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J McGalliard

Publications and source records attributed to J McGalliard.

18 recordsLinked to original sources
PubMed2003

Trypan blue staining of internal limiting membrane and epiretinal membrane during vitrectomy: visual results and histopathological findings.

AIMS: To report on the use of trypan blue (TB) 0.06% for staining the internal limiting membrane (ILM) and epiretinal membrane (ERM) during vitrectomy and report on their histology. METHOD: 14 consecutive patients with idiopathic macular hole or macular pucker (seven patients each) were prospectively recruited for ILM or ERM peel respectively. After pars plana vitrectomy and induction of posterior vitreous detachment, 0.5 ml TB 0.06% in phosphate buffered saline (VisonBlue) was injected over the posterior pole in an air filled eye and left for 2 minutes. The stained tissue was peeled with intraocular forceps. Specimens were evaluated using histochemical and immunohistochemical methods. RESULTS: The average follow up was 4.4 months. Internal limiting membranes and epiretinal membranes were stained satisfactorily in all cases and removed successfully. Eight patients (57%) had improvement of 2 or more Snellen lines. All seven macular holes closed. In the ERM cases, no residual membranes were observed clinically, at the latest follow up. No complications relating to the use of the dye were encountered intraoperatively or postoperatively. Of the 14 procedures, nine (four macular hole and five macular pucker) yielded sufficient tissue for histopathological evaluation. Histological and immunohistological assessment revealed that the morphology of these specimens was similar to that observed in macular hole ILM and macular pucker ERM removed without the aid of dye. CONCLUSION: TB staining facilitated the identification and delineation of ILM and ERM removal during the surgical management of macular holes and macular pucker. The visual outcome of this series and the specimens removed suggest they are no different from those without TB staining. Its use in posterior segment appears to be safe but further studies are required to investigate its long term safety.

Adult↗
PubMed2002

Vitreous penetration of levofloxacin in the uninflamed phakic human eye.

AIMS: To assess the vitreous penetration of oral levofloxacin (a new fluoroquinolone antibiotic with improved Gram positive activity) in uninflamed phakic eyes. METHODS: 15 patients for macula hole surgery were recruited to the study. 10 received a single 500 mg dose of levofloxacin by mouth preoperatively. Five acted as controls. Serum and undiluted vitreous samples were obtained at surgery and analysed by HPLC. RESULTS: Levofloxacin was detectable 2.5 hours after administration in the vitreous. A peak concentration of 1.6 microg/ml (or mg/l) was measured between 2.5 and 4 hours post-dose. CONCLUSION: Oral levofloxacin reaches the vitreous rapidly in the uninflamed phakic eye. Levels did not reach MIC(90) for the commonest infecting organisms. Nevertheless, levofloxacin would be expected to be active against a higher proportion of infecting organisms than either ciprofloxacin or ofloxacin.

Administration, Oral↗
PubMed2000

Synthesis of osteonectin by human retinal pigment epithelial cells is modulated by cell density.

PURPOSE: To determine whether human retinal pigment epithelial (HRPE) cells are able to synthesize the antiadhesive protein osteonectin, also known as secreted protein, acidic and rich in cysteine (SPARC). Additionally, because locally produced SPARC may modulate cellular behavior during tissue repair, to ascertain whether HRPE SPARC production and HRPE proliferation, migration, and/or differentiation are associated, in a simple HRPE wound-healing model. METHODS: Immunohistochemical and Western blot analyses of SPARC protein expression by low- and high-density cultured HRPE cells were undertaken. Total RNA extracted from cultures was studied by reverse transcription-polymerase chain reaction (RT-PCR) and Northern blot analysis. Western and Northern blot analyses were evaluated by densitometry. Experiments were repeated with HRPE cells cultured in the presence of 1, 10, or 100 microM of the differentiating agents butyric acid (BA) and retinoic acid (RA). RESULTS: HRPE cell cultures exhibited SPARC immunoreactivity. Western blot analysis of cell lysates and conditioned media showed a 43-kDa protein. RT-PCR and Northern blot analysis confirmed the presence of SPARC mRNA (with transcripts at 2.2 and 3.0 kb). Protein and mRNA transcript band densitometry revealed a higher proportion of SPARC protein and mRNA in high-density HRPE cell culture than in low-density culture. Neither BA nor RA (at the concentrations assessed) had a significant effect on SPARC production by HRPE cells in high- or low-density culture. CONCLUSIONS: HRPE can synthesize SPARC. Although the findings do not support an invariable association between SPARC production by HRPE and HRPE proliferation, migration, or differentiation, they demonstrate that synthesis of SPARC by HRPE is modulated by cell density.

