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Biomedical subjects

L Rothkoff

Publications and source records attributed to L Rothkoff.

At least 19 recordsLinked to original sources

Tono-Pen tonometry in normal and in post-keratoplasty eyes.

Oculab Tono-Pen tonometry was compared with Goldmann applanation tonometry in 82 eyes of 82 patients with normal corneas and in 54 eyes of 54 patients who had undergone penetrating keratoplasty and whose corneas did not preclude the use of Goldmann tonometer. We found that the intraocular pressure (IOP) in 48% of the eyes with normal corneas and in 57% after keratoplasty has different measurements with Goldmann and Tono-Pen pressures of 3 mm Hg or more. Despite the correlation between the Goldmann tonometer and the Tono-Pen in the group of eyes with normal corneas (r = 0.83) as well as in the group of eyes after keratoplasty (r = 0.79) the Tono-Pen tended to significantly overestimate the Goldmann tonometer reading (p < 0.0001). The mean difference between the two instruments was highest across the lower IOP range (< 9 mm Hg) in the group of eyes after keratoplasty. Because the mean absolute values of the paired differences between Goldmann and Tono-Pen measurements varied significantly across all IOP intervals it was not possible to establish a correction factor which could be used when comparing the two measurements. Based on this study the Tono-Pen consistently overestimated the actual IOP in an unpredictable manner. Where possible Goldmann measurements of the IOP are still to be preferred.

Humans

Atropine in keratoplasty for keratoconus.

A prospective study of 83 eyes in 76 consecutive patients undergoing keratoplasty for keratoconus is presented in which 1% atropine was routinely given at the end of surgery. No case of permanent mydriasis was seen. The syndrome described in the literature of fixed, dilated pupil after the use of atropine in keratoplasty no longer seems to exist and the warning against strong mydriatics appears unwarranted.

Adolescent

Pigmented pupillary pseudomembranes as a complication of argon laser iridotomy.

Two cases are reported in which pupillary pigment occlusion occurred after argon laser iridotomy, reducing visual acuity and preventing fundus visualization. Laser-induced inflammation and subsequent long-term miotic therapy are probably responsible for this complication. Periodic pupillary dilatation is recommended in eyes that require miotics to control their intraocular pressure after laser iridotomy.

Aged

Trabeculotomy in late onset congenital glaucoma.

All eyes of children above the age of 1 year referred because of glaucoma were treated with trabeculotomy as the primary procedure. The surgery was modified by the excision of a rectangle of tissue in the deep scleral bed under the scleral flap instead of the classical radial incision. This serves to exteriorise Schlemm's canal while thinning the scleral tissue, without, however, entering the anterior chamber. A total of 7 eyes in 5 children between the ages of 1 and 9 years were operated upon. In 6 of the 7 eyes intraocular pressure has remained under 20 mmHg without treatment after follow-up of between 18 months and 4 years. In the seventh eye intraocular pressure was controlled for 2 years but has since required epinephrine drops twice daily for the maintenance of pressure below 20 mmHg. In 4 of the 7 eyes flat, diffuse conjunctival filtering blebs are present, but no complications have been encountered. We consider that trabeculotomy may be recommended for children with late-onset congenital glaucoma.

Age Factors

Optic atrophy after irrigation of the lacrimal ducts with chloramphenicol.

A case is presented of permanent visual loss and optic atrophy following irrigation of the lower canaliculus after probing, with a 20% solution of chloramphenicol. A false passage had apparently been created allowing the solution to gain access to the orbital tissues. The ensuing orbital edema probably caused a central retinal artery occlusion. This is a previously unreported complication of a common ophthalmologic procedure.

Adult

Pterygium and basic tear secretion.

In order to investigate the correlation between the occurrence of pterygium and dryness of the eyes, a Schirmer's No. 1 test was done on both eyes in 60 patients with unilateral pterygia. No difference was found between the mean basic secretion of tears in the diseased eyes (15.33 +/- 8.09 mm) and the fellow eyes (15.65 +/- 7.89 mm), and both were in the normal range for this test. This data suggest that dryness of the eyes cannot be regarded as the cause of pterygium.

