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Biomedical subjects

John T Thompson

Publications and source records attributed to John T Thompson.

9 recordsLinked to original sources
PubMed2006

Cataract formation and other complications of intravitreal triamcinolone for macular edema.

PURPOSE: To evaluate complications and results of intravitreal triamcinolone acetonide for treatment of macular edema. DESIGN: Interventional, consecutive, retrospective case series. METHODS: Ninety-three eyes with macular edema arising from retinovascular etiologies were treated with 4 mg intravitreal triamcinolone. Eyes were monitored after injection for visual acuity changes and complications, including cataract formation and increase in intraocular pressure (IOP). Cataract progression was analyzed by linear regression analysis of lens scores from lens opacity standards. RESULTS: The mean visual acuity improved from 20/125 to -1 to 20/100 + 2 by one to two months after injection (P < .001) and was 20/100 at the final examination (P = .006) at a mean of 1.2 years after injection. Complications included a severe, culture-negative inflammatory reaction in one eye (1.1%). IOP increased to 30 mm Hg or more in nine (9.7%) of 93 eyes between 1 and 140 days after injection and was more frequent in eyes receiving one or more preinjection glaucoma drops (two of 13 eyes, 15.4%, vs seven of 80 eyes, 8.75%, without preinjection glaucoma drops). Nuclear sclerosis increased at a rate of 0.175 U per year, posterior subcapsular cataracts at 0.423 U per year, and cortical cataracts at 0.045 U per year. Posterior subcapsular cataract increased by > or = 1 U or required cataract surgery in 45.2% of eyes followed at least one year. CONCLUSIONS: Intravitreal triamcinolone improves visual acuity in most eyes but eyes must be monitored carefully for increase in IOP. Posterior subcapsular cataract formation becomes visually significant in almost half of eyes by one year after injection.

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PubMed2005

Vitrectomy for the treatment of submacular hemorrhages from macular degeneration: a comparison of submacular hemorrhage/membrane removal and submacular tissue plasminogen activator-assisted pneumatic displacement.

PURPOSE: To evaluate two techniques for treatment of large submacular hemorrhages resulting from choroidal neovascularization associated with age-related macular degeneration. METHODS: Retrospective consecutive case series of 42 eyes of 42 patients who presented with submacular hemorrhages of at least 12 disc areas associated with visual loss of 3 months or less duration. One of two treatments was performed: (1) vitrectomy with removal of the submacular hemorrhage/neovascular membrane complex using subretinal forceps (SRH group), or (2) vitrectomy with injection of subretinal tissue plasminogen activator (TPA) followed by air-fluid exchange to achieve pneumatic displacement of the hemorrhage (TPA group). RESULTS: The mean visual acuity in the SRH group improved from 20/1000 -1 to 20/640 -2 at 3 months and 20/640 at 1 year and at the final examination at a mean of 2.92 years (P = .048). The mean visual acuity in the TPA group remained stable initially with a visual acuity of 20/500 preoperatively and 20/640 +2 at 3 months. The visual acuity in the TPA group deteriorated to 20/1000 -2 at 1 year and 20/1000 +2 at the final examination at a mean of 2.3 years (P = .031). Visual acuity improved by at least .3 logMAR units (3 lines) in 44% of the SRH group at 3 months and in 48% at 1 year and at the final examination compared with 20% of the TPA group at 3 months and 13% at 1 year and at the final examination (P = .042 comparing SRH and TPA groups at 1 year and final examination). CONCLUSIONS: Vitrectomy with removal of the subretinal neovascular membrane/hemorrhage complex resulted in better visual results than displacement of the subretinal hemorrhage primarily due to continuing declines in the TPA group.

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PubMed2004

The role of patient age and intraocular gas use in cataract progression after vitrectomy for macular holes and epiretinal membranes.

