyon consisting of cortisone crystals in the inferior anterior chamber angle was detected in one patient and resolved spontaneously within 4 days. CONCLUSIONS: The present clinical study suggests that intravitreal injection of crystalline cortisone with most of the vehicle removed seems to be well tolerated by eyes undergoing pars plana vitrectomy for treatment of complicated diabetic proliferative retinopathy. In view of the antiphlogistic and antiproliferative effect of cortisone, future randomized clinical trials may be indicated to investigate further the role of intravitreal injection of crystalline cortisone in the treatment of proliferative diabetic retinopathy.

Adult↗
PubMed2001

Tectonic sclerokeratoplasty and tectonic penetrating keratoplasty as treatment for perforated or predescemetal corneal ulcers.

PURPOSE: To report the clinical outcome of patients with perforated or predescemetal corneal ulcers treated by tectonic, centric or eccentric penetrating keratoplasty or by tectonic sclerokeratoplasty. DESIGN: Nonrandomized clinical trial. METHODS: The study included 60 patients (60 eyes) with perforated or predescemetal corneal ulcers who were consecutively operated on by the same surgeon. Fifty-two patients underwent tectonic penetrating centric or eccentric keratoplasty. Eight patients with paralimbal corneal ulcers underwent tectonic sclerokeratoplasty. A control group consisted of 76 patients (76 eyes) electively undergoing central penetrating keratoplasty for treatment of inactive central corneal scars. RESULTS: In the study group with perforated or predescemetal corneal ulcers, best-corrected postoperative visual acuity ranged from perception of light to 0.80 (median, 0.10), with 54 of 60 eyes (90%) attaining an improvement of best visual acuity. In 10 of 60 patients (16.7%), tectonic penetrating keratoplasty had to be re-performed because of a recurring corneal ulcer. Patients with sclerokeratoplasty and patients with eccentric keratoplasty did not differ in clinical outcome, despite larger trephine and corneal lesion size in the sclerokeratoplasty group. Among study patients compared with control patients, postoperative visual acuity was significantly lower (P =.01), postoperative refractive and keratometric astigmatism were significantly higher (P <.05), and immunologic graft reactions (P =.02) and suture loosening (P <.001) occurred significantly more often. CONCLUSIONS: Eyes with perforated corneal ulcers or predescemetal corneal ulcers can usually be saved by tectonic keratoplasty or sclerokeratoplasty, with a moderate to considerable amount of remaining useful vision. In case of doubt, one may prefer conservative treatment of corneal ulcers and to electively perform central keratoplasty when the ulcers have healed. For selected clinical situations, sclerokeratoplasty is an alternative to keratoplasty for surgical treatment of paralimbal corneal defects.

Adolescent↗
PubMed2001

Interobserver variability of optic disk variables measured by confocal scanning laser tomography.

PURPOSE: To assess the interobserver variation of confocal laser scanning tomographic measurements of the optic nerve head and to address the question of whether the addition of clinical optic disk photographs is helpful in outlining the optic disk margin and in reducing the observer-related variation of the measurements. PATIENTS AND METHODS: Optic disk variables for 16 eyes of 16 patients with glaucoma, generated by confocal laser scanning laser tomography (Heidelberg Retina Tomograph), were independently evaluated by four experienced glaucoma specialists, and the interobserver variability was calculated. A second separate review by the same observers included the use of clinical stereoscopic color optic nerve head photographs to aid definition of the optic disk margin. RESULTS: Optic disk parameters with the smallest interobserver variation were cup shape measure, maximum cup depth, height variation contour, and mean height contour. The intraobserver variation of these parameters did not increase when clinical optic disk slides were additionally available. Parameters with the highest interobserver variation were volume below surface, volume below reference, volume above surface, and volume above reference. The observer variation of these optic disk parameters increased significantly for two of the four examiners when clinical optic disk slides were additionally available for outlining the optic disk margin. CONCLUSION: Confocal laser scanning tomography of the optic nerve head can be improved significantly if clinical optic disk photographs are additionally available to help in outlining the optic disk margin. Because interobserver variation in the tomographic optic disk measurements can be significant, even if experienced observer are involved, tomographic optic disk measurements may be centralized in reading centers in the case of multicenter studies.

