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M D Wagoner

Publications and source records attributed to M D Wagoner.

At least 19 recordsLinked to original sources
PubMed2001

Intracameral anesthesia: a report by the American Academy of Ophthalmology.

OBJECTIVE: This document describes the technique of intracameral anesthesia and examines the available evidence to address questions about its effectiveness, possible corneal endothelial and retinal toxicity, and the optimal and maximal dose. METHODS: A literature search conducted for the years 1968 to 2000 retrieved over 180 citations that matched the search criteria. Panel members and a methodologist reviewed this information, and it was evaluated for the quality of the evidence presented. RESULTS: Some studies report effectiveness of intracameral anesthesia while others report no effect. In those studies showing an effect, levels of pain in the groups that were compared were low. Short-term studies seem to indicate that preservative (methylparaben)-free lidocaine 1% is well tolerated by the corneal endothelium but that higher concentrations of lidocaine are toxic. There is some evidence of electroretinogram changes after exposure to lidocaine or bupivacaine. CONCLUSIONS: The ideal timing and placement of intracameral anesthesia has not been determined. Because topical anesthesia alone is effective, surgeons may elect to use intracameral anesthesia for incremental pain control in patients who cannot be adequately managed with topical alone. Appropriate patient selection is important when using this method of anesthesia. While short-term studies seem to indicate safety, long-term effects are unknown. Patient preferences for anesthesia are not well studied.

Anesthesia, Local↗
PubMed2001

Pterygium in young members of one family.

PURPOSE: To report a family with aggressive, early-onset pterygium. METHODS: We examined all living relatives (with one exception) of a Saudi Arabian family and found three members with pterygium (onset occurred when the patients were at early 20s, 6, and 4 years of age). RESULTS: Multiple attempts at surgical removal, even in conjunction with application of topical mitomycin C and use of conjunctival autograft, failed to prevent recurrent pterygium, which advanced across the visual axis and produced profound visual disability in the three cases. CONCLUSION: Contrary to previously published reports of familial pterygium, two of the three cases had childhood age at onset and all three had an aggressive clinical course after the onset of recurrent pterygium after surgical resection; genetic identification may be beneficial.

Adolescent↗
PubMed2000

Intracorneal hematoma in Mooren ulceration.

PURPOSE: To report a case of intracorneal hematoma occurring in association with Mooren ulceration. METHOD: Case report. RESULTS: In an 81-year-old man with bilateral Mooren ulceration, a dense intracorneal hemorrhage occurred in the right eye secondary to peripheral corneal neovascularization and was followed by slow resolution over a 3-year period. Following subsequent lamellar and penetrating keratoplasty, histopathologic examination demonstrated the association between the stromal neovascularization and the residual interlamellar hemorrhage, as well as phagocytosis of residual hemosiderin by macrophages. CONCLUSION: Intracorneal hematoma with spontaneous resolution has been documented clinically and histopathologically in an eye with Mooren ulceration.

Aged↗
PubMed2000

Penetrating keratoplasty in eyes with keratoconus and vernal keratoconjunctivitis.

PURPOSE: To determine the prognosis of penetrating keratoplasty in eyes with keratoconus and vernal keratoconjunctivitis. METHODS: The medical records of all patients with keratoconus and vernal keratoconjunctivitis who underwent penetrating keratoplasty at King Khaled Eye Specialist Hospital from January 1, 1986 to December 31, 1996 and for whom at least 24 months' follow-up is available were analyzed retrospectively. RESULTS: Of 85 (61 males, 24 females) patients, 90 eyes met the inclusion criteria. The mean follow-up was 44.7 (range, 26-144) months. At the most recent follow-up visit, 83 (92.2%) grafts were clear. The mean best corrected visual acuity was 20/40. Graft rejection episodes occurred in 12 (13.3%) eyes, with irreversible graft failure occurring in 4 (4.4%) eyes. Bacterial keratitis occurred in 6 (7.7%) eyes, 2 (2.2%) of which developed irreversible graft failure. Herpes simplex keratitis resulted in irreversible graft failure in 1 (1.1%) eye. CONCLUSION: Penetrating keratoplasty in eyes with keratoconus and vernal keratoconjunctivitis has an excellent visual outcome and a low complication rate.