PURPOSE: To evaluate the rate of increase in nuclear sclerosis and posterior subcapsular cataracts in eyes as a function of patient age and use of intravitreal gas at the time of vitrectomy. DESIGN: Observational case series. METHODS: Nuclear sclerosis and posterior subcapsular cataracts were evaluated as a function of patient age and use of intravitreal gas at vitrectomy. SETTING: A clinical practice. STUDY POPULATION: The study population consisted of 301 consecutive eyes. OBSERVATIONAL PROCEDURE: Nuclear sclerotic cataracts and posterior subcapsular cataracts were graded on a scale from 0 to 4.0 before and after vitrectomy. MAIN OUTCOME MEASURE: Linear regression analysis was performed to measure and compare the rate of change in cataract score over time based on patient age and use of intraocular gas. RESULTS: Nuclear sclerotic cataracts showed minimal increase in patients younger than 50 years of age after vitrectomy (0.13 grades/year). Nuclear sclerotic cataracts increased at a rate of 0.7 to 0.9 grades/year (mean, 0.812) in patients aged 50 to 60 years, 60 to 70 years, 70 to 80 years, and 80+ years, even though the baseline nuclear sclerosis scores were progressively greater for each decade. The increase in nuclear sclerotic cataracts in patients younger than 50 years of age was significantly less (P <.001) than in patients aged 50 years or older. Eyes with intraocular gas use had a higher rate of nuclear sclerosis progression (0.8 grades/year) compared with eyes without intraocular gas bubbles (0.5 grades/year; P <.001). Posterior subcapsular cataract scores showed minimal or no increases in all groups. CONCLUSIONS: Patients older than 50 years of age have a similar rate of increase in nuclear sclerotic cataracts, independent of age. The rate is approximately sixfold greater than in patients younger than 50 years of age. Intravitreal gas bubbles are associated with a nuclear sclerosis increase of approximately 60% compared with eyes without use of a gas bubble.

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PubMed2004

Results of macular hole surgery with and without epiretinal dissection or internal limiting membrane removal.

PURPOSE: To evaluate the results of idiopathic macular hole surgery with or without epiretinal dissection or peeling of the internal limiting membrane (ILM). DESIGN: Retrospective consecutive nonrandomized comparative interventional trial. PARTICIPANTS: One hundred seventy-two eyes of 162 patients with previously untreated idiopathic macular holes of <24 months duration. INTERVENTION: All eyes were treated with pars plana vitrectomy by 1 surgeon using 1 of 3 techniques: no epiretinal dissection (116 eyes), epiretinal dissection (27 eyes), or ILM peeling (29 eyes). MAIN OUTCOME MEASURES: Closure of the macular hole and visual acuity. RESULTS: The macular hole was closed with 1 surgery in 92.9% of 56 eyes with epiretinal dissection/ILM peeling versus 79.3% of 116 eyes without dissection (P = 0.03) and was closed with 1 surgery in 85.1% of 27 eyes in the epiretinal dissection group compared with 100% of 29 eyes in the ILM peeling group (P = 0.05). Visual acuity improved 3 or more lines in 57.1% of 56 eyes in the epiretinal dissection/ILM peeling group compared with 38.8% of 116 eyes in the no dissection group 3 months postoperatively (P = 0.03). Visual acuity improved 3 or more lines at 3 months in the no dissection group in 32.2% of 87 eyes placed faceup for 24 hours compared with 58.6% of 29 eyes placed immediately prone postoperatively (P = 0.02). The visual and anatomic results of the no dissection and epiretinal dissection/ILM peeling groups were similar when comparing eyes in the no dissection group placed immediately prone with the epiretinal dissection/ILM peeling eyes also placed immediately prone. Visual improvement of 3 or more lines at 3 months occurred in 79.2% of 24 eyes in the epiretinal dissection group versus 44.8% of 29 eyes in the ILM peeling group (P = 0.01) in eyes with successful macular hole closure. Visual acuity results were similar in all subgroups at the final examination after reoperations. CONCLUSIONS: The faceup position for 24 hours using adjuvants reduced the initial anatomic and visual outcomes of macular hole surgery. Internal limiting membrane peeling improved the likelihood of successful macular hole closure but reduced the amount of initial visual improvement at 3 months compared with epiretinal dissection alone. Final visual acuities were similar in all groups.

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PubMed2004

Vitrectomy for epiretinal membranes with good visual acuity.

