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Biomedical subjects

J V Thomas

Publications and source records attributed to J V Thomas.

At least 19 recordsLinked to original sources
PubMed1997

Bleb infections: clinically different courses of "blebitis" and endophthalmitis.

BACKGROUND AND OBJECTIVES: To assess the differences in history, clinical course, and response between five cases of blebitis and three cases of endophthalmitis following mitomycin trabeculectomy. PATIENTS AND METHODS: The authors conducted a retrospective review of eight consecutive cases of bleb-related infection following successful mitomycin trabeculectomy. RESULTS: All patients with blebitis responded to treatment with return of visual acuity and intraocular pressure to preinfection levels. In the three cases of endophthalmitis, one patient underwent enucleation, one had a final visual acuity of counting fingers, and the third had a visual acuity of 20/60. CONCLUSIONS: Blebitis, a limited form of bleb-related infection with thin, cystic, leaky blebs, responds to intensive topical antibiotic treatment, returning visual acuity and IOP to preinfection levels. Bleb-related endophthalmitis causes a more virulent form of bleb-related infection that involves thin- or thick-walled blebs, with or without leakage, and poor visual prognosis despite immediate intensive topical, systemic, and intravitreal antibiotic administration combined with core vitrectomy.

Administration, Topical↗
PubMed1995

In vitro antimalarial activity of monoterpenic fragment analogues of aplasmomycin.

Synthetic analogues of a monoterpenic fragment of aplasmomycin were tested for their antimalarial activity in Plasmodium falciparum culture in vitro. The antimalarial activities of these agents were evaluated in chloroquine sensitive strains. Parasite growth was inhibited in a dose dependent manner in the presence of the synthetic compounds (3-9).

Animals↗
PubMed1994

Early glottic carcinoma treated with open laryngeal procedures.

OBJECTIVE: The purpose of this study was to determine the recurrence rate and long-term survival of patients treated with open cervical procedures. DESIGN: The study is a retrospective analysis of a cohort of patients who underwent an open laryngeal procedure between 1976 and 1986. The median follow-up was 6.6 years. PATIENTS/PARTICIPANTS: The sample was a consecutive series of 159 patients with early glottic carcinoma without impaired vocal cord mobility. Patients with a history of radiation therapy or surgical treatment elsewhere were excluded. INTERVENTION: Surgical treatment in this group of 159 patients included 82 frontolateral partial vertical laryngectomies, 61 laryngofissures with cordectomy, 12 hemilaryngectomies, and four anterior commissure procedures. OUTCOME MEASURE: Estimates of survival time beyond the day of surgery, time to first recurrence (local, regional, and distant), and time to first local recurrence were obtained with the Kaplan-Meier product-limit method. RESULTS: Eleven patients experienced recurrent laryngeal cancer. Ten patients underwent laryngectomy for recurrence. One patient underwent an anterior commissure procedure. Three of the 11 patients who underwent re-treatment of the larynx were ultimately salvaged. The probability of survival at 3 and 5 years was 91% and 84%, respectively. The probability of remaining free of local recurrence 3 and 5 years after surgery was 94% and 93%, respectively. CONCLUSION: In our experience, open laryngeal procedures continue to be excellent treatment for select cases of early glottic carcinoma. They are versatile and efficacious for managing the wide spectrum of larger T1 glottic carcinomas.

Adult↗
PubMed1994

Cost-benefit analysis of six alternative payment incentives for child therapists.

The outcomes and costs of 6 different methods of motivating therapists to meet service delivery goals at a community mental health center for children and adolescents were evaluated over a 5-year period. The costs and cost-savings benefits of each motivational method were compared with each other and with two baselines. Four incentive interventions generated more cost savings than they required in monetary outlays. Most cost-beneficial were bonuses paid to therapists for each hour of service they delivered over their monthly goals and bonus plans that rewarded therapists for exceeding their goals while also rewarding staff if total department goals were exceeded. The most cost-beneficial system saved $25,542 over 6 months that would have been paid to compensate for therapy hours not delivered, for an incentive investment of $9,726 over the 6 months. This yielded a net benefit of $15,816, or $31,632 annually.

Adolescent↗
PubMed1994

Recurrences after endoscopic management of early (T1) glottic carcinoma.

From 1976 to 1986, 106 patients with early glottic carcinoma were managed endoscopically at our institution. Twenty-four (23%) patients required retreatment of the larynx for local recurrences or new primary lesions after initial endoscopic management. The probability of remaining free of local recurrence 3 years after primary surgery was estimated to be 0.87 and, after 5 years, it was 0.81. Of the 24 patients who required re-treatment of their larynx, 10 did so beyond 3 years, indicating a new second primary. In 1 patient who required retreatment within 3 years, a new primary developed on the opposite cord. Therefore, true local recurrences developed in 13 patients (12.3%); 3 of these patients (2.8%) ultimately required laryngectomy and 3 are dead (2.8%) with disease.

Adult↗
PubMed1993

Indications and results of cordectomy for early glottic carcinoma.

