Current management of cataracts in patients with glaucoma.
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Cataract↗
Biomedical subjects
J D Gottsch
Publications and source records attributed to J D Gottsch.
Complications of semiflexible, closed-loop anterior chamber intraocular lenses.
Anterior chamber intraocular lenses (IOLs) provided good visual rehabilitation of aphakia in a majority of patients. An increasing number of eyes with closed-loop, semiflexible anterior chamber implants are now being seen with decreased vision due to corneal edema and persistent cystoid macular edema. We evaluated 53 such eyes in 52 patients who presented with decreased vision one to 51 months (average, 15 months) after lens implantation. The most frequent lens implanted was the Surgidev Style 10 Leiske IOL. Surgery for IOL removal or exchange with or without penetrating keratoplasty was performed in 34 (64%) of 53 eyes; visual acuity recovery ranged from 20/20 to hand motions (average, 20/80). Despite clear corneal grafts in 24 (92%) of the 26 eyes that underwent corneal transplantation, visual acuity of 20/40 or better was obtained in only nine eyes (26%). Based on the intractable inflammatory sequelae associated with anterior chamber closed-loop IOLs, we strongly urge discontinuation of their use.
Aged↗
Use of posterior chamber lenses in pseudophakic bullous keratopathy.
The occurrence of pseudophakic bullous keratopathy following anterior chamber intraocular lens implantation is well documented. At the time of penetrating keratoplasty and anterior chamber intraocular lens removal, we attempt to reimplant a posterior chamber lens whenever possible because of the complications associated with anterior chamber lenses. We developed a technique to exchange an anterior chamber lens with a posterior chamber lens during penetrating keratoplasty. The intraocular lens loops are inserted in the ciliary sulcus and the optic is sutured to the iris.
Anterior Chamber↗
Glycolytic activity in the human cornea monitored with nuclear magnetic resonance spectroscopy.
This study confirms the feasibility of using nuclear magnetic resonance (NMR) spectroscopy to assess, noninvasively, glucose metabolism in isolated corneal tissue. Glycolytic activity of human corneas was analyzed by high-resolution NMR spectroscopy and spectrophotometric coupling assays. Glucose utilization and lactate formation were readily demonstrated in incubating intact and deepithelialized human corneas utilizing an NMR spectrometer with an array of spectra taken at ten-minute intervals over a period of nine hours. The lactate formation rate by biochemical coupling assays was determined to be approximately 0.50 mumol/hr in the intact cornea and 0.20 mumol/hr in the de-epithelialized cornea. Analysis by NMR spectroscopy of the rate of glucose utilization and lactate formation may be a useful means of determining human donor corneal viability.
Cornea↗
Corneal metabolism monitored with NMR spectroscopy.
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Alanine↗
First do no harm: routine use of aminoglycosides in the operating room.
For decades aminoglycosides have been used routinely in intraocular surgery to prevent and treat endophthalmitis. However, as more and more studies are conducted, the reality is that these drugs are causing more harm than they are preventing. Summarized herein are the most recent studies concluding that even low-dose aminoglycosides can cause toxic retinal damage. The conclusion, with pertinent recommendations from the Johns Hopkins Hospital, Wilmer Eye Institute Infection Control Committee, is that the questionable benefit of use of aminoglycosides intraoperatively is not justified by the risk of injury.
Amikacin↗
Excimer laser calibration system.
BACKGROUND: Excimer laser photoablation for refractive and therapeutic keratectomies has been demonstrated to be feasible and practicable. However, corneal laser ablations are not without problems, including the delivery and maintenance of a homogeneous beam. We have developed an excimer laser calibration system capable of characterizing a laser ablation profile. METHODS: Beam homogeneity is determined by the analysis of a polymethylmethacrylate (PMMA)-based thin-film using video capture and image processing. The ablation profile is presented as a color-coded map. Interpolation of excimer calibration system analysis provides a three-dimensional representation of elevation profiles that correlates with two-dimensional scanning profilometry. Excimer calibration analysis was performed before treating a monkey undergoing phototherapeutic keratectomy and two human subjects undergoing myopic spherocylindrical photorefractive keratectomy. Excimer calibration analysis was performed before and after laser refurbishing. RESULTS: Laser ablation profiles in PMMA are resolved by the excimer calibration system to .006 microns/pulse. Correlations with ablative patterns in a monkey cornea were demonstrated with preoperative and postoperative keratometry using corneal topography, and two human subjects using video-keratography. Excimer calibration analysis predicted a central-steep-island ablative pattern with the VISX Twenty/Twenty laser, which was confirmed by corneal topography immediately postoperatively and at 1 week after reepithelialization in the monkey. Predicted central steep islands in the two human subjects were confirmed by video-keratography at 1 week and at 1 month. Subsequent technical refurbishing of the laser resulted in a beam with an overall increased ablation rate measured as microns/pulse with a donut ablation profile. A patient treated after repair of the laser electrodes demonstrated no central island. CONCLUSIONS: This excimer laser calibration system can precisely detect laser-beam ablation profiles. The calibration system correctly predicted central islands after excimer photoablation in a treated monkey cornea and in two treated human subjects. Detection of excimer-laser-beam ablation profiles may be useful for precise calibration of excimer lasers before human photorefractive and therapeutic surgery.
Animals↗