PURPOSE: To evaluate the visual results of vitrectomy for epiretinal membrane in eyes with a preoperative visual acuity of 20/50 or better. METHODS: The visual results and complications were analyzed following vitrectomy for idiopathic epiretinal membranes and epiretinal membranes secondary to retinal tears. This study was a retrospective, consecutive case series of 40 eyes of 40 patients treated by a single surgeon. RESULTS: The mean preoperative visual acuity was 20/50 +2 (range, 20/30 +1 to 20/50 -3). The mean visual acuity improved to 20/40 +2 (P = .02) by the final examination at a mean of 2.4 years following surgery. The status of the lens at the final examination was correlated with the visual results of surgery. Twenty-one eyes were phakic preoperatively, and 14 of these eyes had cataracts removed by the final examination. The mean preoperative visual acuity in seven eyes that were still phakic at the final examination was 20/50, and this decreased to 20/50 -2 (P = .82). The mean preoperative visual acuity was 20/50 +2 in 33 eyes that were pseudophakic by the final examination, and this improved to 20/32 -2 (P = .005). The visual acuity improved by 2 or more Snellen lines in only one in seven eyes (14%) that were still phakic on the final examination and in 14 of 33 eyes (42.4%) that were pseudophakic by the final examination. There were no serious surgical complications. CONCLUSIONS: Vitrectomy for epiretinal membranes is beneficial in eyes with relatively good preoperative visual acuities, but cataract surgery is necessary in phakic eyes to achieve long-term visual acuity improvement.

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PubMed2003

The role of patient age and intraocular gases in cataract progression following vitrectomy for macular holes and epiretinal membranes.

PURPOSE: To evaluate the rate of increase in nuclear sclerosis and posterior subcapsular cataracts in eyes as a function of patient age and use of intravitreal gas at the time of vitrectomy. METHODS: Nuclear sclerotic cataracts and posterior subcapsular cataracts were graded on a scale of 0 to 4.0 in 301 consecutive eyes prior and subsequent to vitrectomy for macular holes, epiretinal membranes, or vitreomacular traction syndrome. Linear regression analysis was performed to compare the rate of change in cataract score. RESULTS: Nuclear sclerotic cataracts showed minimal increase in patients younger than 50 years of age following vitrectomy (.13 grades per year). Nuclear sclerotic cataracts increased at a rate of .7 to .9 grades per year (mean, .812) in patients from age 50 to 60, 60 to 70, 70 to 80, and 80+ years, even though the baseline nuclear sclerosis scores were progressively greater for each decade. The increase in nuclear sclerotic cataracts in patients younger than 50 years was significantly less (P<.001) than in patients 50 years or older. The fellow nonsurgical eyes of patients 50 years or older also showed smaller increases in nuclear sclerotic cataracts over time (.091 to .342 grades per year; mean, .139). Eyes with intraocular gas use had a higher rate of nuclear sclerosis progression (.8 grades per year) compared to eyes without intraocular gas bubbles (.5 grades per year) (P<.001). Posterior subcapsular cataract scores showed minimal or no increases in all groups. CONCLUSIONS: Patients older than 50 years have a similar rate of increase in nuclear sclerotic cataracts independent of age. The rate is sixfold greater than in patients younger than 50 years and also sixfold greater than the progression of nuclear sclerosis in the fellow nonsurgical eyes. Intravitreal gas bubbles cause nuclear sclerosis to increase by 60%, compared to eyes without use of a gas bubble.

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PubMedDate not supplied

Epiretinal membrane removal in eyes with good visual acuities.

PURPOSE: To evaluate the results of vitrectomy for epiretinal membrane in eyes with a preoperative visual acuity of 20/50 or better. METHODS: The visual results and complications of vitrectomy for epiretinal membranes were analyzed in a retrospective, consecutive case series of 40 eyes of 40 patients treated by a single surgeon. RESULTS: The mean preoperative visual acuity was 20/50 + 2 (range 20/30 + 1 to 20/50 -3). The mean visual acuity improved to 20/40 + 2 (P = 0.02) by the final examination at a mean of 2.4 years following surgery. The status of the lens at the final examination was correlated with the visual results of surgery. Twenty-one eyes were phakic preoperatively and 14 of these eyes had cataracts removed by the final examination. The mean preoperative visual acuity in 7 eyes which were still phakic at the final examination was 20/50 and this decreased to 20/50 -2 (P = 0.82). The mean preoperative visual acuity was 20/50 + 2 in 33 eyes which were pseudophakic by the final examination and this improved to 20/32 -2 (P = 0.005). There were no other serious complications such as retinal detachment or infectious endophthalmitis. CONCLUSIONS: Vitrectomy for epiretinal membranes is safe in eyes with relatively good preoperative visual acuities but cataract surgery is necessary in phakic eyes to achieve long-term visual acuity improvement.

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