Biomedical subjects

M Batterbury

Publications and source records attributed to M Batterbury.

32 records · Page 2Linked to original sources

PubMed1994

The adherence of silicone oil to standard and heparin-coated PMMA intraocular lenses.

During combined cataract extraction and intraocular lens insertion in eyes undergoing removal of silicone oil, we noted that oil became adherent to the implant. This adhesion persisted post-operatively. Although patients seemed not to be symptomatic as a result of this effect, the oil interferes with the fundal examination. Since heparin-coated intraocular lenses are more hydrophilic than unmodified lenses, oil should spread less well on these lenses and therefore be less adherent. This study was conducted to test this hypothesis. Heparin-surface-modified and unmodified polymethylmethacrylate (PMMA) lenses were immersed in 1000 centistoke neat silicone oil and in an emulsion of silicone oil taken from a patient. The lenses were washed with saline solution in an attempt to remove adherent oil. The lenses were photographed for examination and qualitative comparison. It was found that both neat and emulsified silicone oil was strongly adherent to both surface-modified and unmodified lenses, and could not easily be washed off. The heparin-coated lenses showed a tendency for adherence of emulsified oil. It is concluded that heparin coating of intraocular lenses does not prevent, though may reduce, oil adherence. We recommend that care be taken to avoid contact between oil and implant during combined oil removal and cataract extraction.

Adhesiveness↗

PubMed1994

Suppurative keratitis caused by Streptococcus pneumoniae after cataract surgery.

Six elderly patients are described (age range 76-86 years) in whom a characteristic peripheral suppurative keratitis developed 1-36 months after uncomplicated cataract surgery. A corneal section had been used in all patients and four or five interrupted nylon sutures were present at the time of onset. Streptococcus pneumoniae was cultured from a corneal scrape in all cases. Treatment with appropriate antibiotics resulted in slow resolution though supplementary topical steroids were necessary in five of the six patients, and corneal opacification persists in all cases.

Aged↗

PubMed1994

Effect on intraocular pressure of local anaesthesia in eyes undergoing intraocular surgery.

A total of 104 eyes undergoing intraocular surgery were studied to investigate the effect on intraocular pressure (IOP) of peribulbar and retrobulbar anaesthesia in eyes with and without glaucoma. Forty eyes had glaucoma. Intraocular pressure was measured before, immediately after, and 5 minutes after injection of local anaesthetic. Mean IOP rose by 5.8 mm Hg at 1 minute (p < 0.01) and 0.7 mm Hg at 5 minutes (p > 0.05). However, in eyes not receiving external ocular compression after the 1 minute measurement (n = 70, 67%), IOP was still 3.6 mm Hg higher than baseline (p < 0.01), compared with 5.2 mm Hg lower than baseline (p < 0.01) where compression was used. Patients with glaucoma experienced higher and more persistent increases in IOP than those without glaucoma. The increase in IOP varied greatly between patients: the maximum rise was 25 mm Hg, and in one glaucoma patient an IOP of 50 mm Hg occurred, persisting for 5 minutes. At 1 minute, 14 of the glaucoma subjects (35%) had experienced an IOP rise of > or = 10 mm Hg, and four (10%) a rise of > or = 20 mm Hg. These results suggest that the changes in IOP in patients with glaucoma, with an acute increase in IOP being succeeded by an acute decrease on entry into the anterior chamber, may be hazardous. The implications for clinical practice are discussed.

Anesthesia, Local↗

PubMed1994

Prediction of enophthalmos by computed tomography after 'blow out' orbital fracture.

In 11 patients with blow out fracture of the orbit, measurement of orbital volume using computed tomography (CT) more than 20 days after injury correlated well with enophthalmos measured from the same scans (r = 0.87, p < 0.001, SEE 0.63 mm), with a 1 cm3 increase in orbital volume causing 0.8 mm of enophthalmos. This confirms the cause of enophthalmos after blow out fracture to be increase in orbital volume rather than fat atrophy or fibrosis. In a further 25 patients scanned within 20 days of injury the degree of enophthalmos was less marked than would be predicted from the orbital volume measurement. This was probably because of the presence of oedema, haemorrhage, or both behind the globe which would prevent immediate development of enophthalmos. CT measurement of orbital volume within 20 days of injury may predict the final degree of enophthalmos and identify those patients at risk of late enophthalmos, allowing appropriate early surgical intervention.