Blotting, Northern↗
PubMed1998

Visual function and patient satisfaction after macular hole surgery.

PURPOSE: Over recent years success in macular hole surgery has increased in terms of anatomical closure. However, debate still continues on the benefit to the patient in terms of visual outcome. We designed a prospective study to investigate the outcome of full thickness macular hole (FTMH) surgery in terms of anatomical closure, visual outcome, incidence of complications and patient satisfaction. METHODS: Thirty eyes of 30 consecutive patients with FTMH were prospectively studied (stage 2 = 2; stage 3 = 23; stage 4 = 5). All cases had surgery involving vitrectomy, injection of an autologous platelet aggregate over the hole and gas tamponade. At 3 months post-operatively all cases were assessed for closure of the FTMH, Snellen acuity and the incidence of complications. At this stage all patients completed a patient satisfaction questionnaire. RESULTS: Anatomical closure of the hole was achieved in 83% of cases (25/30). Visual improvement of 2 Snellen lines or more occurred in 50% of cases (15/30). A vision of 6/12 or better was achieved in 27% of cases (8/30). A post-operative lens opacity was present in 46% (13/28) of phakic patients and a temporal, peripheral wedge-shaped field defect occurred in 17% (5/30) of cases. In this study, 53%, 70%, 57% and 67% of patients gave a positive response to specific questions about satisfaction with near, intermediate and distance vision and overall visual function respectively. CONCLUSIONS: Although the anatomical success of FTMH surgery is high the functional outcome in terms of Snellen acuity is less rewarding. Analysis of patient satisfaction suggests that the arbitrary visual outcome measures presently used may underestimate the functional benefit to the patient. Improved objective measures of visual outcome are required to assess the benefit of surgery in these cases.

Aged↗
PubMed1998

Endoresection of choroidal melanoma.

AIMS: The results of 52 endoresections for choroidal melanoma are reported. METHODS: The current technique involves vitrectomy, retinal incision over or peripheral to the tumour, haemostasis by raising intraocular pressure and by moderate hypotensive anaesthesia, choroidal incision around tumour, endoresection with vitrector, endodiathermy to bleeding points and residual tumour, fluid-air exchange to reattach retina, endolaser to achieve retinal adhesion around the coloboma and destroy residual tumour in the sclera, silicone oil injection with removal after 12 weeks, cryotherapy to the sclerotomies, and adjunctive ruthenium plaque radiotherapy in selected cases. RESULTS: Patients receiving primary endoresection had a mean age of 53 years, a mean largest basal tumour diameter of 8.2 mm, and a mean tumour thickness of 3.9 mm. 40 tumours extended to within 2 disc diameters of the optic disc, with 17 involving disc. Follow up ranged from 40 days to 7 years (median 20 months). At the last visit, 90% of eyes were retained, with vision of 6/6-6/12 (two), 6/18-6/36 (three), 6/60 to counting fingers (18), hand movements (nine), and light perception (four). The main complications were retinal detachment in 16 and cataract in 25. Secondary endoresection (11) was performed after plaque radiotherapy (four), photocoagulation (four), trans-scleral local resection (two), and proton beam radiotherapy (one), with retention of the eye in nine cases. By the close of the study, no patients developed definite local tumour recurrence but one died of metastatic disease 41 months postoperatively. CONCLUSION: Depending on tumour location, endoresection may conserve central vision or temporal field when radiotherapy would be expected to cause optic neuropathy. Longer follow up is necessary to establish the efficacy of tumour control.

