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Biomedical subjects

J Kopel

Publications and source records attributed to J Kopel.

7 recordsLinked to original sources

[Ultrasonic treatment of hypertonia caused by intraocular silicone oil].

The authors treated 53 patients with uncontrolled glaucoma in silicone oil filled eyes with high intensity focused ultrasound. The silicone oil filled eyes present unusually difficult problems in glaucoma management, since the silicone oil rapidly obstructs filtration openings, and laser techniques have not been effective. The mean pretreatment pressure was 34.2 mmHg. The patients were followed for a mean of 17 months. Seventy-five per cent of ultrasound treated eyes had successful reduction of intraocular pressure to below 20 mmHg with or without concomitant medical treatment at two years after treatment. The complication rate was low in this group of eyes. Five eyes developed hypotonia and three eyes had full thickness scleral perforations but were effectively controlled and developed no other complications during two years of follow-up. This technique appears more effective than cyclo-destructive techniques alone.

Adolescent

Therapeutic ultrasound for the treatment of glaucoma.

We present a summary of the results obtained on 1142 treatments of 1072 eyes treated in our hospital during the last 5 years. Ultrasound has been used to treat 843 eyes with refractory glaucoma and also to restore failed trabeculectomy filtering blebs in 229 eyes. The single treatment success rate with success defined as an IOP > or = 20 mm Hg was 59% at one year and 46% at 3 years. In cases of failed blebs, ultrasound treatment performed 3 to 12 weeks after trabeculectomy revived the blebs of 82% of the phakic eyes when 5 FU subconjunctival injections were performed in the following days.

Glaucoma

Treatment of glaucoma with high intensity focused ultrasound.

Focused high intensity therapeutic ultrasound has been used since 1982 by Coleman and all, to treat patients with uncontrollable intraocular pressure. Three mechanisms may be responsible for lowering intraocular pressure: decreased aqueous humor production in the ciliary epithelium, transscleral outflow of aqueous humor, and increased uveal outflow. We began the use of focused ultrasound to treat glaucoma in April 1987. Up to now (April 1988), we have treated 220 patients. We describe results from patients that had a follow up of 3, 6, 12 months. Successful treatment resulting in pressure less than 20 mm Hg, was obtained in over 80% of patients treated at 90 days post treatment and of 50% after 6 and 12 months. The complication rate is low. Retreatment is safe and effective. Additionally, the use of U.S. to open closed filtering blebs, recently postoperative, has been a success in 90% of the treated eyes after 3 months. The follow-up period of this study is short which makes conclusions about long-term effects and side effects not possible.

Follow-Up Studies

[Principles and histologic effects of the treatment of hypertension with focused high-intensity ultrasound].

Focused high-intensity ultra-sound is used to treat glaucoma. Histopathologic examinations of rabbit and pig eyes following therapeutic ultrasound demonstrated highly localized lesions including destruction of the ciliary epithelium and thinning of the sclera. The bond between the sclera and the ciliary epithelium is weakened. The conjunctiva remains intact. The histologic findings in human eye enucleated after ultra-sound therapy are identical. Three mechanisms for pressure reduction are proposed: transscleral outflow of aqueous humor can occur under the overlying conjunctiva; focal destruction of the ciliary epithelium can reduce aqueous production; scleral scarring produces the potential for separation of the ciliary body and the sclera.

Animals