Adult

A proposed pilocarpine therapeutic test.

For the pilocarpine therapeutic test that we have devised, one drop (0.1 ml) of 2% pilocarpine hydrochloride (an arbitrarily chosen concentration) is instilled in the glaucomatous eye to be treated, and the intraocular pressure is measured hourly for four hours. If the IOP does not fall below 24 mm Hg, which is our chosen pressure limit, the response is considered to be inadequate therapeutically. Our study showed that if an inadequate therapeutic response is obtained, initiation of treatment with 2% pilocarpine is not indicated, since in patients with such a response, continued treatment with 2% pilocarpine will be ineffective in controlling IOPs on subsequent clinical visits. In only those cases of patients with an adequate response to the pilocarpine therapeutic test (with a fall in pressure below 24 mm Hg) was there the likelihood of having the glaucoma controlled with continued 2% pilocarpine treatment.

Glaucoma

The effect of corneal section on early increased intraocular pressue after cataract extraction.

Increased intraocular pressure in the immediate postoperative period commonly occurs after cataract extraction. We compared a series of patients operated on through a limbal section to a series operated on through a corneal section. The incidence of increased IOP was significantly lower in the corneal section group. This supports the theory that trabecular damage is a major factor in causing early increased IOP after cataract extraction.

Cataract Extraction

Two special indications for intraocular lens implantation.

Two cases with special indications for intraocular lens implants are presented. The first case was of a 60-year-old monocular patient with congenital absence of the external nose and multiple limb deformities. The second case was of a young Bedouin girl with bilateral developmental cataracts who had poor living conditions and social objections to wearing spectacles. Intraocular lenses restored good vision.

Adult

Solar retinopathy: visual prognosis in 20 cases.

A report of 20 cases of solar retinopathy associated with watching an eclipse of the sun is presented. Visual prognosis was generally good and most patients had good vision at the end of six months. Paramacular scotomata, image distortion and macular changes were, however, still present in the majority of patients. Transmission of energy through various protective devices was measured with a fluxmeter. The finding of retinal damage after exposure of even short duration through protective devices that reduce the incident irradiance of the sun up to 5,000 times indicates that the damage observed may be other than thermal in nature. It is concluded that no safe method for directly viewing a solar eclipse is generally available, and that the public, especially schoolchildren and their children, should be better acquainted with this hazard.

Adolescent

New Tyndall photometer.

An instrument is described that can accurately measure delicate changes in the Tyndall phenomenon in the anterior chamber of the eye. An important feature is its use of an external light source and its simple adaptation to the slit lamp.

Humans

Subconjunctival dislocation of intraocular lens implant.

Eight weeks after intracapsular cataract extraction with implantation of a Binkhorst iris-clip lens joined with a suture to a peripheral iridectomy at the 12 o'clock position, a 52-year-old woman struck the right side of her head. The corneoscleral wound ruptured for three fourths of its length and the artificial lens was located in the subconjunctiva in the superior-nasal quadrant of the eye. The lens was removed, the iris reposited, and the anterior chamber reformed, and the wound resutured. Her vision was 6/12 (20/40) at the time of discharge.

Eye Injuries

Bilateral cataract: extraction in classic haemophilia with retrobulbar anaesthesia and peripheral iridectomy.

A 47-year-old factor VIII deficient haemophiliac successfully underwent bilateral cataract extraction. The use of cryoprecipitates to achieve haemostasis permitted retrobulbar anaesthesia and a peripheral iridectomy without complication. We consider that the use of cryoprecipitated factor VIII concentrate allows safe elective ocular surgery in patients with classic haemophilia.

Anesthesia, Conduction

Colchicine suppression of corneal healing after strabismus surgery.

Two patients who had previously undergone uneventful operations for strabismus showed healing of corneal dellen and erosion after withdrawal of colchicine therapy. It is suggested that the exhibition of colchicine therapy for familial Mediterranean fever in these two cases was responsible for initial persistence of these two postoperative complications.

Adolescent