Select early glottic carcinomas in patients with normal vocal cord mobility can be successfully treated with cordectomy, performed either endoscopically or by means of an open operation (laryngofissure-cordectomy). From 1976 to 1986, 95 patients underwent cordectomy at our institution. There were 88 men and 7 women, with an age range at the time of surgery of 27 to 84 years. A laryngofissure was used to perform a cordectomy in 61 patients and an endoscopic approach was used in 34. The median number of days in the hospital for the endoscopic group was 2, and for the laryngofissure group it was 6. The Kaplan-Meier product-limit method showed the probability of no recurrence in the first 3 years after an endoscopic cordectomy was 0.9099, and in the laryngofissure-cordectomy group it was 0.9502. To date, there have been four recurrences (11.8%) in the endoscopic group and three (4.9%) in the laryngofissure group. Only one patient with recurrent tumor is known to have died of the cancer. Laryngectomy was necessary for ultimate control in three patients. The Kaplan-Meier survival curve for the 95 patients was the same as that for a sex- and age-matched control group. Cordectomy is an effective treatment option that results in minimal morbidity for select early glottic carcinomas.

Adult↗
PubMed1990

The fluorescent indicator pyranine is suitable for measuring stromal and cameral pH in vivo.

Three pH-sensitive fluorescent indicators (fluorescein, bis-carboxyethyl-carboxyfluorescein and pyranine) were studied to determine their usefulness as probes for the living cornea and anterior chamber. Of the three dyes, pyranine had properties which render it almost ideally suited for this purpose. Adequate concentrations are reached in the cornea and anterior chamber after topical administration; measurements can be made by fluorophotometry for many hours. The pH is calculated by measuring the ratio of fluorescent intensity at two excitation wavelengths, I463/I404, a measurement which is dependent on pH but independent of the concentration of the fluorophore and other variables which can alter the intensity. In the rabbit eye, pyranine in the cornea and anterior chamber was observed to undergo easily measurable changes in fluorescent ratios associated with lid closure and contact lens wear, indicating its sensitivity to mild changes in pH.

Albumins↗
PubMed1990

Surgical goniosynechialysis for angle-closure glaucoma.

Fifteen patients with synechial angle-closure glaucoma uncontrolled by medical and laser therapy were treated with surgical goniosynechialysis. Five patients were treated with goniosynechialysis alone, and ten were treated with goniosynechialysis in combination with other surgical procedures. The procedure was successful, in terms of reducing synechiae, in 14 eyes (93%). The extent of angle closure was reduced from 340 degrees +/- 45 degrees (mean +/- standard deviation) preoperatively to 80 degrees +/- 70 degrees postoperatively; the mean reduction was 260 degrees +/- 95 degrees (P less than 0.0001) for the group overall and 280 degrees +/- 80 degrees (P less than 0.0007) for the subgroup treated with goniosynechialysis alone. The mean preoperative intraocular pressure (IOP) was 40 +/- 4 mmHg. The mean postoperative IOP was 14 +/- 4 mmHg. The mean reduction in IOP was 26 +/- 15 mmHg (P less than 0.0001) for the group overall and 27 +/- 18 mmHg (P less than 0.015) for the subgroup treated with goniosynechialysis alone. Glaucoma medications were reduced from a mean of 2.6 +/- 1.0 preoperatively to 1.1 +/- 1.2 postoperatively for the group overall and to 1.4 +/- 1.5 for the subgroup treated with goniosynechialysis alone. Complications consisted of two eyes with intraoperative bleeding. One of these required intraoperative conversion to surgical trabeculectomy. The other was associated with a transient postoperative IOP elevation to 40 mmHg. Surgical goniosynechialysis may be an effective means of reducing synechiae and lowering IOP, either alone or in conjunction with other surgical procedures, in patients with angle closures of less than 6 months' duration.

Adult↗
PubMed1990

Malignant glaucoma induced by an intraocular lens.

A case of malignant (ciliary block) glaucoma apparently induced by a large posterior chamber intraocular lens (PC-IOL) is presented. The involved eye was small, with an axial length of 21.7 mm and a preoperative refractive error of +8.25 D. An uncomplicated extracapsular cataract extraction with implantation of a PC-IOL with a 7 mm optic was performed. Within 1 week postoperatively, malignant glaucoma developed, for which surgical intervention was required. We recommend avoiding implantation of PC-IOLs with large optics in certain small eyes, since these implants may be more likely than lenses with smaller optics to induce malignant glaucoma in such eyes.

Aged↗
PubMed1988

Use of circularly polarized light in fundus and optic disc photography.

Circularly polarized light was used in fundus and optic disc photography to reduce reflected glare and photographic artifacts originating from the ocular media and the lenses of the fundus camera. A standard fundus camera was used, with circular polarizers placed in the illumination and observation paths. The quality of fundus photography was improved significantly in eyes with intraocular lenses, cataract, vitreous haze, or high myopia as well as in normal eyes, in fundus photography of the retinal periphery, and in optic disc photography.