Diagnostic Techniques, Ophthalmological↗
PubMed2001

Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema.

PURPOSE: To report the clinical outcome of a diabetic patient with macular edema treated with an intravitreal injection of crystalline cortisone. METHODS: Interventional case report. A 73-year-old patient with diabetes mellitus presented with clinically significant diffuse macular edema caused by nonproliferative diabetic retinopathy. Despite grid laser coagulation in the macular region, cystoid macular edema progressed, and within 6 months before the cortisone injection, visual acuity declined from 0.25 to 0.16 and, finally, to 0.10. The patient received a single intravitreal injection of triamcinolone acetonide with topical anesthesia. RESULTS: After the intravitreal injection of triamcinolone acetonide, visual acuity improved from 0.10 to 0.40 during the follow-up period spanning 5 months. Intraocular pressure increased to values up to 30 mm Hg before antiglaucomatous treatment. CONCLUSION: Intravitreal injection of triamcinolone acetonide may be useful for treatment of diabetic macular edema resistant to conventional therapy.

Aged↗
PubMed2001

Central retinal vessel trunk exit and location of glaucomatous parapapillary atrophy in glaucoma.

OBJECTIVE: To evaluate whether the position of the central retinal vessel trunk exit on the lamina cribrosa spatially correlates with the location of parapapillary atrophy in glaucoma. DESIGN: Clinic-based, observational, cross-sectional study. PATIENTS: Color stereo optic disc photographs of 95 patients with primary or secondary open-angle glaucoma and 65 healthy persons were morphometrically evaluated. The intrapapillary and parapapillary region was divided into four quadrants. We determined the position of the central retinal vessel trunk exit on the lamina cribrosa surface and measured the area of parapapillary atrophy and neuroretinal rim in the four quadrants. MAIN OUTCOME MEASURES: The area of neuroretinal rim and parapapillary atrophy and the position of the central retinal vessel trunk exit. RESULTS: Comparing measurements between opposite disc quadrants showed that beta zone of parapapillary atrophy was significantly (P < 0.05) larger and that the neuroretinal rim was significantly smaller when beta zone and neuroretinal rim were measured in the disc quadrant most distant to the central retinal vessel trunk exit, than if the beta zone and neuroretinal rim were measured in the quadrant containing the vessel trunk exit. Comparing measurements in the disc quadrants between eyes with different positions of the central retinal vessel trunk exit revealed that, in the respective disc quadrant, the beta zone was significantly larger and the neuroretinal rim was smaller in eyes with the vessel trunk exiting in the opposite disc quadrant than in eyes with the vessel trunk exit located in the respective disc quadrant where the measurements were obtained. CONCLUSIONS: Position of the central retinal vessel trunk exit on the lamina cribrosa influences the location of parapapillary atrophy in glaucoma. The longer the distance to the central retinal vessel trunk exit, the more enlarged is parapapillary atrophy and the smaller is the neuroretinal rim. This relationship agrees with the spatial relationship between glaucomatous neuroretinal rim loss and enlarged parapapillary atrophy in glaucoma. Diagnostically, it may indicate that, in eyes with an abnormal configuration of parapapillary atrophy or with an abnormal position of the central retinal vessel trunk exit, early glaucomatous rim changes should be looked for in the disc sector that is most distant to the central retinal vessel trunk exit and where parapapillary atrophy may be relatively large.

Adult↗
PubMed2001

Optic disc morphology after arteritic anterior ischemic optic neuropathy.

