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Biomedical subjects

J M Ruderman

Publications and source records attributed to J M Ruderman.

16 recordsLinked to original sources
PubMed1996

Combined phacoemulsification and trabeculectomy with mitomycin-C.

PURPOSE: To examine the safety and efficacy of primary combined phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and trabeculectomy with mitomycin-C (0.4 mg/ml) in patients with open-angle glaucoma and visually significant cataract. SETTING: University-hospital-based glaucoma referral practice. METHODS: In this study, data of 43 patients of a single surgeon were retrospectively analyzed. These consecutive patients had combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy with mitomycin-C. RESULTS: Thirty-eight patients (88%) had open-angle glaucoma and 5 (12%) pseudoexfoliative glaucoma. Thirty-eight patients (88%) had 12 months of follow-up; all had at least 6 months follow-up. Mean preoperative intraocular pressure (IOP) was 21.6 mm Hg +/- 6.8 (SD) (range 12.0 to 41.0 mm Hg) with 2.5 +/- 1.0 glaucoma medications. At last follow-up, mean IOP had decreased to 14.2 +/- 6.2 mm Hg (range 3.0 to 40.0 mm Hg) with 0.5 +/- 0.5 glaucoma medications. Twenty-one patients (55%) had an IOP of 15 mm Hg or less at 12 months. Best corrected visual acuity was 20/40 or better in 31 of 43 patients (72%) at last follow-up. A filtration bleb was noted in 33 of 40 patients (83%) at their last visit. Postoperative IOP spikes occurred in 17 patients (40%), transient hyphema in 12 (28%), transient wound leaks in 11 (26%), and superficial punctate keratopathy in 11 (26%). Three cases of persistent hypotony (IOP less than 5 mm Hg) and 1 case of epithelial downgrowth were also noted. CONCLUSION: Phacoemulsification with IOL implantation and combined trabeculectomy with mitomycin-C produced good visual acuity and excellent IOP control but resulted in some complications. The use of mitomycin-C in combined procedures does not appear to confer a significant benefit.

Antibiotics, Antineoplastic↗
PubMed1994

5-Fluorouracil after primary combined filtration surgery.

We examined the safety and efficacy of 5-fluorouracil in eyes with open-angle glaucoma undergoing combined cataract removal and filtration surgery. We randomly assigned one eye each of 24 patients to receive 5-fluorouracil (five injections of 5 mg during two weeks after surgery) and one eye each of 20 patients to comprise the control group. Preoperatively, the two groups had similar mean intraocular pressure (P = .8) and number of medications (P = .2). The mean intraocular pressure of the 5-fluorouracil group was 18.6 +/- 1.1 mm Hg, with 2.5 +/- 0.3 medications; that of the control group was 18.2 +/- 1.2 mm Hg, with 2.2 +/- 0.2 medications. One year postoperatively, intraocular pressure and the number of medications were significantly reduced by a similar amount in both groups of patients (5-fluorouracil, 14.2 +/- 0.7 mm Hg, 0.8 +/- 0.2 medications; controls, 14.3 +/- 0.6 mm Hg, 1.0 +/- 0.2 medications). Transient superficial punctate keratopathy occurred more frequently (P = .04) in the 5-fluorouracil group (16 of 24 eyes, 67%) than in the control group (seven of 20 eyes, 35%). In our randomized and prospective study, the adjunctive use of 5-fluorouracil did not result in improved control of intraocular pressure one year after combined surgery in eyes with open-angle glaucoma.

Aged↗
PubMed1994

5-Fluorouracil in initial trabeculectomy. A prospective, randomized, multicenter study.