Adult↗
PubMed1997

The effect of anaesthesia on the intraocular volume of the C3F8 gas bubble.

Long-acting intraocular gas bubbles are frequently used during vitrectomy to tamponade retinal breaks. The aim of this study was to determine the effect of nitrous oxide anaesthesia on the size and effectiveness of the post-vitrectomy gas bubble. Twenty vitrectomy procedures with injection of 12% perfluoropropane (C3F8) gas were performed. For 10 of the cases routine anaesthesia with nitrous oxide was used and for 10 cases non-nitrous anaesthesia with propofol was used. The volume of the intraocular gas bubble was estimated 24 hours post-operatively using A-scan biometry. At 24 hours the gas bubble occupied a mean of 65.1% of the eye in anaesthesia with nitrous oxide and a mean of 66.1% in anaesthesia with intravenous propofol. The wide range of values of gas-fill recorded at 24 hours makes comparison of the two groups inappropriate. Several factors may account for this spread of values, but in our opinion it is the uncontrolled leakage from the sclerostomies which is the most likely. This study suggests that anaesthesia using nitrous oxide does not adversely affect the size of the C3F8 gas bubble at 24 hours post-vitrectomy when compared with anaesthesia without nitrous oxide.

Adult↗
PubMed1997

Does cryotherapy before drainage increase the risk of intraocular haemorrhage and affect outcome? A prospective, randomised, controlled study using a needle drainage technique and sustained ocular compression.

AIMS/BACKGROUND: A prospective, randomised, controlled clinical trial was conducted to investigate the effect of performing cryotherapy before drainage of subretinal fluid (SRF) on the incidence of intraocular haemorrhage (IOH) in the management of retinal detachment. METHODS: Eighty eyes of 80 patients with rhegmatogenous retinal detachment requiring SRF drainage were recruited. Thirty four cases were randomised to receive drainage before cryotherapy (drainage, air injection, cryotherapy, and explant = DACE group) while 46 cases had drainage after cryotherapy (cryotherapy, drainage, air injection, and explant = CDAE group). All cases had trans-scleral drainage of SRF using a 27 gauge hypodermic needle combined with prolonged, intraocular hypertension. RESULTS: There was a low incidence of IOH associated with drainage in both groups with no statistically significant difference between the groups (DACE group = 2.9%; CDAE group = 4.3%; p = 0.43). There was no significant difference between the groups in the rate of anatomical success with a single operation (DACE group = 82.4%; CDAE group = 86.9%; p = 0.38). There was no significant difference between the groups in the visual outcome. An improvement of two Snellen lines or more occurred in 52.9% of the DACE group and in 56.5% of the CDAE group (p = 0.93). CONCLUSION: It was concluded that the surgical sequence of applying cryotherapy before drainage of SRF can be safely and effectively performed. The sequences CDAE and CDE, when air injection is not required, along with DACE should all be part of the surgical repertoire for the management of retinal detachments.

Adolescent↗
PubMed1996

'En bloc' dissection of epimacular membranes using aspiration delamination.

'En bloc' dissection is a technique in which epiretinal membranes (ERM) are separated from the retina as a single lamina with a 20-gauge blunt flute needle. We used this technique to remove epimacular membranes of various aetiologies in a consecutive series of 25 eyes, with a minimum follow-up of 5 months (mean 10.4 months). Small residual epicentres of ERM away from the fovea remained in 7 (29.1%) eyes only; 3 were inside and 4 outside the temporal vascular arcades. Postoperatively 64% (16/25) of patients achieved a final visual acuity of 6/12 or better and 76% (19/25) achieved a final visual acuity of 6/18 or better. Progressive lens opacities were the most important postoperative complication in phakic eyes that significantly affected the visual results. This technique successfully removed epimacular membranes over a wide area, without the need to find a starting edge or the use of sharp instruments near the retina. Diaphanous ERMs with ill-defined borders and tenaciously adherent membranes could be removed with minimal trauma to the underlying retina. Histopathological and immunohistochemical examination of 10 ERMs demonstrated the absence of internal limiting lamina in 6 (60%).