Adolescent↗
PubMed1999

Terrien's marginal degeneration associated with posterior polymorphous dystrophy.

PURPOSE: To document an association between Terrien's marginal degeneration and posterior polymorphous dystrophy. METHODS: A 23-year-old Saudi man presented with decreased vision, peripheral corneal thinning with vascularization and scarring, and abnormalities of the posterior stroma and Descemet's membrane. RESULTS: Clinical examination, corneal topography, and specular microscopy were consistent with a diagnosis of Terrien's marginal degeneration and posterior polymorphous dystrophy. CONCLUSION: We report the first case, to our knowledge, of the simultaneous occurrence of Terrien's marginal degeneration with posterior polymorphous dystrophy.

Adult↗
PubMed1999

Chrysosporium parvum keratomycosis.

PURPOSE: To report a case of corneal infection with Chrysosporium parvum, a filamentous fungus usually associated with pulmonary infections. METHODS: A 43-year-old Saudi man had a corneal stromal infiltrate and perforation of his left eye. He was treated with a therapeutic penetrating keratoplasty and topical and systemic antifungal therapy. Corneal scrapings, microbiologic evaluation, and histopathologic examination of the surgical specimen were performed to establish the diagnosis. After the development of recurrent stromal keratitis at the graft-host junction, similar diagnostic and therapeutic maneuvers were performed. RESULTS: Corneal scrapings and histopathologic examination were positive for numerous septate hyphae with endospores, consistent with a diagnosis of filamentous keratomycosis. Microbiologic isolation confirmed the diagnosis of Chrysosporium parvum. Similar diagnostic maneuvers for recurrent keratitis produced identical results. CONCLUSION: To our knowledge, this is the first case of Chrysosporium parvum keratomycosis.

Adult↗
PubMed1998

Meesmann corneal epithelial dystrophy in a Saudi Arabian family.

PURPOSE: Meesmann corneal epithelial dystrophy is a dominantly inherited disorder that was originally reported in Germany and later in descendants of German immigrants to the United States. We report Meesmann corneal epithelial dystrophy in a family that cannot be traced to Germanic origin. METHODS: A 17-year-old Saudi boy from the Al-Qahtani tribe of the Asir region of the kingdom came to the King Khaled Eye Specialist Hospital with classic clinical findings of Meesmann corneal epithelial dystrophy. We examined all members of the immediate family of the index case and members of five branches of the extended family. RESULTS: Meesmann corneal epithelial dystrophy was present in the father and one sister of the index case. Four additional affected individuals were identified in three generations of one branch of the extended family. All but one of the seven affected individuals were aged 17 years or older. Our findings are consistent with previous reports of an autosomal dominant pattern of inheritance, with probable incomplete penetrance or delayed onset of phenotypic expression. CONCLUSION: We report Meesmann corneal epithelial dystrophy in a family without German ancestry.

Adolescent↗
PubMed1997

Penetrating keratoplasty in congenital hereditary endothelial dystrophy.

PURPOSE: The purpose of the study is to determine the outcome of penetrating keratoplasty in congenital hereditary endothelial dystrophy. METHODS: Records of 40 patients (13 males, 27 females) who underwent penetrating keratoplasty (56 eyes) were reviewed. The mean age at surgery was 11.8 years (range, 2 months-35 years). The mean follow-up was 37 months (range, 6-136 months). RESULTS: In 35 (62.5%) of 56 eyes that underwent primary penetrating keratoplasty, the grafts survived. Graft survival analysis showed the probability of obtaining a clear graft is 92% at 1 year, 72% at 2 years, and 56.5% at 5 years. Graft survival was statistically better in eyes where onset of the disease is delayed (P = 0.02), if the graft donor age is between 5 and 30 years versus older than 30 years (P = 0.02), and for patients who kept follow-up appointments versus those who were delinquent (P < 0.03). Visual acuity was 20/40 in 1.9%, 20/50 to 20/80 in 18.9%, 20/100 to 20/300 in 49%, and less than 20/400 in 30.2%. The main causes of graft failure were graft rejection (six eyes) and bacterial keratitis (four eyes). CONCLUSIONS: Penetrating keratoplasty in congenital hereditary endothelial dystrophy is moderately successful, and graft survival is better in cases of delayed onset compared with that of congenital onset. Early surgical intervention is recommended to prevent development or progression of amblyopia.