OBJECTIVE: To evaluate the appearance of the nerve head in patients after giant cell arteritis-induced arteritic anterior ischemic optic neuropathy (A-AION). DESIGN: Noncomparative clinical case series. PATIENTS: The study comprised 29 patients who presented with unilateral A-AION and temporal artery biopsy-proven giant cell arteritis. Stereoscopic optic disc photographs, taken of both the affected and unaffected eyes at the onset of the disease and after a follow-up period of 20.10 +/- 25.36 months (median, 11 months; range, 2-102 months), were morphometrically evaluated. MAIN OUTCOME MEASURES: Size and shape of the optic disc, neuroretinal rim, optic cup, and alpha and beta zones of parapapillary atrophy. RESULTS: In the eyes after A-AION, at the end of the study, the neuroretinal rim was significantly (P = 0.002) smaller, and the optic disc cup area was significantly (P = 0.001) larger than those of the contralateral unaffected eyes. Alpha zone and beta zone of parapapillary atrophy did not vary significantly (P > 0.50). CONCLUSIONS: A-AION, like glaucomatous optic neuropathy, results in neuroretinal rim loss and optic disc cupping. However, in contrast to glaucoma, A-AION is not associated with an enlargement of parapapillary atrophy. The reasons and mechanisms responsible for these similarities and dissimilarities are discussed. Marked clinical, morphologic, and histopathologic similarities in optic disc cupping and loss of neuroretinal rim between A-AION and glaucomatous optic neuropathy are highly suggestive of a common mechanism for the development of the two diseases (i.e., ischemia of the optic nerve head). The subject is discussed at length.

Aged↗
PubMed2001

Intraocular pressure after homologous penetrating keratoplasty.

PURPOSE: To evaluate intraocular pressure (IOP) changes after homologous central penetrating keratoplasty in a noncomparative interventional case series. METHODS: The study included 245 patients undergoing homologous central penetrating keratoplasty for keratoconus (n = 77), herpetic corneal scars (n = 29), nonherpetic corneal scars (n = 46), Fuchs endothelial dystrophy (n = 24), and secondary corneal endothelial decompensation caused by preceding intraocular operations (n = 69). Mean follow-up time was 30.4 +/- 18.7 months (range, 12.1-111.6 months). The same surgeon operated on all patients, and a peripheral iridotomy was routinely performed. RESULTS: On the first postoperative day, IOP was significantly (P = 0.02) higher than that before keratoplasty. Taking the whole study group and taking the study groups separately, IOP measurements determined on the third postoperative day (P = 0.57), 1 week after surgery (P = 0.55), or later (P > 0.50) were not significantly different from the preoperative values. Eyes undergoing keratoplasty with cataract surgery and eyes undergoing keratoplasty without additional intraocular procedures did not vary significantly (P > 0.10) in IOP measurements. IOP did not differ significantly (P > 0.50) between eyes with an immunologic graft reaction (n = 29) and eyes without a reaction (n = 216). Acute angle-closure glaucoma was not detected in any of the patients. IOP measurements were statistically independent of suture type (P > 0.10), age (P > 0.05), preoperative and postoperative refractive error (P > 0.05), preoperative and postoperative corneal astigmatism (P > 0.10), preoperative and postoperative visual acuity (P > 0.10), diameter of graft and trephine (P > 0.15), and oversize of the graft (P > 0.50). Postoperative IOP measurements were significantly (P < 0.01) correlated with preoperative IOP values. CONCLUSIONS: In eyes with a peripheral iridotomy performed during surgery, homologous central penetrating keratoplasty usually does not markedly change IOP. The main risk factor for postoperatively increased IOP is increased IOP before surgery.

Adolescent↗
PubMed2001

Intraocular pressure and silicone oil endotamponade.

PURPOSE: To evaluate intraocular pressure after instillation and eventual removal of silicone oil in patients undergoing pars plana vitrectomy combined with silicone oil endotamponade. METHODS: The study included 198 patients who underwent pars plana vitrectomy with silicone oil endotamponade (5,000 centistoke viscosity), in whom silicone oil was removed and in whom follow-up after oil removal was at least 3 months. All patients were operated on by one of two surgeons. RESULTS: After silicone oil instillation, intraocular pressure increased significantly (P < 0.001) from 12.9 +/- 4.4 mm Hg preoperatively to 16.1 +/- 5.5 mm Hg postoperatively. Intraocular pressure was statistically (P > 0.20) independent of the duration of silicone oil tamponade. Twenty percent of the 198 patients had at least one postoperative intraocular pressure measurement that was higher than 21 mm Hg. Main reasons for increased intraocular pressure were closed inferior iridectomy, iris neovascularisation, silicomacrophagocytic open-angle glaucoma secondary to silicone oil emulsification, and preoperative history of glaucoma. Glaucomatous optic nerve damage was detected in 14 (14 of 198, 7.1%) eyes, including 8 eyes with preoperative antiglaucoma treatment. Silicone oil emulsification occurring in 40 (40 of 198, 20.2%) patients did not statistically influence intraocular pressure after oil removal. Ocular hypotony occurred in 10 (10 of 198, 5.1%) patients after oil release leading to intraocular hemorrhages and loss of vision in 3 patients. CONCLUSION: Clinically significant increased intraocular pressure after pars plana vitrectomy with silicone oil endotamponade occurs relatively rarely, can usually be well controlled by topical antiglaucoma medication, and is reversible in most patients after oil removal. In patients with increased intraocular pressure and silicone oil endotamponade, oil removal may be preferred to invasive antiglaucoma surgery to reduce intraocular pressure.