Enophthalmos↗

PubMed1993

Is high initial aqueous outflow of benefit in trabeculectomy?

A modification of the trabeculectomy technique was designed in an attempt to increase the outflow of aqueous into the subconjunctival space in the early post-operative period. This 'high flow' method was compared with a control group of eyes undergoing a standard trabeculectomy. Fifty-three eyes of 44 patients were recruited to this study. Follow-up was for a minimum of 12 months (mean 20 months). The high flow method resulted in lower intraocular pressures (IOP) on days 1 and 2 and shallower anterior chambers without increased incidence of conjunctival wound leak, suggesting that high outflow was indeed achieved. However, long-term control of IOP was not better than that achieved by the conventional technique. IOP control (IOP < 21 mmHg) was achieved in 64.2% of eyes (34 eyes) without additional topical medication. IOP control with topical medication was satisfactory in the remaining 19 eyes, and no patient required further drainage surgery. Further analysis of the data showed that the most important factor determining success or failure of trabeculectomy in controlling IOP was the duration and number of prior topical medications. The success rate for trabeculectomy was significantly higher in those eyes with a shorter duration and quantity of prior topical therapy.

Aged↗

PubMed1992

Long-term drift and timolol therapy: possible role for pulsed therapy.

Eyes treated with a topical betablocker may exhibit the phenomenon of longterm drift, leading to loss of intraocular pressure control. It has been suggested that discontinuation of the betablocker may restore sensitivity to betablocker therapy, and that this phenomenon might be enhanced by the administration of an adrenergic agonist during this holiday period. This study was set up to examine further this hypothesis. Nine patients with ocular hypertension receiving treatment with timolol were entered into the study. Timolol was discontinued then re-started after four weeks of treatment with dipivefrin. This treatment cycle was repeated after a further four weeks. IOP was measured every two weeks. Re-introduction of timolol was associated with a significant lowering of IOP at two weeks (3.2 mmHg in the first cycle, p < 0.01, 3.4 mmHg in the second cycle, p < 0.01). Discontinuation of timolol and treatment with dipivefrin was not associated with a significant change in IOP.

Aged↗

PubMed1992

Ocular hypertension: correlation of anterior chamber angle width and risk of progression to glaucoma.

Twenty five patients with ocular hypertension (OH) and a narrow angle and 34 patients with OH and an open angle were followed for an average of six years. One eye of each patient had been randomly assigned to treatment with topical timolol. A shallow axial anterior chamber depth and a narrow angle (van Herick Grade 2 or less) was associated with the development of angle-closure glaucoma (ACG) in the narrow angle group, but the open angle group developed significantly more visual field loss. Nine patients (36%) in the narrow angle group developed ACG, and nine patients (26.5%) in the open angle group developed glaucomatous discs and field loss. The reduction in intraocular pressure due to topical timolol was equal in the narrow angle and the open angle groups, but topical timolol did not protect against the development of angle-closure glaucoma or visual field loss.

Aged↗

PubMed1992

Peribulbar anaesthesia: failure to abolish the oculocardiac reflex.

Peribulbar anaesthesia is a form of regional anaesthesia which has been used with increasing popularity in cataract surgery. Recently indications for its use have been extended to include surgery for vitreo-retinal disease and strabismus. This study shows that in nine of 11 patients in whom the oculocardiac reflex was stimulated by traction on an extra-ocular muscle, peribulbar anaesthesia failed to abolish the reflex. In each of these patients, the reflex manifested as a bradycardia. In one subject, the bradycardia was profound, showing no QRS complex for five seconds. We recommend that cardiac rhythm be monitored throughout procedures performed under peribulbar anaesthesia, and that a vagolytic agent be available for immediate use.

Anesthesia, Conduction↗

PubMed1991

Long-term endothelial cell loss and breakdown of the blood-aqueous barrier in cataract surgery.