Adolescent↗
PubMed1993

Suspected nafcillin-induced interstitial nephritis.

OBJECTIVE: To present a case of nafcillin-induced interstitial nephritis. METHODOLOGY: Case report and literature review. SETTING: Hospital. RESULTS: Three days following initiation of nafcillin therapy for staphylococcal pneumonia, an 80-year-old woman developed allergic manifestations and progressive renal impairment suggestive of acute allergic interstitial nephritis. These manifestations were completely reversed within 96 hours of cessation of nafcillin therapy. CONCLUSIONS: In the clinical setting of acute renal failure in a patient on nafcillin therapy, acute interstitial nephritis should be considered. Prompt cessation of nafcillin therapy has generally been associated with reversal of symptoms and an improvement in renal function.

Acute Disease↗
PubMed1992

Oxytalan fibres in proliferative vitreoretinopathy.

The distribution of elastic and related fibres was studied in 29 fibrocellular membranes associated with proliferative vitreoretinopathy using histochemical, immunohistochemical and ultrastructural techniques. Ten subretinal and ten epiretinal membranes were subjected to light microscopical investigation, whilst the remaining nine membranes were examined by transmission electron microscopy. Oxytalan fibres, an elastic fibre precursor that is found in a variety of normal and pathological connective-tissue matrices, were identified in all of the specimens. Mature elastic fibres were not observed in any of the 29 membranes. The demonstration that oxytalan connective-tissue fibres contribute to the infrastructure of PVR membranes adds further evidence to the suggestion that this proliferative tissue might be the result of a repair mechanism.

Adolescent↗
PubMed1989

1988 Joint Commission survey in a community hospital.

JCAHO is increasingly emphasizing the importance of quality patient care and has recently mandated the involvement of pharmacy to help optimize patient care. To comply with the JCAHO requirements, the pharmacy department must develop standards and protocols that are ultimately designed to improve patient care. This article describes how we optimized patient care by complying with the JCAHO standards and prepared for the survey.

Accreditation↗
PubMedDate not supplied

Endonasal laser dacryocystorhinostomy and external dacryocystorhinostomy outcome profile in a general ophthalmic service unit: a comparative retrospective study.

PURPOSE: To evaluate the outcome profile of endonasal laser dacryocystorhinostomy (ENL-DCR) in comparison with external dacryocystorhinostomy (ENL-DCR) carried out as part of general ophthalmic service within the same center. METHODS: Patients who have undergone external or endonasal laser DCR in the authors institute with a minimum follow-up of 9 months and at least 3 months after removal of the tubes were invited to participate in this research. We used a questionnaire and a systematic clinical examination for detecting lacrimal passage patency and function. Patients were classified into categories: complete anatomical and physiological success; anatomical success with partial relief of symptoms; anatomical success with no relief of symptoms; anatomical failure. The endoscopic view of the ostium vertical location has been classified into four levels. RESULTS: One hundred and ten external-DCR and 53 Endonasal-DCR procedures were evaluated. Free communication (anatomical success) was achieved in 82% undergoing Ext-DCR and in 58% undergoing ENL-DCR. A significant number of patients continued to have symptoms in spite of a patent fistula (54% for Ext-DCR and 39% for ENL-DCR). The site of the opening of the internal ostium was significantly related to the persistence of symptoms in spite of free communication (P < 0.001, chi-square test). CONCLUSION: In this series of patients undergoing DCR in a general ophthalmic unit, the standard Ext-DCR technique has a higher anatomical success rate than the endoscopic laser DCR but not necessarily with equivalent rate of relief of symptoms. An inferiorly placed ostium is more likely to result in complete relief of symptoms.

Adult↗