PURPOSE: Postoperative subconjunctival 5-fluorouracil (5-FU) injections increase the success of filtration surgery in eyes with prior filtration failure or cataract removal and in eyes with secondary glaucoma. The authors evaluate the safety and benefit of adjunctive 5-FU in eyes undergoing initial trabeculectomy. METHODS: Patients with phakic, uncontrolled, open-angle glaucoma who were undergoing initial trabeculectomy were prospectively assigned to the 5-FU group on the first postoperative day. Patients in this group received five 5-mg injections during 2 weeks after surgery. Patients in the control group received no injections. RESULTS: Preoperative intraocular pressure (IOP) and number of antiglaucoma medications were similar in the 5-FU (n = 32) and control (n = 30) groups. Transient superficial punctate keratopathy was the only postoperative complication that occurred more frequently (P < 0.05) in the 5-FU (14 eyes) than in the control eyes (3 eyes). Patients were followed for a minimum of 1 year or until a study endpoint was reached: IOP of 21 mmHg or greater with maximum medical therapy (2 5-FU eyes and 8 control eyes; P < 0.03) or cataract removal after filtration (5 treated and 3 control eyes). At last follow-up (mean, > 20 months), IOP and the number of antiglaucoma medications were significantly lower (P < 0.02) in the 5-FU eyes (IOP, 12.0 +/- 1.3 mmHg; medications, 0.2 +/- 0.1) than in the control eyes (IOP, 16.8 +/- 1.3 mmHg; medications, 0.8 +/- 0.2). Intraocular pressure was 20 mmHg or lower in 94% of 5-FU eyes and in 73% of control eyes (P < 0.03) and 16 mmHg or lower in 84% of 5-FU eyes and in 57% of control eyes (P < 0.02). CONCLUSIONS: Adjunctive 5-fluorouracil increases the rate of success, decreases the level of postoperative IOP, and reduces the need for postoperative antiglaucoma medication in eyes with open-angle glaucoma undergoing initial trabeculectomy.

Aged↗
PubMed1992

Apraclonidine and argon laser trabeculoplasty.

Sixty patients with medically uncontrolled open-angle glaucoma (intraocular pressure greater than 21 mm Hg) were randomly assigned to one of two treatment regimens with apraclonidine before undergoing 360-degree argon laser trabeculoplasty. One drop of apraclonidine 1% was instilled one hour before and immediately after laser treatment in 30 eyes or apraclonidine was delivered only after trabeculoplasty in 30 eyes. Intraocular pressure before laser treatment, number of antiglaucoma medications, and the laser treatment settings were comparable between the two groups. The mean and percent change in intraocular pressures were similar in both treatment groups one and two hours after trabeculoplasty. One drop of apraclonidine 1% instilled immediately after argon laser trabeculoplasty prevented intraocular pressure increase one hour and two hours postoperatively as effectively as its instillation both one hour before and immediately after laser treatment.

Administration, Topical↗
PubMed1989

Low-dose 5-fluorouracil and glaucoma filtration surgery.

We show that a 40-mg total dose of subconjunctival 5-fluorouracil after glaucoma filtering surgery can provide a success rate comparable to that demonstrated in prior studies employing a higher dose. Sixty-four eyes with poor prognoses underwent filtering surgery with postoperative subconjunctival injections of 5 mg of 5-fluorouracil daily for seven days followed by one injection 1 week later. In 75% percent of the eyes intraocular pressure stabilized at 21 mm Hg or less regardless of medications used. The majority of failures occurred within 6 months of treatment. Postoperative corneal epithelial defects occurred in 30% of the cases, conjunctival wound leaks in 6.3%. A 40-mg dose of subconjunctival 5-fluorouracil appears to be effective and may be associated with a lower incidence of postoperative complications than higher doses.

Adolescent↗
PubMed1987

A randomized study of 5-fluorouracil and filtration surgery.

We conducted a randomized study of 26 patients with a poor prognosis undergoing filtration surgery with and without a low dose of 5-fluorouracil. Mean preoperative intraocular pressure (+/- S.E.M.) in the 5-fluorouracil group (n = 14) was 38.4 +/- 3.08 mm Hg; in the control group (n = 12) it was 41.2 +/- 5.0 mm Hg. Mean postoperative intraocular pressure (+/- S.E.M.) at six to 18 months was 14.4 +/- 1.4 mm Hg in the 5-fluorouracil group and 30.7 +/- 3.9 mm Hg in the control group (P less than .01). Of 14 patients in the 5-fluorouracil group, 12 had a successful outcome at 12 months. Of 12 patients in the control group, three had a successful outcome during this same interval.