Adolescent↗
PubMed1995

Clinical analysis of excimer laser photorefractive keratectomy using a multiple zone technique for severe myopia.

PURPOSE: In an investigational procedure, excimer laser photorefractive keratectomy for severe myopia was performed at three clinical trial centers to determine the effectiveness of the multiple zone technique. METHODS: A VisX Model Twenty/Twenty excimer laser (VisX, Santa Clara, California) was used to perform photorefractive keratectomy on 14 severely myopic eyes (-10.37 to -24.5 diopters) of 12 patients by using a multiple zone technique. Postoperative follow-up ranged from six months to two years; retreatments were performed on four patients, with a follow-up of at least nine months. RESULTS: At six months postoperatively, before retreatment, three of the 14 eyes were within 2 diopters and seven of the 14 eyes were within 4 diopters of attempted correction. Regression of effect to more severe myopia was worse in five eyes treated with nitrogen gas blowing. Retreatments also demonstrated considerable myopic regression. Three patients had loss of two or more lines of best-corrected visual acuity, and these patients also had moderate or severe levels of haze. CONCLUSION: Excimer laser photorefractive keratectomy for severe myopia using a multiple zone technique is associated with considerable regression, haze, and loss of best-corrected visual actuity, especially when performed in association with nitrogen gas blowing.

Adult↗
PubMed1995

Extracapsular cataract extraction with or without posterior chamber intraocular lenses in eyes with cataract and high myopia.

PURPOSE: To compare the results of insertion of low-power or zero-power posterior chamber intraocular lenses (PC IOLs) after cataract extraction in eyes with high myopia with leaving the eye aphakic. METHODS: The outcome of extracapsular cataract extraction (ECCE) with low-power or zero-power PC IOLs in 184 consecutive highly myopic (axial length = 26.0 mm or longer) eyes was compared with 184 consecutive highly myopic eyes receiving ECCE without PC IOLs. Axial length, preoperative visual acuity, age, sex, and follow-up were similar between both groups. RESULTS: In the pseudophakic eyes, there was a statistically significantly better visual outcome (P = 0.006), decreased incidence of posterior capsule opacification (13.6% versus 33.2%, P < 0.01), and decreased requirement for YAG capsulotomy (6.5% versus 17.9%, P < 0.01). There were two retinal detachments in the pseudophakic eyes compared with four in the aphakic eyes. There were no sight-threatening complications in 12 pseudophakic eyes after YAG capsulotomy. There were four sight-threatening complications (2 retinal detachments, 2 cases of uveitis with secondary glaucoma) in 33 aphakic eyes after YAG capsulotomy. CONCLUSIONS: The use of PC IOLs may result in a lower complication rate and better visual outcome after ECCE in eyes with cataract and high myopia.

Adult↗
PubMed1995

Long-term results of epikeratoplasty for keratoconus.

By analysis of outpatient records at the Massachusetts Eye and Ear Infirmary, the clinical course of 10 consecutive patients who underwent epikeratoplasty for keratoconus was reviewed to determine their clinical and functional status 5 years after surgery. Eight of 10 patients (80%) had clear, intact lenticules at 12 months. During a mean follow-up of 67 months (range = 35-101 months), each maintained long-term stability of best corrected vision, refractive astigmatism, and keratometric astigmatism. The mean uncorrected visual acuity improved from 20/660 to 20/134, whereas the mean spectacle corrected acuity improved from 20/260 to 20/30. All but one patient had a spectacle acuity equal to hard contact lens acuity. However, no patients were corrected to 20/20 at the end of the follow-up period. Refractive and keratometric astigmatism stabilized by 12 months (mean = 3.62 and 3.05 D, respectively), and decreased slightly during the longer period of follow-up (mean = 2.94 and 2.17 D, respectively). Epikeratoplasty is a useful method of visual rehabilitation in highly selected cases of keratoconus in which there is no central opacity, preoperative hard contact lens acuity is worse than 20/40, the average keratometry is < 60 D, contact lens intolerance is present, and in which the patient will tolerate some degree of reduced contrast sensitivity and < 20/20 high contrast acuity.

Contrast Sensitivity↗