Adolescent↗
PubMed2001

Regression of neovascular iris vessels by intravitreal injection of crystalline cortisone.

PURPOSE: To report the clinical outcome of patients who received an intravitreal injection of crystalline triamcinolone acetonide as treatment of neovascular glaucoma. PATIENTS AND METHODS: The study included 14 eyes of 14 patients with secondary neovascular glaucoma attributable to proliferative diabetic retinopathy (n = 9) or ischemic central retinal vein occlusion (n = 5). All patients received an intravitreal injection of 20 mg of crystalline triamcinolone acetonide as the only procedure (n = 4) or in combination with additional procedures, such as goniosynechiolysis (n = 1), phacoemulsification and intraocular lens implantation (n = 2), or transscleral peripheral retinal cryocoagulation (n = 7). Mean follow-up time was 3.10 +/- 2.40 months (median, 3.5 months; range, 0.50-5.7 months). A goniosynechiolysis was carried out in those patients in whom the anterior chamber was circumferentially closed. RESULTS: After surgery, including the first days after surgery, the patients were nearly pain-free. Intraocular pressure was significantly (P < 0.01) reduced from 33.4 +/- 14.5 mm Hg before surgery to 20.7 +/- 8.2 mm Hg at the end of the follow-up period. Postoperative visual acuity (mean, 0.09 +/- 0.07; median, 0.10; range, finger counting to 0.25) was slightly but not significantly (P = 0.31) better than the preoperative values. Degree of rubeosis iridis decreased significantly (P = 0.02) from 2.6 +/- 1.3 relative units to 1.3 +/- 1.2 relative units. When considering only the four patients for whom the intraocular cortisone injection was the only procedure performed, mean intraocular pressure decreased from 26.5 +/- 12.1 mm Hg to 21.75 +/- 11.3 mm Hg. CONCLUSIONS: Intravitreal injection of crystalline cortisone with most of the vehicle removed may be a potentially useful additional tool in the treatment of neovascular glaucoma.

Aged↗
PubMed2001

Retinal redetachment after removal of intraocular silicone oil tamponade.

AIM: To evaluate frequency and risk factors of retinal redetachment after removal of intraocular silicone oil tamponade. METHODS: The study included 225 patients who consecutively underwent intraocular silicone oil removal at a mean interval of 10 months after pars plana vitrectomy had been performed by one of two surgeons. Mean follow up time was 17.37 (SD 14.40) months (range 3.02-67.42 months). RESULTS: In 57 of 225 (25.3%) patients, the retina detached after removal of silicone oil. Risk factors for retinal redetachment were the following: number of previously unsuccessful retinal detachment surgeries (p=0.0008); surgeon (p=0.007); visual acuity before silicone oil removal (p=0.009); incomplete removal of vitreous base (p=0.01); absence of an encircling band in eyes with proliferate vitreoretinopathy in which an inferior retinotomy had not been performed (p=0.01); and indication for pars plana vitrectomy. Rate of retinal redetachment was statistically (p>0.05) independent of the technique of silicone oil removal and duration of silicone oil endotamponade. CONCLUSION: Retinal redetachment after removal of silicone oil endotamponade can occur in approximately a fourth of patients, depending on the criteria to use and to remove silicone oil. Risk factors for recurrent detachment included the following: number of previously unsuccessful retinal detachment surgeries, surgeon, preoperative visual acuity, incomplete removal of the vitreous base, absence of an encircling band, and reason for pars plana vitrectomy. The rate of retinal redetachment is independent of the technique of silicone oil removal and duration of silicone oil endotamponade, with a minimal duration of silicone oil tamponade of about 3 months in the present study.

Adolescent↗