Progressive endothelial cell loss and endothelial cell loss induced at the time of surgery occurs in all eyes with rigid anterior chamber intraocular lenses (IOLs). Eyes with surgical tuck or late ovaling of the pupil following surgery have greater yearly rates of cell loss than eyes that have no complications. This progressive loss may be related to chronic uveitis from iris chafing by the implant or to direct mechanical damage to the corneal endothelium. We have demonstrated that fluorophotometry shows chronic damage to the blood-aqueous barrier in all eyes with rigid anterior chamber IOLs, but this does not correlate with the degree of endothelial cell loss. Our results suggest there is damage to the blood-aqueous barrier and to the corneal endothelium, but the damage to the latter influences progressive endothelial cell loss.

Aged↗

PubMed1991

The cataract explosion: the changing pattern of diagnoses of patients attending an ophthalmic outpatient department.

An outpatient diagnostic index was used to analyse data relating to a sample of new patients attending the Southampton Eye Hospital in 1979 and 1986. Our main findings are an increased demand for cataract surgery by an increasingly aged population and a trend towards operating on cataracts at an earlier stage in their development. These and other results are discussed.

Age Factors↗

PubMed1989

Anterior tucking of the iris caused by posterior chamber lenses with polypropylene loops.

One hundred ten eyes that had extracapsular cataract extraction with posterior chamber lens implantation were examined gonioscopically to ascertain the frequency of anteriorly displaced polypropylene loops "tucking" into the posterior iris surface. The association with iris transillumination defects and the development of postoperative uveitis, hyphema, and raised intraocular pressure were also recorded. Sixty-six eyes (60%) had one or two anteriorly tucked loops; 28 of them (25%) had some associated iris transillumination defect related to the implant. Twenty eyes (18%) developed persistent postoperative uveitis; 15 of them had anteriorly tucked loops. Two eyes had postoperative hyphema and in both these eyes the loops were anteriorly tucked. The means of recognizing and preventing potential complications are discussed.

Follow-Up Studies↗

PubMed1989

Complications of anterior chamber lens implants and their effects on the endothelium.

A five-year follow-up study of 186 eyes which were subject to intracapsular cataract extraction and rigid anterior chamber lens implantation is reported. Ninety-two per cent of cases achieved a visual acuity of 6/12 or better. Serial corneal endothelial cell counts were performed. In 37 pairs of eyes the median difference in operative endothelial cell loss between the operated and un-operated eyes was -7.3% (95% Confidence Interval from -8.7 to -6.1%). Iris tuck occurred in 22.0% and late 'iris ovalling' developed in a further 15.6% of eyes. The median operative endothelial cell loss for those eyes with iris tuck was -9.7% and this was significantly higher than that of eyes with no long-term complications (median loss = -7.3%). The median operative endothelial cell loss for those eyes which developed late ovalling was -8.0% and this was not significantly greater than that of the eyes with no long-term complications (p = 0.745). There was a progressive median endothelial cell loss for all operated eyes and this progressive cell loss was significantly greater for those eyes with iris tuck when compared with those with no complications (p = 0.045).

Aged↗

PubMedDate not supplied

Collagen corneal shields.

Collagen corneal shields were developed as a corneal bandage lens and are currently indicated for ocular surface protection following surgery and in traumatic and nontraumatic corneal conditions. Collagen shields are manufactured from porcine or bovine collagen and three different collagen shields are currently available with dissolution times of 12, 24, and 72 hours. The theoretical, experimental, and clinical evidence supports a role for collagen corneal shields as a drug delivery device and in the promotion of epithelial and stromal healing. Presoaking the collagen shield in a pharmacological agent with adjunctive topical treatment represents the most efficacious method of utilizing collagen shields for drug delivery. In microbial keratitis collagen shields can enhance drug delivery, promote epithelial and stromal healing, neutralize collagenases, and reduce corneal inflammation. This review will examine the evidence that supports the role of collagen shields in drug delivery and corneal wound healing. Despite a large volume of experimental (animal) work, studies on human subjects, particularly randomized controlled trials, are lacking. The authors are advocating the reassessment of the application and benefits of corneal collagen shields to clinical practice.

Anti-Bacterial Agents↗

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↗