Female↗
PubMed1987

A prospective, randomized study of 5-fluorouracil and filtration surgery.

Our study shows that use of a small dose of subconjunctival 5-FU provides significantly lower postoperative intraocular pressure than does no antimetabolite treatment. Morphology of the postoperative blebs suggests that increased filtration results in lower intraocular pressure in the 5-FU group. Corneal epithelial defects were as common with a low dose as with higher doses previously described.

Adolescent↗
PubMed1986

Comparison of the Challenger digital applanation tonometer and the Goldmann applanation tonometer.

We compared the Challenger electronic tonometer to the Goldmann applanation tonometer in 70 eyes without corneal abnormalities. There was a good overall correlation between the two machines. Correlations between interobserver readings were excellent, demonstrating that obtaining reproducible measurements is possible with either machine. However, the scattergrams indicated that the Challenger tonometer gave consistently lower readings and showed more variability than the Goldmann tonometer. Additionally, the mean underestimation of intraocular pressure increased as the intraocular pressure increased above 20 mm Hg. Therefore, the Challenger electronic tonometer as presently calibrated is not accurate enough for clinical use in the detection and management of glaucoma.

Adult↗
PubMed1986

Postoperative suprachoroidal hemorrhage following filtration procedures.

We reviewed the charts of 500 patients who underwent filtration procedures and found ten patients who developed postoperative suprachoroidal hemorrhage (PSCH) following surgery. The incidence (2% overall) is especially high in those patients who were aphakic (6.6%) or who had high myopia (10%). Nine patients developed PSCH within the first four postoperative days. Pain, nausea, and vomiting were common presenting symptoms of PSCH although not invariably present. Postoperative suprachoroidal hemorrhage is related to prolonged hypotonia and inflammation; prevention centers on proper case selection and on avoiding a precipitous rise in postoperative intravascular pressure. Initial treatment consisted of anterior chamber reformation and drainage of suprachoroidal blood, often followed by vitrectomy and scleral buckling procedures. Four eyes (40%) obtained final visual acuities of 20/200 or better, four (40%) were reduced to counting fingers or hand motions, and two (20%) lost all light perception.

Adult↗
PubMed1985

Simmons' tamponade shell for leaking filtration blebs.

We used the Simmons' tamponade shell to successfully treat four of five patients who had leaking filtration blebs after glaucoma surgery. Bleb leaks in both the immediate postoperative period as well as many years following surgery were treated. In each case, previous pressure patching had been unsuccessful. Permanent closure of the leaks with the shell tamponade occurred within three days. Use of this technique is an effective alternative to surgical repair.

Adult↗
PubMed1983

Effects of corticosteroid pretreatment on argon laser trabeculoplasty.

We treated 18 patients with open-angle glaucoma with topical 1.0% prednisolone acetate before performing argon laser trabeculoplasty in an attempt to prevent the increase in intraocular pressure frequently observed during the immediate postoperative period. Intraocular pressure was measured hourly for eight hours postoperatively and was increased in 14 patients. The mean maximum increase, 7.72 +/- 8.62 mm Hg, occurred an average of 3.06 +/- 1.86 hours after laser treatment. Substantial increases in intraocular pressure (more than 15 mm Hg) were observed in five patients within eight hours postoperatively. There were no significant differences in the intraocular pressures of these patients and of 20 similar patients with open-angle glaucoma who did not receive corticosteroid therapy immediately, one week, and two months postoperatively. Corticosteroid pretreatment of patients undergoing laser trabeculoplasty apparently does not influence either the increase in intraocular pressure during the immediate postoperative period or the intraocular pressure two months after treatment.

Administration, Topical↗
PubMed1983

Pupillary block following Nd:YAG laser capsulotomy.

A patient who developed opacification of the posterior lens capsule three years after phacoemulsification was treated with a Nd:YAG laser capsulotomy. Five hours later he developed pupillary block, elevated intraocular pressure, and transient loss of vision. To our knowledge, this major complication following Nd:YAG laser surgery has not previously been reported.

Adult↗