Fundus Oculi↗
PubMed1986

Optic disc cupping in arteritic anterior ischemic optic neuropathy resembles glaucomatous cupping.

Five cases of anterior ischemic optic neuropathy secondary to biopsy-proven giant cell arteritis are presented. In each case, cupping of the optic disc, which closely resembled glaucomatous cupping, was observed in the affected eye. The presence of glaucoma was ruled out on the basis of normal intraocular pressures and normal tonographic measurements of facility of outflow. These cases indicate that arteritic ischemic optic neuropathy can result in optic disc cupping, which closely resembles glaucomatous cupping. The similarities in the appearance of cupping of these discs with that seen in eyes with glaucoma suggest that the pathogenesis of cupping in glaucoma and in arteritic ischemic optic neuropathy may share some common mechanisms.

Aged↗
PubMed1985

Effect of cataract surgery on intraocular pressure reduction obtained with laser trabeculoplasty.

Thirty-nine eyes of 34 patients with open-angle glaucoma who had been treated successfully with argon laser trabeculoplasty underwent either extracapsular cataract extraction with posterior chamber intraocular lens implantation or intracapsular cataract extraction without lens implantation. Cataract surgery did not have a significant effect on the magnitude of intraocular pressure reduction obtained with laser trabeculoplasty. This study supports the view that eyes with coexisting cataract and glaucoma may benefit from laser trabeculoplasty before cataract surgery.

Aged↗
PubMed1985

Laser trabeculoplasty re-treatment.

Because of inadequate control of intraocular pressure, 26 eyes of 24 patients with primary and secondary open-angle glaucoma who had previously undergone argon laser trabeculoplasty were re-treated. Re-treatment was successful in ten eyes (38%); their average decrease in intraocular pressure was 10.2 mm Hg. After laser re-treatment, three eyes (12%) had marked increases in intraocular pressure, ranging from 10 to 37 mm Hg above baseline, necessitating urgent surgical intervention.

Adult↗
PubMed1985

Extracapsular cataract extraction and posterior chamber intraocular lens implantation in glaucomatous eyes.

Two hundred ninety-six eyes of 250 patients undergoing extracapsular cataract extraction (ECCE) with or without the implantation of a posterior chamber intraocular lens (PC-IOL) were studied. Pre-existing glaucoma of varying severity was present in 139 eyes and no known ocular pathology other than cataract in 157 eyes. During the first eight weeks following surgery, intraocular pressure elevations greater than or equal to 15 mmHg above baseline were seen in 23% of glaucomatous eyes controlled before surgery with glaucoma medications, in 39% of glaucomatous eyes controlled before surgery with argon laser trabeculoplasty, and in only 3% of nonglaucomatous eyes. The implantation of a PC-IOL did not influence the incidence of postoperative intraocular pressure (IOP) elevations. Among glaucomatous eyes with severe preoperative visual field loss (split fixation or central island less than or equal to 10 degrees), 9.7% had worsening of visual field after surgery. Open angle glaucoma of unclear etiology developed in 1.4% of normal eyes following uncomplicated ECCE with PC-IOL implantation. Surgical techniques the authors have found useful in glaucomatous eyes undergoing ECCE with PC-IOL implantation are discussed.

Aged↗
PubMed1985

Shock-wave effect on anterior segment structures following experimental neodymium:YAG laser iridectomy.

The short-pulse laser may prove superior to the argon laser in producing noninvasive iridectomies. Little is known of the effects of the laser shock-wave on anterior segment structures adjacent to the iris. To investigate this question, iridectomies were produced in two owl monkeys using a neodymium (Nd):YAG laser and tissues were evaluated by light microscopy and scanning and transmission electron microscopy. For purposes of comparison, one eye received an iridectomy produced by an argon laser. Results indicate that while clean iris colobomas can be produced with a well-focused Nd:YAG laser, its shock-wave affects tissues in both the trabecular meshwork and corneal endothelium if the iridectomy is located within 0.8 mm of the limbus. No damage to the trabecular meshwork or corneal endothelium was evident after the argon laser iridectomy.

Animals↗
PubMed1985

Effect of pilocarpine in treatment of intraocular pressure elevation following neodymium: YAG laser posterior capsulotomy.

A prospective study was conducted in 30 eyes of 30 patients to determine if pilocarpine would prevent increased intraocular pressure following Q-switched neodymium (Nd):YAG laser posterior capsulotomy. Fifteen eyes were given pilocarpine 4%, immediately following laser therapy and every hour until bedtime. Fifteen eyes served as untreated controls. Our results show that without prophylactic therapy, 10 of 15 eyes (67%) had a post-laser intraocular pressure (IOP) elevation of greater than 10 mmHg, while only one of 15 (6.6%) of the pilocarpine-treated eyes had a rise of that magnitude. The facility of outflow was reduced by 42% in the untreated eyes in contrast to an increase of 3% in those eyes treated with pilocarpine. Thus, pilocarpine 4% is effective in reducing the incidence and magnitude of elevated IOP following Nd:YAG posterior capsulotomy.

Cataract Extraction↗